Using MedPAR data as a measure of urinary tract infection rates: implications for the Medicare inpatient DRG payment
1Partners, Inc., Rockville, Maryland, USA.
Abstract:
A valuable metric of hospital performance is the rate of nosocomial infections, particularly urinary tract infections (UTIs). Current measurement techniques are expensive to administer and are not widely available. Determining a measurement index of nosocomial UTI incidence using Medicare Provider Analysis and Review (MedPAR) data to make recommendations may better align hospital payment with delivery of quality healthcare. There is significant variation among hospitals' calculated nosocomial UTI rates. In a sample hospital, the hospital received an estimated $675,000 in additional payments from Medicare due to payments for secondary nosocomial UTIs. The Comparative MedPAR Nosocomial UTI Index is a meaningful tool for determining nosocomial UTI rates as a measure of hospital quality. Additional improvements to the tool include incorporating risk factors based upon initial diagnosis, Major Diagnostic Category (MDC), and other diagnoses. Patients would benefit if the Centers for Medicare and Medicaid Services (CMS) discontinued the practice of paying hospitals for hospital-acquired infections, as this practice discourages adoption of infection-reducing initiatives.
Insights
Measuring hospital-acquired urinary tract infections (UTIs) is crucial for quality assessment. A new index using Medicare data can identify variations in nosocomial UTI rates, potentially improving healthcare payments and patient outcomes.
Area of Science:
- Healthcare quality assessment
- Infection control
- Health services research
Background:
- Nosocomial infections, especially urinary tract infections (UTIs), are key indicators of hospital performance.
- Current UTI measurement methods are costly and not widely accessible.
- Medicare Provider Analysis and Review (MedPAR) data offers a potential resource for tracking nosocomial UTIs.
Purpose of the Study:
- To develop a measurement index for nosocomial UTI incidence using MedPAR data.
- To align hospital payments with healthcare quality by accurately assessing UTI rates.
- To provide recommendations for improving hospital quality metrics.
Main Methods:
- Utilizing Medicare Provider Analysis and Review (MedPAR) data to calculate nosocomial UTI rates.
- Developing the Comparative MedPAR Nosocomial UTI Index.
- Analyzing variations in calculated nosocomial UTI rates among hospitals.
Main Results:
- Significant variations exist in hospitals' calculated nosocomial UTI rates.
- A sample hospital received substantial additional Medicare payments for secondary nosocomial UTIs ($675,000).
- The Comparative MedPAR Nosocomial UTI Index demonstrates utility in measuring hospital quality via UTI rates.
Conclusions:
- The Comparative MedPAR Nosocomial UTI Index is a valuable tool for assessing hospital quality.
- Incorporating patient risk factors (diagnosis, MDC) can enhance the index.
- Discontinuing Medicare payments for hospital-acquired infections could incentivize infection reduction initiatives.
Related Concept Videos
01:25Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:30Urinary Tract Calculi III: Medical Management
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:17Urinary Tract Infection IV: Nursing Management