Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-22T20:35:37.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

Published online by Cambridge University Press:  10 May 2017

Jereen Z. Kwong ,
Yingjie Weng ,
Micaela Finnegan ,
Robyn Schaffer ,
Austin Remington ,
Catherine Curtin ,
Kathryn M. McDonald ,
Jay Bhattacharya  and
Tina Hernandez-Boussard
Jereen Z. Kwong
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Yingjie Weng
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
Micaela Finnegan
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Robyn Schaffer
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Austin Remington
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Catherine Curtin
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
Kathryn M. McDonald
Affiliation:
Stanford University Center for Health Policy, Stanford, California
Jay Bhattacharya
Affiliation:
Stanford University Center for Health Policy, Stanford, California
Tina Hernandez-Boussard*
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California
*
Address correspondence to Tina Hernandez-Boussard, Department of Medicine (Biomedical Informatics), Stanford School of Medicine, 1265 Welch Road, Stanford, CA 94305-5479 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy’s effect on rates of targeted orthopedic SSIs among the Medicare population.

DESIGN

We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000–2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach.

RESULTS

Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6–0.8) and RR, 0.8l; 95% CI, 0.7–0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8–1.1).

CONCLUSIONS

While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time.

Infect Control Hosp Epidemiol 2017;38:817–822

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 817 - 822
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. This work was presented at the 2016 Academy Health Annual Research Meeting, Boston, Massachusetts, on June 25, 2016.

References

REFERENCES

1. VanLare, JM, Conway, PH. Value-based purchasing--national programs to move from volume to value. N Engl J Med 2012;367:292–295.CrossRefGoogle Scholar
2. Serious reportable events. National Quality Forum website. http://www.qualityforum.org/topics/sres/serious_reportable_events.aspx. Published 2011. Accessed January 22, 2016.Google Scholar
3. Never events. Centers for Medicare and Medicaid Services website. https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/smd073108.pdf. Published 2008. Accessed November 15, 2015.Google Scholar
4. Hospital-acquired conditions and present on admission indicator reporting provision. Medicare Learning Network. Centers for Medicare and Medicaid Services website. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/wPOAFactSheet.pdf. Published 2014. Accessed September 20, 2015.Google Scholar
5. Agency for Healthcare Research and Quality. HCUP Databases. In Human and Health Services ed. Rockvelle, MD. Agency for Healthcare Research and Quality; 2015.Google Scholar
6. Greene, LR. Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. Am J Infect Control 2012;40:384–386.CrossRefGoogle Scholar
7. Radcliff, KE, Neusner, AD, Millhouse, PW, et al. What is new in the diagnosis and prevention of spine surgical site infections. Spine J 2015;15:336–347.Google Scholar
8. Deyo, RA, Nachemson, A, Mirza, SK. Spinal-fusion surgery—the case for restraint. N Engl J Med 2004;350:722–726.Google Scholar
9. Belatti, DA, Phisitkul, P. Trends in orthopedics: an analysis of Medicare claims, 2000–2010. Orthopedics 2013;36:e366–e372.CrossRefGoogle ScholarPubMed
10. Kandilov, AM, Coomer, NM, Dalton, K. The impact of hospital-acquired conditions on Medicare program payments. Medicare Medicaid Res Rev 2014;4.Google Scholar
11. Daniels, A, Kawaguchi, S, Hart, R. Hospital charges associated with “never events”: comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty. J Neurosurg Spine 2016;25:165–169.CrossRefGoogle ScholarPubMed
12. Coomer, NM, Kandilov, AM. Impact of hospital-acquired conditions on financial liabilities for Medicare patients. Am J Infect Control 2016;44:1326–1334.Google Scholar
13. McNair, PD, Luft, HS. Enhancing Medicare’s hospital-acquired conditions policy to encompass readmissions. Medicare Medicaid Res Rev 2012;2. doi: 10.5600/mmrr.002.02.a03.CrossRefGoogle ScholarPubMed
14. Hospital-acquired conditions (HAC) in acute inpatient prospective payment system (IPPS) hospitals. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Downloads/FY_2013_Final_HACsCodeList.pdf. Published 2013. Accessed March 16, 2017.Google Scholar
15. Farrar, S, Yi, D, Sutton, M, Chalkley, M, Sussex, J, Scott, A. Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis. BMJ Clin Res 2009;339:b3047.Google Scholar
16. Meyer, BD, Viscusi, WK, Durbin, DL. Workers’ compensation and injury duration: evidence from a natural experiment. Am Econ Rev 1995;85:322–340.Google Scholar
17. Bertrand, M, Duflo, E, Mullainathan, S. How much should we trust differences-in-differences estimates? Qtr J Econ 2004;119:249–275.CrossRefGoogle Scholar
18. Dimick, JB, Ryan, AM. Methods for evaluating changes in health care policy: the difference-in-differences approach. JAMA 2014;312:2401–2402.CrossRefGoogle ScholarPubMed
19. Gidwani, R, Bhattacharya, J. CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis. J Gen Intern Med 2015;30:588–596.CrossRefGoogle ScholarPubMed
20. Houchens, R, Elixhauser, A. Final report on calculating nationwide inpatient sample (NIS) variances, 2001. Rockville, MD: Agency for Healthcare Research and Quality; 2005. 2002–2003.Google Scholar
21. Skramm, I, Saltyte Benth, J, Bukholm, G. Decreasing time trend in SSI incidence for orthopaedic procedures: surveillance matters!. J Hosp Infect 2012;82:243–247.CrossRefGoogle ScholarPubMed
22. McNair, PD, Luft, HS, Bindman, AB. Medicare’s policy not to pay for treating hospital-acquired conditions: the impact. Health Aff (Millwood) 2009;28:1485–1493.Google Scholar
23. Bratzler, DW, Houck, PM. Surgical Infection Prevention Guideline Writers W. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005;189:395–404.Google Scholar
24. Greene, L. Guide to the elimination of orthopedic surgical site infections. Association for Professionals in Infection Control and Epidemiology website. http://www.apic.org/Resource_/EliminationGuideForm/34e03612-d1e6-4214-a76b-e532c6fc3898/File/APIC-Ortho-Guide.pdf. Published 2010. Accessed April 10, 2017.Google Scholar
25. Joint Commission. The Joint Commission’s Implementation Guide for NPSG.07.05.01 on Surgical Site Infections. https://www.jointcommission.org/implementation_guide_for_npsg070501_ssi_change_project/. Published 2013. Accessed June 10, 2016, 2016.Google Scholar
26. Ingraham, AM, Cohen, ME, Bilimoria, KY, et al. Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement. J Am Coll Surg 2010;211:705–714.Google Scholar
27. Levi, AD, Dickman, CA, Sonntag, VK. Management of postoperative infections after spinal instrumentation. J Neurosurg 1997;86:975–980.CrossRefGoogle ScholarPubMed
28. Weigelt, JA, Dryer, D, Haley, RW. The necessity and efficiency of wound surveillance after discharge. Arch Surg 1992;127:77–81.CrossRefGoogle ScholarPubMed
29. Calderwood, MS, Kleinman, K, Soumerai, SB, et al. Impact of Medicare’s payment policy on mediastinitis following coronary artery bypass graft surgery in US hospitals. Infect Control Hosp Epidemiol 2014;35:144–151.Google Scholar
30. Services CfMM. Accuracy of coding in hospital-acquired conditions-present on admission program. https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/downloads/accuracy-of-coding-final-report.pdf. Published 2012. Accessed March 16, 2017.Google Scholar
31. Burns, EM, Rigby, E, Mamidanna, R, et al. Systematic review of discharge coding accuracy. J Pub Health 2012;34:138–148.CrossRefGoogle ScholarPubMed
32. Lidor, AO, Moran-Atkin, E, Stem, M, et al. Hospital-acquired conditions after bariatric surgery: we can predict, but can we prevent? Surg Endosc 2014;28:3285–3292.CrossRefGoogle ScholarPubMed
33. Anderson, GF, Hussey, PS, Frogner, BK, Waters, HR. Health spending in the United States and the rest of the industrialized world. Health Aff (Millwood) 2005;24:903–914.CrossRefGoogle ScholarPubMed
34. Hospital-acquired condition(HAC) reduction program. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Published 2015. Accessed April 10, 2017.Google Scholar