Skip to main content
×
Home

Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals

  • Michael S. Calderwood (a1) (a2), Ken Kleinman (a2), Stephen B. Soumerai (a2), Robert Jin (a2), Charlene Gay (a2), Richard Piatt (a2), William Kassler (a3), Donald A. Goldmann (a4), Ashish K. Jha (a5) and Grace M. Lee (a2) (a6)...
Abstract
Background.

The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery.

Objective.

To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data.

Methods.

We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006-September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007-September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates.

Results.

We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23-0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74-0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN.

Conclusions.

The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation.

Copyright
Corresponding author
Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP Building, 5th Floor, Boston, MA 02115 (mcalderwood@partners.org)
References
Hide All
1.Centers for Medicare and Medicaid Services; Department of Health and Human Services. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist 2007;72(162):4737947428.
2.Centers for Medicare and Medicaid Services (CMS). Hospital-Acquired Conditions. Baltimore: CMS, 2012. http://vww.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/. Accessed September 11, 2013.
3.Rosenthal MB. Non-payment for performance? Medicare's new reimbursement rule. N Engl J Med 2007;357(16):15731575.
4.Lee GM, Kleinman K, Soumerai SB, et al.Effect of nonpayment for preventable infections in U.S. hospitals. N Engl J Med 2012; 367(15):14281437.
5.Meddings JA, Reichert H, Rogers MA, Saint S, Stephansky J, McMahon LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 2012;157(5):305312.
6.Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta: Centers for Disease Control and Prevention, 2009. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed September 11, 2013.
7.Brown PP, Kugelmass AD, Cohen DJ, et al.The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg 2008;85(6):19801986.
8.Agency for Healthcare Research and Quality (AHRQ). HCUP-net: A Tool for Identifying, Tracking, and Analyzing National Hospital Statistics. Rockville, MD: AHRQ, 2013. http://hcupnet.ahrq.gov/. Accessed September 11, 2013.
9.Edwards JR, Peterson KD, Mu Y, et al.National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37(10): 783805.
10.Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20(11):725730.
11.Lucet JC; Parisian Mediastinitis Study Group. Surgical site infection after cardiac surgery: a simplified surveillance method. Infect Control Hosp Epidemiol 2006;27(12):13931396.
12.Kaye KS, Anderson DJ, Sloane R, et al.The effect of surgical site infection on older operative patients. J Am Geriatr Soc 2009; 57(1):4654.
13.Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network. Atlanta: CDC, 2013. http://www.cdc.gov/nhsn/. Accessed September 11, 2013.
14.Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309332.
15.University of Minnesota School of Public Health. Research Data Assistance Center. Minneapolis: University of Minnesota, 2013. http://www.resdac.org/. Accessed September 11, 2013.
16.Harvard Pilgrim Health Care Institute; Harvard Medical School. The PAICAP Project. Boston: Harvard Pilgrim Health Care Institute and Harvard Medical School, 2013. http://www.paicap.org/. Accessed September 11, 2013.
17.American Hospital Association (AHA). Annual Survey Database Fiscal Year 2009. Chicago: AHA, 2010.
18.Shadish WR, Cook TD, Campbell DT. Experimental and quasiexperimental designs for generalized causal inference. Boston: Houghton Mifflin, 2002.
19.Sands KE, Yokoe DS, Hooper DC, et al.Detection of postoperative surgical site infections: comparison of health plan-based surveillance with hospital-based programs. Infect Control Hosp Epidemiol 2003;24(10):741743.
20.Harrington G, Russo P, Spelman D, et al.Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2004;25(6):472476.
21.Berríos-Torres SI, Mu Y, Edwards JR, Horan TC, Fridkin SK. Improved risk adjustment in public reporting: coronary artery bypass graft surgical site infections. Infect Control Hosp Epidemiol 2012;33(5):463469.
22.Bundy JK, Gonzalez VR, Barnard BM, Hardy RJ, DuPont HL. Gender risk differences for surgical site infections among a primary coronary artery bypass graft surgery cohort: 1995-1998. Am J Infect Control 2006;34(3):114121.
23.Russo PL, Spelman DW. A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2002;23(7):372376.
24.Friedman ND, Bull AL, Russo PL, et al.An alternative scoring system to predict risk for surgical site infection complicating coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2007;28(10):11621168.
25.Fakih MG, Sharma M, Khatib R, et al.Increase in the rate of sternal surgical site infection after coronary artery bypass graft: a marker of higher severity of illness. Infect Control Hosp Epidemiol 2007;28(6):655660.
26.Vogel TR, Dombrovskiy VY, Lowry SF. In-hospital delay of elective surgery for high volume procedures: the impact on infectious complications. J Am Coll Surg 2010;211(6):784790.
27.Agency for Healthcare Research and Quality (AHRQ). Healthcare Cost and Utilization Project: Overview of Comorbidity Software. Rockville, MD: AHRQ, 2013. http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed September 11, 2013.
28.Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36(1): 827.
29.Culver DH, Horan TC, Gaynes RP, et al.Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(3B):152S157S.
30.Piatt R, Kleinman K, Thompson K, et al.Using automated health plan data to assess infection risk from coronary artery bypass surgery. Emerg Infect Dis 2002;8(12):14331441.
31.Huang SS, Livingston JM, Rawson NS, Schmaltz S, Platt R. Developing algorithms for healthcare insurers to systematically monitor surgical site infection rates. BMC Med Res Methodol 2007;7:20.
32.Huang SS, Placzek H, Livingston J, et al.Use of Medicare claims to rank hospitals by surgical site infection (SSI) risk following coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2011;32(8):775783.
33.Calderwood MS, Ma A, Khan YM, et al.Use of Medicare diagnosis and procedures codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery. Infect Control Hosp Epidemiol 2012;33(1):4049.
34.Calderwood MS, Kleinman K, Bratzier DW, et al.Use of Medicare claims to identify US hospitals with a high rate of surgical site infection after hip arthroplasty. Infect Control Hosp Epidemiol 2013;34(1):3139.
35.Meddings J, Saint S, McMahon LF Jr. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare's new payment policy. Infect Control Hosp Epidemiol 2010;31(6):627633.
36.McNutt R, Johnson TJ, Odwazny R, et al.Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality? Qual Manag Health Care 2010; 19(1): 1724.
37.Ryan AM. Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost. Health Serv Res 2009;44(3):821842.
38.Werner RM, Kolstad JT, Stuart EA, Polsky D. The effect of pay-for-performance in hospitals: lessons from quality improvement. Health Aff (Millwood) 2011;30(4):690698.
39.Ryan AM, Blustein J. The effect of the MassHealth hospital pay-for-performance program on quality. Health Serv Res 2011; 46(3):712728.
40.Jha AK, Joynt KE, Orav EJ, Epstein AM. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med 2012;366(17):16061615.
41.Houle SK, McAlister FA, Jackevicius CA, Chuck AW, Tsuyuki RT. Does performance-based remuneration for individual health care practitioners affect patient care?: a systematic review. Ann Intern Med 2012;157(12):889899.
42.McHugh M, Van Dyke K, Osei-Anto A, Haque A. Medicare's payment policy for hospital-acquired conditions: perspectives of administrators for safety net hospitals. Med Care Res Rev 2011; 68(6):667682.
43.Hoff T, Hartmann CW, Soerensen C, Wroe P, Dutta-Lin M, Lee G. Making the CMS payment policy for healthcare-associated infections work: organizational factors that matter. J Healthc Manag 2011;56(5):319335.
44.Centers for Medicare and Medicaid Services; Department of Health and Human Services. Medicare Program; Hospital Inpatient Value-Based Purchasing Program. Fed Regist 2011; 76(88):2649026547.
45.Centers for Medicare and Medicaid Services; Department of Health and Human Services. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY2012 Rates; Hospitals' FTE Resident Caps for Graduate Medical Education Payment; Final Rule. Fed Regist 2011:76 (160):5147551846.
46.Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network (NHSN): CMS Requirements. Atlanta: CDC, 2013. http://www.cdc.gov/nhsn/cms/index.html. Accessed September 11, 2013.
47.Centers for Medicare and Medicaid Services (CMS). Medicare Hospital Compare. Baltimore: CMS, 2013. http://www.medicare.gov/hospitalcompare/. Accessed September 11, 2013.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 26 *
Loading metrics...

Abstract views

Total abstract views: 146 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.