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

2015 ◽  
Vol 36 (8) ◽  
pp. 871-877 ◽  
Author(s):  
Alison Tse Kawai ◽  
Michael S. Calderwood ◽  
Robert Jin ◽  
Stephen B. Soumerai ◽  
Louise E. Vaz ◽  
...  
Keyword(s):  
New York ◽  
Odds Ratio ◽  
Times Series ◽  
Hospital Acquired Conditions ◽  
Medicare Patients ◽  
Study Population ◽  
Tract Infections ◽  
Additional Payment ◽  
Healthcare Associated ◽  
Hospital Acquired

BACKGROUNDThe 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.OBJECTIVETo examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).STUDY POPULATIONAdult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.DESIGNWe used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.RESULTSBefore the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).CONCLUSIONSThe Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

2015 ◽  
Vol 37 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Michael S. Calderwood ◽  
Louise E. Vaz ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
Melisa D. Rett ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Differential Impact ◽  
Payment Policy ◽  
Operating Margin ◽  
Hospital Acquired Conditions ◽  
Operating Margins ◽  
Additional Payment ◽  
Hospital Acquired ◽  
Present On Admission

AbstractIn October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy’s differential impact in hospitals with high vs low operating margins. Medicare’s payment policy may have had an impact on reducing central line–associated bloodstream infections in hospitals with low operating margins.Infect. Control Hosp. Epidemiol. 2015;37(1):100–103

scholarly journals Factors associated with survival in patients with COVID -19 admitted to a community hospital in New York City

2021 ◽  
Vol 8 (2) ◽  
pp. 27-33
Author(s):  
Ajay P Singh ◽  
Ahmed Shady ◽  
Ejiro Gbaje ◽  
Marlon Oliva ◽  
Samantha Golden Espinal ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Oxygen Saturation ◽  
York City ◽  
Odds Ratio ◽  
Community Hospital ◽  
Cox Regression ◽  
The Elderly ◽  
Hazard Ratio ◽  
Study Population

Introduction: COVID-19 has been associated with increased mortality in old age, hypertension and male gender. Higher prevalence of increased body mass index (BMI), mechanical ventilation and renal failure has been found in the patients admitted to our New York City community hospital; accordingly we aim to explore the association between these parameters and survival in our patients. Methods: Retrospective review of patients admitted with the COVID-19 disease March 14 to April 30 of 2020. Analysis using Cox regression models, Log rank tests and Kaplan Meier curves was done for a total of 326 patients that met our criteria. Results: The adjusted odds of death for those at least 75 years of age were higher than those within the age group of 18 to 44 years. The patients with over 92% oxygen saturation had lower adjusted odds of death than those with 88 to 92% oxygen saturation (Odds Ratio (OR)=0.2, 95% CI=0.06, 0.70), as well as lower adjusted hazard of dying (Hazard Ratio (HR)=0.4, 95% CI=0.21, 0.87). Intubation was associated with a higher adjusted odds ratio (OR=57.8, 95% CI=17.74, 188.30) and adjusted hazard ratio HR=5.4 (95% CI=2.59, 11.21) for death. After controlling for age and gender, neither levels of serum D-dimer nor creatinine were found to be significantly associated with mortality The factors that comprise metabolic syndrome, i.e., elevated BMI, diabetes, hypertension, and hyperlipidemia, were found to have no significant association with the outcome of death after controlling for age and sex and they also had no significant association with the time until death. Conclusions: In the study population, COVID-19 was associated with increased mortality in patients who required intubation, and in the elderly, which may be explained by changes in the immune system over time. Elevated BMI, though not statistically significant, was present in the majority of our study population, which may have contributed to the group's high mortality.

scholarly journals Impact of Female External Urinary Catheter on Indwelling Catheter Use and Catheter-Associated Urinary Tract Infection Rates

2021 ◽  
Vol 1 (S1) ◽  
pp. s5-s5
Author(s):  
Lea Monday ◽  
Geehan Suleyman ◽  
George Alangaden ◽  
Stephanie Schuldt ◽  
Catherine Jackman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Catheter ◽  
Indwelling Catheter ◽  
Significant Difference ◽  
Pressure Injury ◽  
Utilization Ratio ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
The Impact

Background: Catheter-associated urinary tract infections (CED: TIs) are one of the most prevalent healthcare-associated infections. They can lead to bacteremia and increased length of stay, healthcare costs, and mortality. Indwelling urinary catheter (IUC) prevention bundles, nurse-driven removal protocols, and the use of external catheters can help reduce CED: TIs. However, female external urinary catheters (FEUCs) have only recently become widely available. FEUCs were introduced at our institution in July 2017. The purpose of this study was to evaluate the impact of FEUC on IUC utilization ratio and overall CED: TI rate in an 844-bed teaching hospital in southeastern Michigan. Methods: We retrospectively evaluated the utilization ratio of FEUCs (female FEUC days per patient days ×1,000) and female IUCs (IUC days per patient days ×1,000), and labia hospital-acquired pressure injury (HAPI) rate due to FEUC from July 2017 through June 2019. We compared the overall (male and female) CED: TI rate per 1,000 IUC days in the preintervention period (January 2016 to June 2017) to the postintervention period (July 2017 to June 2019). Results: In total, 4,013 FEUCs were placed during the intervention period. The utilization ratio of FEUC increased by 59% and the utilization ratio of female IUC decreased by 13% over the course of the 2 years. Only 1 HAPI was reported during the observation period at a rate of 0.025% (1 of 4,013). The overall CED: TI rate decreased from 1.60 to 1.40 (P = .372). Conclusion: Introduction of a FEUC was associated with a decrease in the IUC utilization ratio in female patients with minimal adverse events; however, there was no significant difference in the overall CED: TI rate.Funding: NoDisclosures: None

scholarly journals Pathogens Isolated in Respiratory Tract Samples of Recently Hospitalized Patients: Implications for Primary Care Physicians

2020 ◽  
Author(s):  
Oryan Henig ◽  
Anat Reiner Benaim ◽  
Ami Neuberger
Keyword(s):  
Streptococcus Pneumoniae ◽  
Respiratory Tract ◽  
Elderly Patients ◽  
Oral Antibiotic ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Entire Cohort ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Hospital Acquired

Abstract Background. Little is known about the etiology of community-acquired lower respiratory tract infections (CA-LRTI), and treatment is largely empirical. We aimed to provide clinicians with microbiologic data of the more severe cases, i.e. those that result in hospital admission. Methods. A retrospective observational cohort study was conducted at a tertiary care hospital in Haifa, Israel. Consecutive respiratory tract samples obtained from admitted patients older than 12 years between 2014 and 2020 were included. Pathogen distribution and drug susceptibility were described, and factors associated with 14 day mortality rates were analyzed using a multivariable logistic regression with a stepwise model reduction. Results. A total of 1,395; 2,212; and 2,760 samples were included in the community-acquired, healthcare-associated and hospital-acquired LRTI groups, respectively. Gram negative bacteria were the most common bacteria isolated. Streptococcus pneumoniae was over represented in patients admitted to the intensive care unit (ICU) with CA-LRTI and healthcare-associated LRTI (accounting for 20% and 10.1% of patients admitted to the ICU versus 12.6% and 6.4% of patients in the entire cohort, p < 0.001). Streptococcus pneumoniae was susceptible to penicillin in around 50% of cases; to erythromycin in 65% of cases; and to fluoroquinolones and 3rd generation cephalosporins in more than 95% of cases. Twenty-five percent of other typical community-acquired pathogens (Hemophillus influenza, Moraxella spp., and Bordatella spp.) were resistant to ampicillin. Susceptibility of Gram negative bacteria to penicillins with and without a β-lactamase inhibitor and to second generation cephalosporins was lower than 50%. In the multivariable analysis, factors that were associated with increased mortality in the entire cohort were: age, admission to an ICU or surgical department, healthcare-associated or hospital-acquired infections, and infections with gram negative bacteria, Staphylococcus aureus, and Stenotrophomonas or Acinetobacter baummannii. Conclusions. Our data shows that gram negative bacteria are common causative agents among elderly patients with multiple comorbidities. Streptococcus pneumoniae and other typical community acquired pathogens are proportionally more common in younger patients, although most absolute cases occur in elderly patients. The susceptibility pattern of these community pathogens suggests that for high-risk patients the choice of effective oral antibiotic agents in the community is limited.

Prevention of healthcare associated infections

2019 ◽  
pp. 233-304 ◽  
Author(s):  
Nizam Damani
Keyword(s):  
Prevention And Control ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

scholarly journals Impact of Centers for Medicare and Medicaid Services Non-Reimbursement on Hospital-Acquired Conditions Following Spine Procedures

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Layton Lamsam ◽  
Michael Zhang ◽  
Marc Carmichael ◽  
Hriday P Bhambhvani ◽  
Ian D Connolly ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Lumbar Fusion ◽  
International Classification Of Diseases ◽  
Hospital Acquired Conditions ◽  
Classification Of Diseases ◽  
Tract Infections ◽  
Anterior Discectomy And Fusion ◽  
Insured Patients ◽  
Hospital Acquired ◽  
Present On Admission

Abstract INTRODUCTION In an effort to reduce inpatient complications, the Centers for Medicare and Medicaid Services (CMS) discontinued reimbursements for certain complications beginning in October 2008. These were termed hospital-acquired conditions (HACs), and include surgical site infection, deep venous thrombosis, catheter-associated urinary tract infections, and falls, among others. The effect of this policy has not been extensively studied in the spine surgery population. METHODS A retrospective administrative insurance claims database containing data on Medicare and commercially insured patients was used to extract information on admissions associated with 1- and 2-level anterior discectomy and fusion (ACDF), lumbar laminectomy (LL), lumbar discectomy (LD), and 2- and 3-level posterior lumbar fusion (PLF). Relevant HACs were selected using International Classification of Diseases-9 codes, and a present-on-admission indicator was estimated using prior records. Difference-in-difference (DID) regressions were used to estimate the effect of the CMS nonreimbursement policy on Medicare insured patients compared to a similarly aged nonMedicare patient populations. RESULTS A total of 23 120 and 38 290 commercially insured patients met criteria. Of those, 20 265 (33%) underwent ACDF, 24 918 (41%) underwent LL or LD, and 16 227 (26%) underwent PLF. From 2007 to 2014, 2.4% (95% CI: 2.2-2.6%) and 2.2% (2.1-2.4%) of admissions were associated with at least 1 HAC in the Medicare and commercial cohorts, respectively (P = .08). A DID regression on the occurrence of any HAC, which included patients from 2007 to 2010, explained 0.8% of the total variance (adjusted multiple R2 = 0.008). Medicare insurance, postpolicy admissions, and their interaction term were not significant (all P > .29). CONCLUSION In this study, we found no effect of the CMS policy on rates of HAC in spinal surgery patients. This suggests that this policy, implemented in 2008, has not reduced HAC occurrence in this spine surgery population compared to our control population.

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