COSTS ASSOCIATED WITH PRESSURE WOUNDS IN THE U.S. INPATIENT HOSPITAL POPULATION

Abstract

The 2008 Hospital-Acquired Conditions Initiative from CMS prohibited hospitals from receiving extra Medicare and/or Medicaid payments for hospital-acquired stage III and IV pressure ulcers and all stage I and II pressure ulcers. Previous research has estimated costs attributable to pressure ulcers with the use of multiple regression modeling, which may not adequately adjust for differences in health and disease status between patients who do and do not develop pressure ulcers. The purpose of this study was to employ propensity score matching (PSM) to estimate the incremental cost of pressure ulcers among a nationally representative inpatient population. All patients with a diagnosed pressure ulcer (N= 948,930) were identified from the 2012 National Inpatient Sample Database. Average unadjusted inpatient episode costs were $66,064 (± $967) and $35,844 (± $440) for patients with and without pressure ulcers, respectively. Using PSM, patients with pressure ulcers were matched to patients without pressure ulcers on sex, age, race/ethnicity, urban vs. rural residence, median income quartile of residential zip code, diagnosis of malnutrition, as well as the quantity of chronic conditions and diagnoses listed on the patient record. In the PSM-matched sample (N=1,896,450), the average total cost for patients with pressure ulcers was $66,779 (± $981) compared to $54,511 (± $552, p < .0001) for those without pressure ulcers, a difference of 22.5%. Health care systems that focus efforts on reducing the incidence and duration of pressure ulcers in their inpatient populations have the potential to realize significant savings, even among high-acuity patients.