title: Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis.
abstract: BACKGROUND
  Most (59% to 86%) hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTIs). As of 2008, claims data are used to deny payment for certain hospital-acquired conditions, including CAUTIs, and publicly report hospital performance.
  
  
  OBJECTIVE
  To examine rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment for CAUTI lowers hospital payment.
  
  
  METHODS
  Before-and-after study of all-payer cross-sectional claims data.
  
  
  METHODS
  96 nonfederal acute care Michigan hospitals.
  
  
  METHODS
  Nonobstetric adults discharged in 2007 (n = 767 531) and 2009 (n = 781 343).
  
  
  METHODS
  Hospital rates of UTIs (categorized as catheter-associated or hospital-acquired) and frequency of reduced payment for hospital-acquired CAUTIs.
  
  
  RESULTS
  Hospitals frequently requested payment for non-CAUTIs as secondary diagnoses: 10.0% (95% CI, 9.5% to 10.5%) of discharges in 2007 and 10.3% (CI, 9.8% to 10.9%) in 2009. Hospital rates of CAUTI were very low: 0.09% (CI, 0.06% to 0.12%) in 2007 and 0.14% (CI, 0.11% to 0.17%) in 2009. In 2009, 2.6% (CI, 1.6% to 3.6%) of hospital-acquired UTIs were described as CAUTIs. Nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781 343 (0.003%) hospitalizations in 2009.
  
  
  CONCLUSIONS
  Data are from only 1 state and involved only 1 year before and after nonpayment for complications. Hospital prevention practices were not examined.
  
  
  CONCLUSIONS
  Catheter-associated UTI rates determined by claims data seem to be inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current nonpayment policy for hospital-acquired CAUTI is low. Claims data are currently not valid data sets for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties.
  
  
  BACKGROUND
  Blue Cross Blue Shield of Michigan Foundation.
authors.affiliation: University of Michigan Medical School, Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA. meddings@umich.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Meddings
authors.forename: Heidi
authors.initials: H
authors.lastname: Reichert
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Joe
authors.initials: J
authors.lastname: Stephansky
authors.forename: Laurence F
authors.initials: LF
authors.lastname: McMahon
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000191:economics* / Q000453:epidemiology; D059019:Clinical Coding; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D004469:Economics, Hospital; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000191:economics; D008824:Michigan / Q000453:epidemiology; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000191:economics* / Q000453:epidemiology / Q000209:etiology