Decisions to reimburse the use of a specific medical device / technology or a service are being based on data that shows benefit to the patient. Data is gathered through conducted clinical studies or on specific complications that are observed or reported in the literature.
Here is an example.


Catheter-related Infection


Infection Control/Universal Precautions:


The Guidelines for the Prevention of Intravascular Catheter-related Infections Center for Disease Control (CDC), the Agency for Healthcare Research and Quality (AHRQ), and the Institute for Healthcare Improvement's (IHI) Central Line Bundle Program have proposed a series of recommendations that, when applied collectively, and consistently decrease the incidence of CRBSI. Their findings also show that significant cost savings can be realized when these strategies are implemented. To incentivise healthcare institutions to incorporate these practices into their standards of care, CMS has adopted revised reimbursement for these preventable infections.


The following are the suggested practices of the Central Line Bundle utilized to decrease CRBSI.


  • Hand hygiene:
    Before inserting a line, practitioners must wash their hands well, following prescribed sterilization procedures. “A quick scrub won't do,” explains Dr. Thomas G. Rainey,  “We need the operating-room version.”(1)
  • Maximal barrier precautions:
    Caregivers must wear sterile gloves, gown, head cover and mask and the patient must be completely draped with a sterile sheet.  “A few dish-towel sized drapes around the site aren't enough,” says Rainey. “Two-foot catheters can easily pick up bacteria if they touch a non-sterile surface.”(1)  Setting up at least a four-foot by four-foot field is the best practice.
  • Chlorhexidine as antiseptic:
    Because bacteria are killed only in the drying process, chlorhexidine rather than iodine-based solutions must be used to disinfect the site. Because chlorhexidine with alcohol dries much faster, it reduces the likelihood that the catheter will be inserted before bacteria have died off.  Cleansing with a back and forth frictional scrub will penetrate the pores and skin crevices and provide maximum effectiveness.
  • Appropriate catheter site selection and post-placement care:
    Placement of the catheter must be carefully considered.  Though many physicians have a preferred site for central lines, placement should never be rote, says Rainey.  “Head movements can dislodge a line placed in the jugular, yet the femoral vein in the groin can be a pretty dirty area.”(1)   Physicians must weigh risks and benefits site by site, patient by patient, to figure out the safest location.  After the safest location is determined, use a sterile gown, mask, eye shield, gloves, head covering, per INS standards plus provide a mask for the patient or have him or her turn head to the side while placing the line.
  • Make use of maximum barriers for example full draping after the has beem skin prepared.
  • Utilize sharps containers to help prevent injuries




(1) Rainey, T.G., Putting safety on the line (central). April, 30, 2007.

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