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. 2013 Sep 25;3(3):mmrr.003.03.a08.
doi: 10.5600/mmrr.003.03.a08. eCollection 2013.

Medicare non-payment of hospital-acquired infections: infection rates three years post implementation

Samuel K Peasah  1 , Niccie L McKay  1 , Jeffrey S Harman  2 , Mona Al-Amin  3 , Robert L Cook  4
Affiliations

Medicare non-payment of hospital-acquired infections: infection rates three years post implementation

Samuel K Peasah et al. Medicare Medicaid Res Rev. .

Abstract

Background: Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005.

Objective: We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI).

Data: Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011.

Study design: We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy.

Principal findings: Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant.

Conclusions: The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.

Keywords: Hospital-Acquired Infections; Medicare; Patient Outcomes.

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Figures

Exhibit 2.
Exhibit 2.. Graph of Percentage of Cases of CAUTI, VCAI, HA-CAUTI (Hospital-Acquired) and HA-VCAI (Hospital-Acquired) Per Quarter
Exhibit 3.
Exhibit 3.. Trend of the Proportion of Hospital-Acquired Infections to Discharges of All Respective Infections Per Quarter
See this image and copyright information in PMC

References

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