Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes

doi:10.1059/0003-4819-150-12-200906160-00013

Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes

Sanjay Saint, MD, MPH;
Jennifer A. Meddings, MD, MSc;
David Calfee, MD, MS;
Christine P. Kowalski, MPH; and
Sarah L. Krein, PhD, RN

From the Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, and the Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan, and Mount Sinai School of Medicine, New York, New York.

Abstract

Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is 1 of the hospital-acquired complications chosen by the Centers for Medicare & Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help readers understand the potential consequences of the recent CMS rule changes, the authors examine the preventability of catheter-associated infection, review the CMS rule changes regarding catheter-associated urinary tract infection, offer an assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. Although the CMS rule changes related to catheter-associated urinary tract infection are controversial, they may do more good than harm, because hospitals are likely to redouble their efforts to prevent catheter-associated urinary tract infection, which may minimize unnecessary placement of indwelling catheters and facilitate prompt removal. However, even if forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection is commendable, these efforts will have opportunity costs and may have unintended consequences. Therefore, how hospitals and physicians respond to the CMS rule changes must be monitored closely.

Article and Author Information

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.
Grant Support: By the National Institute of Diabetes and Digestive and Kidney Diseases (R21-DK078717; Dr. Saint) and the National Institute of Nursing Research (R01-NR010700; Drs. Saint and Krein). Salary support for Dr. Saint was also provided through an Advanced Career Development Award from the Health Services Research & Development Program of the Department of Veterans Affairs.
Potential Financial Conflicts of Interest: Honoraria: S. Saint (VHA, Institute for Healthcare Improvement, CR Bard).
Requests for Single Reprints: Sanjay Saint, MD, MPH, Division of General Medicine, University of Michigan Health System, 300 North Ingalls, Room 7E08, Campus Box 0429, Ann Arbor, MI 48109-0429; e-mail, saint{at}med.umich.edu.
Current Author Addresses: Dr. Saint: Division of General Medicine, University of Michigan Health System, 300 North Ingalls, Room 7E08, Campus Box 0429, Ann Arbor, MI 48109-0429.
Dr. Meddings: 300 North Ingalls, Room 7D10, Campus Box 0429, Ann Arbor, MI 48109-0429.
Dr. Calfee: Mount Sinai School of Medicine, Department of Medicine, One Gustave L. Levy Place, New York, NY 10029.
Ms. Kowalski and Dr. Krein: Health Services Research and Development (11H), Ann Arbor Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.
Author Contributions: Conception and design: S. Saint, D. Calfee.
Analysis and interpretation of the data: S. Saint, J.A. Meddings, C.P. Kowalski, S.L. Krein.
Drafting of the article: S. Saint, J.A. Meddings, D. Calfee, C.P. Kowalski.
Critical revision of the article for important intellectual content: S. Saint, J.A. Meddings, C.P. Kowalski, S.L. Krein.
Final approval of the article: S. Saint, J.A. Meddings, D. Calfee, C.P. Kowalski, S.L. Krein.
Obtaining of funding: S. Saint, C.P. Kowalski, S.L. Krein.
Administrative, technical, or logistic support: C.P. Kowalski.
Collection and assembly of data: J.A. Meddings.