A study by the University of Michigan shows a Medicare policy that withholds excess payments for catheter-associated urinary tract infections during hospital stays, seldom changes payments.
In 2008, this Medicare policy, aimed at cutting costs and improving care, stopped paying hospitals extra to treat preventable hospital-obtained UTIs. Infections included those obtained after a catheter had been put in place. U-M authors say that this policy is using inaccurate data for identifying these complications.
This analysis shows there is little change in hospital payment due to withheld payments for hospital-acquired catheter-associated UTIs. In 2009, it was found that eliminating payment for this infection only decreased hospital pay for 25 hospitals (0.003 percent of all adult hospital stays in Michigan). This is quite low in comparison with the anticipated savings, considering this condition is one third of all hospital-obtained infections.
The results, published in the Annals of Internal Medicine, stresses that careful dataset selection is critical when measuring and penalizing hospital performance. The problem, authors point out, is that the policy is based on claims data used exclusively for billing. In order for the infection to be listed correctly, multiple billing codes must be used to indicate the UTI is from a catheter and occurred after hospital admission. In the end, most cases are listed as general UTIs and hospitals continue to receive payments.
Lead author Jennifer Meddings, MD, MSc, an assistant professor in the Department of Internal Medicine, Division of General Medicine at U-M Medical School says, “If the cases you wish to penalize are not documented in the dataset chosen, the policy’s intended impact will be limited.”
The fault does not fall on the billing coders who organize the claim data because coders can only list diagnoses as physicians describe them in the medical records. The policy has also expanded to include additional hospital-acquired conditions, such as bed sores. Researchers warn similar coding problems could occur and disrupt intended financial savings.
“We don’t have any evidence on whether it has prompted hospitals to improve patient care to prevent these infections, but we do know that it did not lead to large financial savings,” Meddings comments.
Conclusions suggest that billing data is wrong for use in comparing hospitals by their catheter-associated UTI rates. Meddings and her colleagues say that hospitals that accurately report their claims data will be unfairly penalized due to their higher reported rates. This will take place in 2015 when billing data is used to penalize hospitals with the highest rate of infections.
Written by Kelly Fitzgerald