Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals

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Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals

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dc.contributor.author Calderwood, Michael Simmons
dc.contributor.author Kleinman, Kenneth Paul
dc.contributor.author Soumerai, Stephen Bertram
dc.contributor.author Jin, Robert
dc.contributor.author Gay, Charlene
dc.contributor.author Piatt, Richard
dc.contributor.author Kassler, William
dc.contributor.author Goldmann, Donald Alan
dc.contributor.author Jha, Ashish Kumar
dc.contributor.author Lee, Grace M.
dc.date.accessioned 2017-05-16T17:21:52Z
dc.date.issued 2014
dc.identifier.citation Calderwood, Michael S., Ken Kleinman, Stephen B. Soumerai, Robert Jin, Charlene Gay, Richard Piatt, William Kassler, Donald A. Goldmann, Ashish K. Jha, and Grace M. Lee. 2014. “Impact of Medicare’s Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals.” Infection Control & Hospital Epidemiology 35 (02) (February): 144–151. doi:10.1086/674861. en_US
dc.identifier.issn 0899-823X en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:32692606
dc.description.abstract The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery. To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data. We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006-September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007-September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates. We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23-0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74-0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN. The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation. en_US
dc.language.iso en_US en_US
dc.publisher Cambridge University Press (CUP) en_US
dc.relation.isversionof doi:10.1086/674861 en_US
dash.license LAA
dc.title Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal Infection Control & Hospital Epidemiology en_US
dash.depositing.author Soumerai, Stephen Bertram
dc.date.available 2017-05-16T17:21:52Z

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