title: 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).
  
  
  METHODS
  Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Mercer University-College of Pharmacy.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Peasah
authors.affiliation: Mercer University-College of Pharmacy.
authors.forename: Niccie L
authors.initials: NL
authors.lastname: McKay
authors.affiliation: University of Florida-Department of Health Services Research, Management, and Policy.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.affiliation: Suffolk University-Sawyer Business School.
authors.forename: Mona
authors.initials: M
authors.lastname: Al-Amin
authors.affiliation: University of Florida-Department of Epidemiology.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Cook
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: Hospital-Acquired Infections; Medicare; Patient Outcomes
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