Hospital-acquired UTIs rarely reported in data used to implement penalties

September 5, 2012, University of Michigan Health System
Jennifer Meddings, M.D., MSc, is an assistant professor in the Department of Internal Medicine, Division of General Medicine at U-M Medical School. Credit: U-M Health System, Department of Public Relations and Marketing Communications

Aiming to cut expenses and improve care, a 2008 Medicare policy stopped paying hospitals extra to treat some preventable, hospital-acquired conditions – including urinary tract infections (UTIs) in patients after bladder catheters are placed.

But a statewide analysis by the University of Michigan shows there was very little change in hospital payment due to removing pay for hospital-acquired catheter-associated UTIs. For all adult hospital stays in Michigan in 2009, eliminating payment for this infection decreased hospital pay for only 25 hospital stays (0.003 percent of all stays). This is in great contrast to the large savings anticipated, given that this condition accounts for nearly one third of all hospital-acquired infections.

The reason, U-M authors say, is that the "no-pay" uses billing data that is inaccurate for identifying such complications.

The findings were published in the , alongside an editorial that emphasizes the national policy implications of the U-M findings. U-M's analysis, the editorial says, argues that careful dataset selection is crucial when used to measure and penalize .

"We think the policy was well intended but its financial savings from non-payment for catheter-associated UTI are negligible because of the data used to implement the policy," says lead author Jennifer Meddings, MD, MSc, an assistant professor in the Department of Internal Medicine, Division of General Medicine at U-M Medical School.

The problem, authors say, is that the policy relies on claims data previously used only for billing – but multiple billing codes must be listed correctly to indicate that a UTI is due to a catheter and occurred only after admission to the hospital. As a result, most cases are listed as simple UTIs and hospitals continue receiving payment as usual.

"If the cases you wish to penalize are not documented in the chosen, the policy's intended impact will be limited," Meddings notes.

But the blame doesn't fall on billing coders who generate the claims data, authors say, as coders can only list the diagnoses as described by physicians in the medical record (following federal guidelines.)

Meanwhile, the well-publicized policy implemented by the Centers for and Medicaid Services has expanded to include more hospital-acquired conditions for nonpayment, such as pressure ulcers (or bed sores). But the authors warn that similar coding problems with other conditions may also stymie 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 says.

The findings suggest that billing data is inaccurate for comparing hospitals by their -associated UTI rates. Because billing data is anticipated to be used in 2015 to penalize hospitals with the highest infection rates, authors say, hospitals that report accurately in claims data will be unfairly penalized because their reported rates will be higher.

Explore further: Few hospitals aggressively combat catheter-associated urinary tract infections

Related Stories

Few hospitals aggressively combat catheter-associated urinary tract infections

December 8, 2011
Hospitals are working harder than ever to prevent hospital-acquired infections, but a nationwide survey shows few are aggressively combating the most common one – catheter-associated urinary tract infections.

Medicare penalty appears to drive hospital infection prevention efforts

May 1, 2012
The 2008 decision by the Centers for Medicare & Medicaid Services (CMS) to cease additional reimbursement to hospitals for certain healthcare-associated infections (HAIs) has led to enhanced focus on infection prevention ...

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.