title: Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.
abstract: BACKGROUND
  In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008.
  
  
  METHODS
  In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days.
  
  
  RESULTS
  Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p < .001; 95% confidence interval: 8.39-8.56). Among HAPU cases were trends of more elderly patients, greater case-mix index, and more surgical cases. The analysis of covariance model identified CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates.
  
  
  CONCLUSIONS
  HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.
authors.affiliation: Section of Hospital Medicine, University of Chicago, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Padula
authors.forename: Mary Beth F
authors.initials: MB
authors.lastname: Makic
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.forename: Manish K
authors.initials: MK
authors.lastname: Mishra
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult