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

Written by:
Peasah SK, McKay NL, Harman JS, Al-Amin M, Cook RL.   Are you the author?
Mercer University-College of Pharmacy; University of Florida-Department of Health Services Research, Management, and Policy; Suffolk University-Sawyer Business School; University of Florida-Department of Epidemiology.

Reference: Medicare Medicaid Res Rev. 2013 Sep 25;3(3). pii: mmrr.003.03.a08.
doi: 10.5600/mmrr.003.03.a08

PubMed Abstract
PMID: 24753974