UTI payment study reveals big holes in datasets used for performance measures

A University of Michigan study shows that Medicare’s 2008 policy removing payment for catheter-based urinary tract infections (CAUTI) has had little impact on hospital pay. But the study has triggered a cascade of questions concerning how datasets are used as performance measures.

At first glance, the statewide study conducted by University of Michigan Health System (U-M) seems to indicate that Medicare’s removal of payment for CAUTIs resulted in savings for only 0.003 percent of adult hospital stays in 2009. But the statistics, taken from billing data, don’t represent the whole picture.

The glitch, researchers say, is that although the billing codesets are different for UTIs and CAUTIs, physicians often document the infections as simple UTIs. So, if policy-makers examine hospital data specifically for rates of CAUTIs, the billing codes won’t be a true reflection of CAUTI rates vs. other types of UTIs.

The findings have raised questions over the reliability of datasets to evaluate performance, since the study reveals how faulty dataset documentation and parameter selection can produce skewed results when used to analyze specific subsets of conditions. The study has surfaced just as anxiety is growing over hospital penalties for excessive readmissions, which are scheduled to begin October 1. 

As hospitals are made increasingly accountable for high infection rates via penalties, the hospitals that report accurately could receive poorer performance scores than those who don’t make the distinction, the U-M authors warn.  

The U-M analysis was published in the September issue of Annals of Internal Medicine.

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