The Centers for Medicare and Medicaid Services (CMS) implemented policy changes in 2008 to eliminate additional Medicare coverage of mediastinitis following coronary artery bypass graft (CABG) surgery. To evaluate the impact of this policy on mediastinitis rates, Grace Lee, MD, MPH and colleagues from the Harvard Pilgrim Health Care Institute, as well as researchers from other institutions, conducted a study using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data.
The team compared mediastinitis rates (adjusted for secular trends) before and after the policy. Billing rates were obtained from Medicare inpatient claims following over 600,000 CABG surgeries in more than 1200 hospitals in the United States. Prospective surveillance rates came from ~ 150 NHSN hospitals in 29 states performing close to 95,000 CABG procedures.
Results demonstrated an immediate decrease in coding for index admission mediastinitis when payment policy changes were implemented and a decreasing trend in coding for index admission mediastinitis in the post- versus pre-intervention period.
Interestingly, the new policy did not appear to affect infection rates as measured using NHSN data. The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection resulted in changes in coding for infections, but did not change actual infection rates during the initial 2 years following policy implementation.
Click this link to read the abstract in Infection Control and Hospital Epidemiology.