title: Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections.
abstract: BACKGROUND
  The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.
  
  
  OBJECTIVE
  To examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).
  
  
  METHODS
  Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy. DESIGN We used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.
  
  
  RESULTS
  Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11-1.23]; for CAUTI, 1.19 [1.16-1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69-0.81]; for CAUTI, 0.87 [0.79-0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97-0.99]; for CAUTI, 0.99 [0.97-1.00]).
  
  
  CONCLUSIONS
  The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Alison Tse
authors.initials: AT
authors.lastname: Kawai
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Calderwood
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Jin
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.affiliation: 3Division of Pediatric Infectious Diseases,Doernbecher Children's Hospital,Oregon Health and Science University,Portland,Oregon.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Vaz
authors.affiliation: 4Institute for Healthcare Improvement,Cambridge,Massachusetts.
authors.forename: Donald
authors.initials: D
authors.lastname: Goldmann
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
mesh_terms: D055499:Catheter-Related Infections / Q000191:economics*; D014487:Centers for Medicare and Medicaid Services, U.S.; D003428:Cross Infection / Q000191:economics*; D006291:Health Policy; D017722:Hospital Charges / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D006278:Medicare / Q000191:economics*; D012052:Reimbursement, Incentive; D014481:United States; D062885:Urinary Catheters; D062666:Vascular Access Devices