Abstract
The Partnership for Patients (PfP) and the Agency for Healthcare Research and Quality (AHRQ) have reported a 23.5% decline in hospital-acquired pressure ulcers (HAPU) over 4 years resulting in a cumulative cost savings of more than $10 billion and 49 000 averted deaths, claiming that this significant decline may have been spurred in part by Medicare payment incentives associated with severe (stage 3 or 4) HAPUs. Hospitals with a high rate of severe HAPUs have a payment penalty imposed, creating a financial disincentive to report severe HAPUs, possibly contributing to the magnitude of the reported decline. Despite the financial disincentive to report, the number of severe HAPUs found in claims data over the corresponding 4-year period did not decline but instead remained unchanged. The results from claims data, combined with some flaws in estimating HAPUs, call into question the validity of the decline in HAPUs reported by PfP and AHRQ.
Highlights
Keywords Partnership for Patients, quality measurement, pressure ulcers, hospital-acquired complications In September 2015, the Partnership for Patients (PfP),[1] a public-private initiative led by the Centers for Medicare & Medicaid Services (CMS) received $1.1 billion in Affordable Care Act funding to continue its work in reducing preventable hospital-acquired conditions and readmissions.[2]
The present on admission (POA) designation allowed for the identification of hospital-acquired complications, thereby enabling the implementation of 2 policies affecting the payment of hospital-acquired pressure ulcers (HAPU): POA, because they would be counted as a major complication or comorbidity and would increase Medicare Severity–Diagnosis Related Groups (MS-DRGs) payment
Beginning in fiscal year (FY) 2015, theAccountable Care Act of 2010 established the Hospital-Acquired Condition Reduction Program (HACRP) that requires that the 25% of hospitals with the poorest performance on hospital-acquired complications have their Medicare payments reduced by 1%
Summary
In September 2015, the Partnership for Patients (PfP),[1] a public-private initiative led by the Centers for Medicare & Medicaid Services (CMS) received $1.1 billion in Affordable Care Act funding to continue its work in reducing preventable hospital-acquired conditions and readmissions.[2]. The cumulative reduction in HAPUs across the 4-year time period was estimated to result in cost savings of more than $10 billion, and 49 000 averted deaths In support of these significant declines in a relatively short time period, PfP and AHRQ explained that, the precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. This effort has been spurred in part by Medicare payment incentives and catalyzed by the US Department of Health and Human Services Partnership for Patients (PfP) initiative.[3]. The Medicare payment incentives related to the reporting of pressure ulcers can be summarized as follows:
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