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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

Published online by Cambridge University Press:  24 April 2015

Alison Tse Kawai*
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Michael S. Calderwood
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts
Robert Jin
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Stephen B. Soumerai
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Louise E. Vaz
Division of Pediatric Infectious Diseases, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon
Donald Goldmann
Institute for Healthcare Improvement, Cambridge, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Grace M. Lee
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Address correspondence to Alison Tse Kawai, Department of Population Medicine, Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215 (



The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.


To 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).


Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.


We 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.


Before 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]).


The 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

Original Articles
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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