Medicare reimbursement attributable to catheter-associated urinary tract infection in the inpatient setting: a retrospective cohort analysis

Abstract

Background: Most catheter-associated urinary tract infections (CAUTIs) are considered preventable and thus a potential target for health care quality improvement and cost savings.

Objectives: We sought to estimate excess Medicare reimbursement, length of stay, and inpatient death associated with CAUTI among hospitalized beneficiaries.

Research design: Using a retrospective cohort design with linked Medicare inpatient claims and National Healthcare Safety Network data from 2009, we compared Medicare reimbursement between Medicare beneficiaries with and without CAUTIs.

Subjects: Fee-for-service Medicare beneficiaries aged 65 years or older with continuous coverage of parts A (hospital insurance) and B (supplementary medical insurance).

Results: We found that beneficiaries with CAUTI had higher median Medicare reimbursement [intensive care unit (ICU): $8548, non-ICU: $1479) and length of stay (ICU: 8.1 d, non-ICU: 3.6 d) compared with those without CAUTI controlling for potential confounding factors. Odds of inpatient death were higher among beneficiaries with versus without CAUTI only among those with an ICU stay (ICU: odds ratio 1.37).

Conclusions: Beneficiaries with CAUTI had increased Medicare reimbursement and length of stay compared with those without CAUTI after adjusting for potential confounders.

Figure 1.

Flow diagram of eligibility and inclusion in analysis of CAUTI cases and controls who were Medicare beneficiaries and discharged from an inpatient hospitalization in 2009. Abbreviations: CAUTI, catheter-associated urinary tract infection; ICU, intensive care unit; BSI, bloodstream infection; ABUTI, asymptomatic bacteremic urinary tract infection. ^aIncluded hospitalizations met inclusion criteria and had unique linkage patterns. ^bThe control pool was restricted to specific case characteristics.