OBJECTIVE: In 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). We sought to understand why this policy did not impact central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.
DESIGN: Retrospective cohort study.
SETTING: Acute care US hospitals.
PARTICIPANTS: Fee-for-service Medicare patients discharged 1/1/2007-12/31/2011.
METHODS: Using inpatient Medicare claims data, we analyzed billing practices before and after the HAC policy, including the use and POA designation of codes for CLABSI or CAUTI. Then, in the three year period following policy implementation, we determined the impact on diagnosis-related groups (DRG) determining reimbursement, as well as hospital characteristics associated with having experienced a reimbursement impact.
RESULTS: From 1/1/07-12/31/11, there were 65,205,607 Medicare fee-for-service hospitalizations at 3,291 acute care, non-federal US hospitals. Based on coding, CLABSI and CAUTI affected 0.23% and 0.06% of these hospitalizations, respectively. In addition, following the HAC policy, 82% of the CLABSI codes and 91% of the CAUTI codes were marked as POA, a big increase in the use of this designation. Finally, of the small number of CLABSI and CAUTI coded as not POA, there was a financial impact on only 0.4% of the hospitalizations with a CLABSI code and 5.7% with a CAUTI code.
CONCLUSIONS: Part of the reason the HAC policy did not have its intended impact is that billing codes for CLABSI and CAUTI were rarely used, commonly listed as POA in the post-policy period, and infrequently impacted hospital reimbursement.
