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Claims Data Lacks Accuracy And Consistency Needed To Inform Nonpayment Or Hospital Comparisons

The Centers for Medicare & Medicaid Services (CMS) limits payment for key “preventable” complicating conditions acquired during hospital stay. The is used to deny payment, and the data is reported publicly so that hospitals can be compared by complication rate.

Catheter-associated () was the first condition targeted for such . Researchers examined data from 96 Michigan hospitals to compare rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often of lowers .

The researchers found that only 2.6 percent of all hospital-acquired UTIs were described in the claims data as catheter-related, making financial savings based on nonpayment negligible. Further, epidemiologic studies report that most hospital-acquired UTIs are catheter-associated (59 – 86 percent), which makes the accuracy of the claims data suspect.

The researchers and the author of an accompanying editorial conclude that current hospital claims data may not be an accurate source for measures used to compare institutions and guide financial incentives.

According to the editorialist, consistent use of electronic health records, sharing best practices, and focusing on patient-centered care and safety can improve the accuracy of the data hospitals are reporting.


Annals of Internal Medicine Sept. 4, 2012

American College of Physicians