JOURNAL ARTICLE

Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis

Jennifer A Meddings, Heidi Reichert, Mary A M Rogers, Sanjay Saint, Joe Stephansky, Laurence F McMahon
Annals of Internal Medicine 2012 September 4, 157 (5): 305-12
22944872

BACKGROUND: Most (59% to 86%) hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTIs). As of 2008, claims data are used to deny payment for certain hospital-acquired conditions, including CAUTIs, and publicly report hospital performance.

OBJECTIVE: To examine rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment for CAUTI lowers hospital payment.

DESIGN: Before-and-after study of all-payer cross-sectional claims data.

SETTING: 96 nonfederal acute care Michigan hospitals.

PATIENTS: Nonobstetric adults discharged in 2007 (n = 767 531) and 2009 (n = 781 343).

MEASUREMENTS: Hospital rates of UTIs (categorized as catheter-associated or hospital-acquired) and frequency of reduced payment for hospital-acquired CAUTIs.

RESULTS: Hospitals frequently requested payment for non-CAUTIs as secondary diagnoses: 10.0% (95% CI, 9.5% to 10.5%) of discharges in 2007 and 10.3% (CI, 9.8% to 10.9%) in 2009. Hospital rates of CAUTI were very low: 0.09% (CI, 0.06% to 0.12%) in 2007 and 0.14% (CI, 0.11% to 0.17%) in 2009. In 2009, 2.6% (CI, 1.6% to 3.6%) of hospital-acquired UTIs were described as CAUTIs. Nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781 343 (0.003%) hospitalizations in 2009.

LIMITATIONS: Data are from only 1 state and involved only 1 year before and after nonpayment for complications. Hospital prevention practices were not examined.

CONCLUSION: Catheter-associated UTI rates determined by claims data seem to be inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current nonpayment policy for hospital-acquired CAUTI is low. Claims data are currently not valid data sets for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties.

PRIMARY FUNDING SOURCE: Blue Cross Blue Shield of Michigan Foundation.

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