Two and a half million patients are treated each year for pressure ulcers, and Medicare research estimates that each pressure ulcer adds $43,180 in costs to a hospital stay1. The increased risk of infection, impairment to functional status and decreased quality of life associated with pressure ulcers does not just hurt the patient. It creates ripples into the population health domain as the burden of care shifts to post-acute caregivers, like skilled nursing facilities.
While hospital-acquired infections and other unintended harm capture the focus of healthcare executives and the public, oftentimes hospital-acquired pressure ulcers do not get the same attention. The subsequent burden on patients, families and communities is not as widely publicized, but that is changing.
Quality, regulatory and financial pressures make pressure ulcer prevention a value-based purchasing and population health priority. Quality leaders and pressure ulcer prevention advocates have an important voice at the table as acute care leaders identify strategies to deliver safe, efficient and cost-effective care. These experts offer senior leaders a high-impact opportunity to improve their organization’s quality cycle management efforts.
Here are four actions that care providers and pressure ulcer prevention advocates can take to draw attention to the dangers of hospital acquired-pressure ulcers and have a well-informed discussion with senior leaders:
Watch the clock. The first step is to understand the timelines and implications of CMS’s quality programs. Hospital-acquired pressure ulcer occurrences are additive toward your organization’s Patient Safety Indicator – 90 (PSI-90) calculation for both the Hospital Value Based Purchasing (HVBP) and Hospital-Acquired Conditions (HAC) penalties. It is important to be aware that the performance period for both of these measures in federal fiscal year 2016 concluded June 30, 2014, especially as you are evaluating the contribution of specific hospital-acquired pressure ulcer incidents toward your HVBP performance. For federal fiscal year 2017, CMS raises the stakes by putting up to two percent of Medicare reimbursement at risk.
Know your scores! With the fall 2016 release of the CMS HVBP and HAC penalties, these two programs place a combined three percent of an organization’s CMS reimbursement at risk. While the PSI-90 measure carries different weight in each program, it is important to recognize how quality improvement is critical to success here. Work with your organization’s analytical and financial teams to obtain your organization’s performance scores – and determine where your opportunities are.
Institute “Andon.” Compare your administratively coded cases to your clinical findings and reconcile documentation discrepancies before the acute care record is closed and “the bill is dropped.” This is the equivalent of an Andon System in Lean healthcare; in other words, “stop the line” to alert care providers, examine the patient record and correct documentation deficiencies prior to moving the record through to the next stage of the process.
Start the conversation. High-quality, cost-effective healthcare is a shared goal among clinical leaders, hospital operators and finance and materials management teams. Initiating a well-informed discussion with these stakeholders can open new doors to advance the quality agenda. As value-based care models, population health strategies and at-risk partnerships continue to flourish, hallmarks of care quality – such as hospital-acquired pressure ulcer rates – are an increasingly important bargaining tool and differentiator for healthcare organizations. Quality leaders and pressure ulcer experts can provide much-needed guidance to organization leaders as they work with payers and compete for market share.
If you are interested in learning more about pressure ulcers and how they can affect quality-driven reimbursement models, CLICK HERE.
1: Agency for Healthcare Research & Quality (2011). Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. AHRQ Publication No. 11-0053-EF, April 2011. Agency for Healthcare Research and Quality, Rockville, MD.
I’m a healthcare improvement professional who designs, implements and provides leadership oversight for solutions that improve the quality, efficiency and cost of healthcare. I have a diverse blend of clinical, operational and analytical experience that spans pre-hospital, acute, chronic and long term care. When I’m not working, you’ll find me riding/racing bicycles through the woods or spending time with my son camping, snowboarding or nagging him to do chores. Connect with me on Twitter or LinkedIn.