Additional software (3M Coding and Reimbursement System) was also used to assist coders in assigning the proper billing codes. Billing codes and POA designations were based on documentation in the medical record of the diagnosis of central line–associated infection and the presence of infection at hospital admission. Trained coding personnel used CMS Official Coding Guidelines to assign billing codes. A case identified by the 2008 CMS rule criteria was defined by ICD-9 Clinical Modification code 999.31 and a POA variable of “no” and will hereafter be referred to as HAC. Results of these 2 queries were then linked to match cases of ICD-9 code 999.31 with their POA variable. A separate query of the hospital billing data in the Enterprise Data Repository was completed to collect the POA variable. This data repository was queried for all hospital encounter-based cases with International Classification of Diseases, Ninth Revision ( ICD-9) code 999.31 (“infection due to central venous catheter”) at the 3 hospitals. Billing codes were accessed via the Duke University Healthcare System Enterprise Data Repository. Three separate electronic databases were used to identify cases. We hypothesized that the 2 case-finding methods would frequently disagree.Ĭase-Finding Methods and Study Definitions This retrospective study was designed to compare the concordance of criteria from the 2008 CMS rule that defined HAC with traditional IC methods to identify cases of central line–related infections. 10įew studies have examined the use of billing codes to identify patients with CLABSI since the 2008 CMS rule. However, policy-makers and researchers agree that, although absolute perfection is not achievable, there is a lower threshold of validity below which stakeholders will not accept a measure as meaningful, which could stifle efforts to drive improvements in care. Traditional IC methods have been previously criticized for elements of subjectivity and are considered a proxy measure for the true, unknown incidence. 5– 9 At present, there is no measure of central line–related bloodstream infection that perfectly reflects clinical truth. Most authors who have studied this topic emphasize that billing data are inaccurate when compared with traditional surveillance methods. The validity of using billing data as the source for HAI surveillance has been questioned by authors of multiple studies. Infections designated as POA were eligible for additional reimbursement, whereas those acquired after admission were not. The CMS ruling required billing coders to determine whether infections were present on admission (POA) or acquired after admission. HAI cases targeted for reduced payment were identified using administrative billing code data derived from a billing coder’s interpretation of the clinician’s documentation of disease and timing of onset. The CMS final rule went into effect on October 1, 2008, and stipulated that hospitals would no longer receive additional reimbursement for 10 HACs, 3 of which were HAIs. The intent was to incentivize hospitals to develop successful programs to prevent HACs and decrease overall costs. The hospital-acquired condition (HAC) is a quality measure created by the Centers for Medicare and Medicaid Services (CMS) to reduce payments to hospitals for hospital-acquired complications of care. The collective desires to decrease HAI, save human lives, and save money have led to the development of external quality measures to use in exerting financial pressure on hospitals to encourage prevention practices.

For example, the Centers for Disease Control and Prevention (CDC) report that rates of central line–associated bloodstream infection (CLABSI) have decreased in US intensive care units (ICUs) by an estimated 58%, saving approximately 6,000 lives, from 2001 to 2009.

1 HAI prevention campaigns promoted by individuals, hospitals, professional societies, and government agencies have resulted in substantial successes. Most healthcare providers agree that many of the 1.7 million healthcare-associated infections (HAIs) that occur each year in the United States are preventable.

Hospital compare clabsi