Does nonpayment for UTIs unfairly punish hospitals?
Hospital are preparing for Oct. 1, 2008 when Medicare will no longer pay for specific hospital acquired conditions (HACs). However, a recent article in the Journal of the American Medical Association (JAMA) questions the fairness of Medicare not paying for all urinary tract infections (UTIs) that are acquired during a hospital stay. (“Nonpayment for Harms Resulting from Medical Care,” published in a December issue of JAMA (2007;298(23):2782-2784, Heidi L. Wald, MD, MSPH; Andrew M. Kramer, MD)
According to the article, indwelling urinary catheters are used by hospitals more than almost any other medical device. As a result, these devices account for 80 percent of nosocomial UTIs, 40 percent of all nosocomial infections, and cost the health care system more than $400 million annually. In fact, UTIs in patients having indwelling catheters for more than four days are generally considered unavoidable due to bacterial colonization over time.
The article raises the question of how are hospitals expected to handle not getting paid for treating conditions that are sometimes unavoidable? While clinician education is important to reduce preventable UTIs, the facts prove that there are instances when UTIs are unavoidable. Proactively testing patients for UTIs on admission will raise costs, as will the proactive treatment of UTIs with antibiotics on catheterized patients that are not yet showing symptoms. One option that the article considers is for CMS to adopt an exclusion to the rule for patients who require intermediate- or long-term catheters as part of their care.
Access the article here.
Posted: 2/12/2008
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