Using MedPAR data as a measure of urinary tract infection rates: implications for the Medicare inpatient DRG payment system.

A valuable metric of hospital performance is the rate of nosocomial infections, particularly urinary tract infections (UTIs). Current measurement techniques are expensive to administer and are not widely available. Determining a measurement index of nosocomial UTI incidence using Medicare Provider Analysis and Review (MedPAR) data to make recommendations may better align hospital payment with delivery of quality healthcare. There is significant variation among hospitals' calculated nosocomial UTI rates. In a sample hospital, the hospital received an estimated $675,000 in additional payments from Medicare due to payments for secondary nosocomial UTIs. The Comparative MedPAR Nosocomial UTI Index is a meaningful tool for determining nosocomial UTI rates as a measure of hospital quality. Additional improvements to the tool include incorporating risk factors based upon initial diagnosis, Major Diagnostic Category (MDC), and other diagnoses. Patients would benefit if the Centers for Medicare and Medicaid Services (CMS) discontinued the practice of paying hospitals for hospital-acquired infections, as this practice discourages adoption of infection-reducing initiatives.