PHOENIX — The proposed cessation of Medicare reimbursement for management of surgical site infections would have a deleterious impact on hospital finances and create institutional disincentives for surgery on the sicker, more complex patients at increased risk, Joshua A. Cohn said at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.
Last August, the Centers for Medicare and Medicaid Services proposed rule CMS-1488-P, which as of Oct. 1, 2008, would end reimbursement for the increased care associated with hospital-acquired infections CMS deems preventable. It is clear that CMS considers all surgical site infections (SSIs) as falling within this “preventable” category, said Mr. Cohn, a medical student at the University of Michigan, Ann Arbor.
Mr. Cohn and coworkers analysed data from the National Surgical Quality Improvement Program on a randomly selected population of 5,409 patients who underwent surgery during 2003–2006 within the University of Michigan Health System.
The 320 patients who developed SSIs had significantly higher preoperative rates of sepsis, chronic obstructive pulmonary disease, and numerous other comorbid conditions, along with increased postoperative complications.
In a multivariate linear regression analysis controlling for the significant pre- and postoperative factors related to SSIs, the occurrence of an SSI was independently associated with an $8,304 increased cost to insurers.
As a result of this payment, the medical center made a profit of $2,738 per patient with an SSI. Had CMS-1488-P been in effect at the time of the study, however, the hospital instead would have lost an average of $5,566 per patient.