Claims Data and Non-Payment for Hospital Acquired Urinary Tract Infections

Fighting CAUTIs
Source: AllenHospital.org

As many of us are aware, since 2008, claims data are used to deny payment for certain hospital-acquired conditions, including catheter-associated urinary tract infections (CAUTIs). Is this an effective strategy?

Here is an article in the Annals of Internal Medicine on billing claims data and hospital acquired urinary tract  infections.

From the study, hospital rates of CAUTI were very low:
2007: 0.09% (CI, 0.06% to 0.12%) 
2009: 0.14% (CI, 0.11% to 0.17%))

In addition, hospitals frequently requested payment for non-CAUTIs as secondary diagnoses: 2007: 10.0% (95% CI, 9.5% to 10.5%) 
2009: 10.3% (CI, 9.8% to 10.9%).

The implication? In this study, the threat of nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781,343 (0.003%) hospitalizations in 2009. Minuscule.

Although CAUTIs are the most common hospital acquire infections (and also the least severe), determining  CAUTI rates by claims appears inaccurate and discordant.  The financial impact of non-payment for CAUTIs also appears wimpy. 

CAUTIs are simply not captured by for billing purposes. We need another strategy.