Infection Control & Hospital Epidemiology
Table 2. Characteristics of Hospitals Impacted and Not Impacted by CMS HAC Policy CLABSI
899
CAUTI
Hospital Characteristic No DRG Changes, No. ≥1 DRG Changes, No. (%) P Value No DRG Changes, No. (%) ≥1 DRG Changes, No. (%) P Value Region
Midwest
Northeast South West
City sizea Metropolitan Micropolitan Rural
Hospital bed size <100
100–399 400 +
Type of ownership For profit
Not for profit Public
Teaching statusb Graduate teaching Major teaching Minor teaching Nonteaching
494 (23) 396 (19) 784 (37) 431 (20)
1,766 (84) 290 (14) 49 (2)
250 (12)
1,440 (68) 415 (20)
381 (18)
1,447 (69) 277 (13)
418 (20) 245 (12) 162 (8)
1,280 (61)
17 (27) 17 (27) 13 (21) 16 (25)
54 (86) 9 (14) 0 (0)
4 (6)
35 (56) 24 (38)
7 (11)
49 (78) 7 (11)
10 (16) 17 (27) 5 (8)
31 (49) <.01 .27 .05
217 (26) 171 (21) 266 (32) 179 (21)
.47
722 (87) 96 (12) 15 (2)
<.01 66 (8)
516 (62) 251 (30)
106 (13) 645 (77) 82 (10)
207 (25) 138 (17) 68 (8)
420 (50)
33 (32) 27 (26) 30 (29) 12 (12)
88 (86) 11 (11) 3 (3)
10 (10) 60 (59) 32 (31)
16 (16) 72 (71) 14 (14)
24 (24) 20 (20) 7 (7)
51 (50) NOTE. CMS, Center for Medicare and Medicaid Services; HAC, hospital-acquired condition; CLABSI, central line–associated bloodstream infection; CAUTI, catheter-associated urinary tract
infection; DRG, diagnosis-related group. aMetropolitan has a population >50,000. Micropolitan has a population of 10,000–50,000. Rural has a population <10,000. bGraduate teaching hospital has a residency training program approved by the Council for Graduate Medical Education, Major teaching hospital is a member of the Council of Teaching Hospitals, Minor Teaching Hospital has a medical school affiliation reported to the American Medical Association, and all others classified as nonteaching.
Coding following implementation of the CMS HAC policy
From 2009 to 2011, a total of 117,246 of 41,276,090 Medicare discharges (0.28%) had an HAC code for CLABSI. The CLABSI HAC code was designated as POA in 94,648 of the 117,246 dis- charges (80.7%) where it was used. Similarly, over these same 3 years, a total of 25,616 of 41,276,090 Medicare discharges (0.06%) had an HAC code for CAUTI. The CAUTI HAC code was designated as POA in 23,204 of the 25,616 discharges (90.6%) where it was used. Between 2009 and 2011, only 22,598 Medicare discharges had
a CLABSI HAC coded as either POA=No (N=20,476) or POA=Missing (N=2,122), and only 2,412 Medicare discharges had a CAUTI HAC coded as either POA=No (N=2,255) or POA=Missing (N=157). Thus, CLABSI and CAUTI coding with the potential to impact the DRG assignment was a rare event. Overall, only 0.05% of Medicare discharges had a CLABSI code listed as not POA (or missing POA status), and 0.006% of
Medicare discharges had a CAUTI code listed as not POA (or missing POA status).
Impact on diagnosis-related group assignment
We were able to determine MS-DRG assignments for 20,213 of the 20,476 Medicare discharges with a CLABSI HAC code that was not POA and for 2,204 of 2,255 Medicare discharges with a CAUTI HAC code that was not POA. Not reimbursing for a CLABSI HAC code dropped the DRG assignment in only 92 of the 20,476 admissions (0.4%) for which the code was not POA. Similarly, not reimbursing for a CAUTI HAC code dropped the DRG assignment in only 129 of the 2,255 admissions (5.7%) where the code was not POA. Between 2009 and 2011, there were 2,168 acute-care, non-
federal US hospitals with at least 1 discharge containing a CLABSI HAC code, and 63 of these hospitals (2.9%) had the DRG assignment impacted for at least 1 discharge. For this same
.06
.72
.75
.29
.86
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