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.

Design: Before-and-after study of all-payer cross-sectional claims data.

Setting: 96 nonfederal acute care Michigan hospitals.

Patients: Nonobstetric adults discharged in 2007 (n = 767 531) and 2009 (n = 781 343).

Measurements: 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.

Limitations: Data are from only 1 state and involved only 1 year before and after nonpayment for complications. Hospital prevention practices were not examined.

Conclusion: 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.

Primary funding source: Blue Cross Blue Shield of Michigan Foundation.

Appendix Figure 1. Hospital rates^a of non-catheter-associated UTIs and catheter-associated UTIs In 2009 as hospital-acquired and present-on-admission events

Four Michigan hospitals listed invalid POA codes for all diagnoses and all hospitalizations in the 2009 HCUP-ID dataset (black bars). Because an invalid POA code generates an error, invalid codes would be corrected by hospitals prior to final submission to payers. UTI: Urinary Tract Infection; non-CAUTI: Non-catheter-associated Urinary Tract Infection; CAUTI: Catheter-associated Urinary Trad Infecton. ^aHospital's rate of diagnosis calculated as the percentage of each hospital's adult discharges with the indicated diagnosis.

Figure 1. Data Inclusion and Exclusion Criteria

Abbreviations: HCUP Healthcare Cost and Utilization Project; SID - State Inpatient Dataset; LOS - Length of Stay: DRG - Diagnosis-related Group; Rehab - Rehabilition: VA - Veterans Affairs.

Figure 2. Michigan hospital rates^a In 2009 (top) and change In rates from 2007 to 2009 (bottom)

non-CAUTI: Non-catheter-associated Urinary Tract Infection; CAUTI: Cathater-associated Urinary Trad Infection. ^aHospital's rate of diagnosis calculated as the percentage of each hospital's adult discharges with the indicated diagnosis.

Figure 3. Hospital rates^a of hospital-acquired catheter-associated UTIs and hospital-acquired non-catheter-associated UTIs in 2009

non-CAUTI: Non-catheter-associated Urinary Tract Infection; CAUTI: Catheter-associated Urinary Tract Infection. ^aHospital's rate of diagnosis calculated as the percentage of each hospital's adult discharges with the indicated diagnosis.