Hospital-acquired infections rarely reported

Medicare's penalty of hospital-acquired infections has done little to actually change payments, due to inaccurate reporting, according to a statewide analysis by the University of Michigan.

The study published in this week's Annals of Internal Medicine shows disappointing results of the 2008 policy that the Centers for Medicare & Medicaid Services anticipated would save Medicare big.

"We don't have any evidence on whether it has prompted hospitals to improve patient care to prevent these infections, but we do know that it did not lead to large financial savings," Jennifer Meddings, an assistant professor at the U of Michigan Medical School, said in a research announcement today.

Even though the "well-intended" Medicare policy, as U of Michigan researchers called it, targeted infections, inconsistencies in billing data let hospitals with catheter-associated urinary tract infections slide by.

"If you just looked at the billing data, you would already think that hospitals are doing a great job to prevent this complication," Meddings told Reuters Health. But that's not necessarily the case.

Even worse, Medicare might unfairly penalize hospitals that report accurately, study authors said.

"Their data gets translated into higher rates (of hospital-acquired UTIs) in their claims data, so they look like a bad hospital," Meddings said. "You certainly don't want to discourage hospitals from documenting well."

Researchers looked at about 100 acute care hospitals in Michigan and found payment for this infection decreased pay for a fraction of hospitals--only 25 hospital stays or 0.003 percent of all stays.

Part of the reporting inaccuracies come from most cases being listed as simple UTIs--and not indicating that a UTI is due to a catheter and occurred only after admission to the hospital--in which hospitals receive payment as usual.

For instance, if a nurse puts in and takes out the catheter, it's the doctor's records used for billing.

Researchers noted the study has far-reaching implications for similar Medicare policies that target other hospital-acquired conditions for nonpayment, such as pressure ulcers and bed sores.

Bernard Rosof from North Shore-LIJ Health System in Huntington, N.Y., suggested in an accompanying commentary that Medicare use electronic health records instead of billing records may help ensure the full picture of preventable complications, Reuters Health reported.

For more information:
- see the research announcement
- here's the study abstract and accompanying editorial
- read the Reuters Health article

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