1230. Does Nonpayment for Hospital-Acquired Catheter-Associated Urinary Tract Infections Lead to Over-Testing and Increased Antimicrobial Prescribing?
Session: Oral Abstract Session: Impact of National Policy on HAI Reporting and Prevention
Friday, October 19, 2012: 2:45 PM
Room: SDCC 32 AB
Background: On 1 October 2008, in an effort to stimulate catheter-associated urinary tract infection (CAUTI) prevention efforts, the Centers for Medicare & Medicaid Services (CMS) implemented a policy of not reimbursing hospitals for hospital-acquired CAUTI. Since any urinary tract infection present on admission would not fall under this initiative, concerns have been raised that it may encourage more testing for and treatment of asymptomatic bacteriuria.

Methods: We conducted a retrospective multicenter cohort study with time series analysis of all adults admitted to the hospital 16 months before and 16 months after policy implementation in participating Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals. Our outcomes were frequency of urine culture testing on admission and antimicrobial use.

Results: A total of 39 hospitals from 22 states submitted data on 2,362,742 admissions. In 35 hospitals affected by the CMS rule changes, the median frequency of urine culturing did not change after CMS policy implementation (19.2% pre-policy vs. 19.3% post-policy). The monthly frequency of urine culturing increased pre-policy (0.5% increase/month) and decreased post-policy (0.25% decrease/month, p<0.001). In the subset of 10 hospitals providing antimicrobial use data, the median frequency of fluoroquinolone antimicrobial use did not change substantially (14.6% to 14.0% post-policy). The monthly frequency of fluoroquinolone use increased pre-policy (1.26% increase/month) and decreased post-policy (0.60% decrease/month, p<0.001).

Conclusion: We found no evidence that CMS nonpayment policy resulted in over-testing to screen for and document a diagnosis of urinary tract infection as present on admission.

Daniel Morgan, MD, MS1, Jennifer Meddings, MD, MSc2, Sanjay Saint, MD, MPH3, Ebbing Lautenbach, MD, MPH, MScE4, Michelle Shardell, PhD5, Deverick J. Anderson, MD, MPH6, Aaron M. Milstone, MD, MHS7, Marci Drees, MD, MS8, Lisa Pineles, MA5, Nasia Safdar, MD, PhD9, Jason E. Bowling, MD10, David K. Henderson, MD11, Deborah Yokoe, MD, MPH, FSHEA12, Anthony Harris, MD, MPH5 and SHEA Research Network13, (1)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (2)University of Michigan, Ann Arbor, MI, (3)The University of Michigan Health System, Ann Arbor, MI, (4)Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, (5)Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, (6)Duke University Medical Center, Durham, NC, (7)The Johns Hopkins Medical Institution, Baltimore, MD, (8)Christiana Care Health System, Newark, DE, (9)Section of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, (10)University of Texas Health Science Center at San Antonio, San Antonio, TX, (11)National Institutes of Health Clinical Center, NIH, Bethesda, MD, (12)Brigham and Women's Hospital, Boston, MA, (13)SHEA, Arlington, VA


D. Morgan, None

J. Meddings, AHRQ: Grant Investigator, Research grant
BCBSFM: Grant Investigator, Research grant
SHEA: Speaker's reimbursement for this 2012 MTC session on CAUTI prevention, also have received honoraria from SHEA for On-The-CUSP project role as National Core Faculty.
RAND: honoraria for preparation of AHRQ CAUTI prevention chapter, Honoraria for preparation of AHRQ CAUTI prevention chapter

S. Saint, None

E. Lautenbach, None

M. Shardell, None

D. J. Anderson, Merck, Inc.: Grant Investigator and Speaker's Bureau, Grant recipient and Speaker honorarium
UpToDate Online: Author, Licensing agreement or royalty
Robert Wood Johnson Foundation: Grant Investigator, Grant recipient

A. M. Milstone, None

M. Drees, None

L. Pineles, None

N. Safdar, None

J. E. Bowling, None

D. K. Henderson, None

D. Yokoe, None

A. Harris, None

S. Research Network, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.