Sanjay Saint, MD, MPH; Jennifer A. Meddings, MD, MSc; David Calfee, MD, MS; Christine P. Kowalski, MPH; Sarah L. Krein, PhD, RN
Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is 1 of the hospital-acquired complications chosen by the Centers for Medicare & Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help readers understand the potential consequences of the recent CMS rule changes, the authors examine the preventability of catheter-associated infection, review the CMS rule changes regarding catheter-associated urinary tract infection, offer an assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. Although the CMS rule changes related to catheter-associated urinary tract infection are controversial, they may do more good than harm, because hospitals are likely to redouble their efforts to prevent catheter-associated urinary tract infection, which may minimize unnecessary placement of indwelling catheters and facilitate prompt removal. However, even if forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection is commendable, these efforts will have opportunity costs and may have unintended consequences. Therefore, how hospitals and physicians respond to the CMS rule changes must be monitored closely.
By failing to prepare, you are preparing to fail.
E. coli = Escherichia coli. * The catheter-associated urinary tract infection diagnosis will increase payment if the patient has no other complications or comorbid conditions that would have generated the same level of illness as measured by the Medicare Severity Diagnosis-Related Group assignment used to determine payment rates. † “Error” refers to an omission (incompleteness) or mistake in the codes assigned for billing, which can lead to an inaccurate misclassification of a hospital-acquired catheter-associated urinary tract infection to a condition that would generate payment (such as a non–catheter-associated urinary tract infection, or a catheter-associated urinary tract infection that was present on admission). Such errors could occur because the provider documentation did not accurately describe the conditions sufficient for the hospital coder to recognize, or because the hospital coder did not understand that all 3 codes were required for this specific condition.
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Rajasreepai Ramachandra pai
June 20, 2009
This article is a timely response to the rise in iatrogenic urinary tract infections. The aseptic precautions for cathetrizations versus patient condition is a delicate issue that needs to be addressed
Saint S, Meddings JA, Calfee D, Kowalski CP, Krein SL. Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes. Ann Intern Med. ;150:877–884. doi: 10.7326/0003-4819-150-12-200906160-00013
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Published: Ann Intern Med. 2009;150(12):877-884.
Healthcare Delivery and Policy, Hospital Medicine, Hospital-Acquired Infections, Infectious Disease, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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