Claims Data Lacks Accuracy, Consistency Needed to Inform Nonpayment or Hospital Comparisons

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The Centers for Medicare & Medicaid Services (CMS) limits payment for key "preventable" complicating conditions acquired during hospital stay. The claims data is used to deny payment, and the data is reported publicly so that hospitals can be compared by complication rate.

Catheter-associated urinary tract infection (CAUTI) was the first condition targeted for such nonpayment. In a study in the current issue of the Annals of Internal Medicine, researchers examined data from 96 Michigan hospitals to compare rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment of CAUTI lowers hospital payments.

The researchers found that only 2.6 percent of all hospital-acquired UTIs were described in the claims data as catheter-related, making financial savings based on nonpayment negligible. Further, epidemiologic studies report that most hospital-acquired UTIs are catheter-associated (59 percent to 86 percent), which makes the accuracy of the claims data suspect.

The researchers and the author of an accompanying editorial conclude that current hospital claims data may not be an accurate source for measures used to compare institutions and guide financial incentives. According to the editorialist, consistent use of electronic health records, sharing best practices, and focusing on patient-centered care and safety can improve the accuracy of the data hospitals are reporting.
 

Reference: Jennifer A. Meddings JA, et al. Effect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection: A Statewide Analysis. Annals of Internal Medicine. Sept. 4, 2012, Vol 157, No. 5.

Source: Annals of Internal Medicine

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