Study shows hospitals misreport HAIs to avoid penalties

Hospitals may be guilty of upcoding to avoid penalties for high rates of hospital-acquired infections, according to a study from the Stanford Graduate School of Business.

The study, led by Mohsen Bayati, suggests providers are misreporting HAIs as present-on-admission infections in claims data, a practice that could increase reimbursement or help avoid financial penalties for high HAI rates.

The study's authors looked at states that require strict reporting of HAIs with data from states that have weak reporting requirements. They found hospitals in weakly regulated states reported substantially lower rates of HAIs as well as higher rates of POA infections.

Overall, the researchers estimate there are more than 10,000 upcoded infections annually, resulting in an added costs of $200 million.

Furthermore, the authors said their findings suggest increasing financial penalties alone may not reduce HAI incidence and may even exacerbate the problem.

"Medicare's current plan to increase penalties through the HAC [hospital-acquired conditions] Reduction Program does not address these concerns, and may in fact exacerbate the problem since hospitals with high HAC rates will face even greater financial pressure to engage in upcoding," the researchers wrote.

Researchers made several policy recommendations based on their results, including a new measure for targeted HAI auditing and suggestions for effective adverse event reporting systems.




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