Pressure ulcers are usually expensive, painful and preventable. They are also one of the conditions for which the Centers for Medicare & Medicaid Services (CMS) will not reimburse, unless it is proven that the patient had the condition upon hospital admission.
This change will go into effect in October 2008, and affects reimbursement for urinary catheter infections, coronary artery bypass graft infections, and other illnesses and adverse events. Since pressure ulcers are common and expensive to treat, the reimbursement changes could have massive repercussions on hospital budgets.
Pressure ulcers are areas of localized damage to the skin and underlying tissue and are caused by pressure or friction,1 and are also known as pressure sores, bed sores and decubitus ulcers. Elderly and/or immobile patients are the most frequent victims, even though a wealth of mattresses, seat cushions and other products are available to prevent pressure ulcers. More so, there is widespread clinical knowledge about how to prevent these wounds, and yet they occur anyway.
In 2007, CMS reported 257,412 cases of preventable pressure ulcers as secondary diagnoses.1 The average cost for these cases was $43,180 per hospital stay.1 The incidence of new pressure ulcers in acute-care patients is around 7 percent, with wide variation among institutions, according to a consensus paper from the International Expert Wound Care advisory panel.