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Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

Published online by Cambridge University Press:  24 April 2015

Alison Tse Kawai ,
Michael S. Calderwood ,
Robert Jin ,
Stephen B. Soumerai ,
Louise E. Vaz ,
Donald Goldmann  and
Grace M. Lee
Alison Tse Kawai*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Michael S. Calderwood
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts
Robert Jin
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Stephen B. Soumerai
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Louise E. Vaz
Affiliation:
Division of Pediatric Infectious Diseases, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon
Donald Goldmann
Affiliation:
Institute for Healthcare Improvement, Cambridge, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Alison Tse Kawai, Department of Population Medicine, Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215 ([email protected]).
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Abstract

BACKGROUND

The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.

OBJECTIVE

To examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).

STUDY POPULATION

Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.

DESIGN

We used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.

RESULTS

Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).

CONCLUSIONS

The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.

Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 8 , August 2015 , pp. 871 - 877
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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