Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

Kawai, Alison Tse; Calderwood, Michael S.; Jin, Robert; Soumerai, Stephen B.; Vaz, Louise Elaine; Goldmann, Donald A.; Lee, Grace M.

doi:10.1017/ice.2015.86

Cited by 21 publications

(14 citation statements)

References 25 publications

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“…Our findings contrast with prior analyses demonstrating a sudden decline in Medicare billing rates for targeted HAIs after the 2008 Medicare HAC policy [9, 10]. One possibility is that many hospitals had already initiated prevention programs or modified their billing practices for these conditions as a result of the 2008 Medicare program, which increased awareness of HAIs among hospital leadership and targeted the same conditions.…”

Section: Discussioncontrasting

confidence: 98%

Impact of the 2012 Medicaid Health Care–Acquired Conditions Policy on Catheter-Associated Urinary Tract Infection and Vascular Catheter–Associated Infection Billing Rates

Rhee

Wang

Jentzsch

et al. 2018

Open Forum Infectious Diseases

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Section: Discussioncontrasting

confidence: 98%

Impact of the 2012 Medicaid Health Care–Acquired Conditions Policy on Catheter-Associated Urinary Tract Infection and Vascular Catheter–Associated Infection Billing Rates

Rhee

Wang

Jentzsch

et al. 2018

Open Forum Infectious Diseases

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“…This problem was previously demonstrated when financial reimbursement programs targeted limited codes as indicators of specific HAIs. 25,26 Our code sets purposely include a larger number of billing codes to account for variable use of specific codes across hospitals.…”

Section: Discussionmentioning

confidence: 99%

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Calderwood

Huang

Keller

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validationMETHODSInfection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency).RESULTSUpon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy.CONCLUSIONSClaims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.Infect Control Hosp Epidemiol 2017;38:1091–1097

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“…Two studies evaluated the effect of Medicare not funding "never events" and hospital acquired conditions. G. M. examined the impact on two types of infections covered by the scheme and Kawai et al (2015) examined effects on coding and billing practices.…”

Section: In Which Countries and Settings Were The Schemes And Studies?mentioning

confidence: 99%

Financial Incentives to Encourage Value-Based Health Care

2016

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This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.

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Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

Cited by 21 publications

References 25 publications

Impact of the 2012 Medicaid Health Care–Acquired Conditions Policy on Catheter-Associated Urinary Tract Infection and Vascular Catheter–Associated Infection Billing Rates

Impact of the 2012 Medicaid Health Care–Acquired Conditions Policy on Catheter-Associated Urinary Tract Infection and Vascular Catheter–Associated Infection Billing Rates

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Financial Incentives to Encourage Value-Based Health Care

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