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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

  • Alison Tse Kawai (a1), Michael S. Calderwood (a1) (a2), Robert Jin (a1), Stephen B. Soumerai (a1), Louise E. Vaz (a3), Donald Goldmann (a4) (a5) and Grace M. Lee (a1) (a5)...

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

Corresponding author
Address correspondence to Alison Tse Kawai, Department of Population Medicine, Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA 02215 (
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3. PD McNair , HS Luft , AB Bindman . Medicare’s policy not to pay for treating hospital-acquired conditions: the impact. Health Aff (Millwood) 2009;28:14851493.

4. M McHugh , K Van Dyke , A Osei-Anto , A Haque . Medicare’s payment policy for hospital-acquired conditions: perspectives of administrators from safety net hospitals. Med Care Res Rev 2011;68:667682.

5. R McNutt , TJ Johnson , R Odwazny , 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;19:1724.

6. H Wald , A Richard , VV Dickson , E Capezuti . Chief nursing officers’ perspectives on Medicare’s hospital-acquired conditions non-payment policy: implications for policy design and implementation. Implement Sci 2012;7:78.

7. CW Hartmann , T Hoff , JA Palmer , P Wroe , MM Dutta-Linn , G Lee . The Medicare policy of payment adjustment for health care-associated infections: perspectives on potential unintended consequences. Med Care Res Rev 2012;69:4561.

10. KJ Bozic , LM Grosso , Z Lin , et al. Variation in hospital-level risk-standardized complication rates following elective primary total hip and knee arthroplasty. J Bone Joint Surg Am 2014;96:640647.

12. PS Romano , HJ Mull , PE Rivard , et al. Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health Serv Res 2009;44:182204.

15. C Zhan , A Elixhauser , CL Richards Jr, et al. Identification of hospital-acquired catheter-associated urinary tract infections from Medicare claims: sensitivity and positive predictive value. Med Care 2009;47:364369.

17. JA Meddings , H Reichert , MA Rogers , S Saint , J Stephansky , LF McMahon . Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 2012;157:305312.

18. JA Meddings , H Reichert , T Hofer , LF McMahon Jr. Hospital report cards for hospital-acquired pressure ulcers: how good are the grades? Ann Intern Med 2013;159:505513.

26. TM Waters , MJ Daniels , GJ Bazzoli , et al. Effect of Medicare’s nonpayment for hospital-acquired conditions: lessons for future policy. JAMA Intern Med 2015;175:347354.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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Appendix 1-2

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