UTI rarely reported in dataset for hospital penalties

A 2008 Medicare policy to stop payment for preventable, hospital-acquired conditions such as post-catheterization urinary tract infections has led to very little change in hospital payment, say researchers from the University of Michigan, Ann Arbor.

For all adult hospital stays in Michigan in 2009, eliminating payment for catheter-associated UTIs decreased hospital pay for only 25 hospital stays (0.003% of all stays). This is in contrast to the large savings anticipated, given that this condition accounts for nearly one-third of all hospital-acquired infections, according to the study’s authors.

The reason is that the "no-pay" policy uses billing data that is inaccurate for identifying such complications, say the authors, whose findings were published in the Annals of Internal Medicine (2012; 157:305-12).

“We think the policy was well intended, but its financial savings from non-payment for catheter-associated UTI are negligible because of the data used to implement the policy,” said first author Jennifer Meddings, MD, MSc.

The problem, the authors say, is that the policy relies on claims data previously used only for billing, but multiple billing codes must be listed correctly to indicate that a UTI is due to a catheter and occurred only after admission to the hospital. As a result, most cases are listed as simple UTIs and hospitals continue receiving payment as usual.

"If the cases you wish to penalize are not documented in the dataset chosen, the policy’s intended impact will be limited," Dr. Meddings said.

The study was accompanied by an editorial that emphasizes the national policy implications of the findings (Ann Intern Med 2012; 157:379-80). Editorial author Bernard Rosof, MD, of Hofstra North Shore-Long Island Jewish School of Medicine in New York, argued that careful dataset selection is crucial when used to measure and penalize hospital performance.

Funding for the study was provided by the Blue Cross Blue Shield of Michigan Foundation.

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