title: Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.
abstract: OBJECTIVE
  To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals.
  
  
  METHODS
  Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed.
  
  
  METHODS
  Nonfederal acute care California hospitals (N = 311).
  
  
  METHODS
  Adults discharged from acute-care hospitals.
  
  
  METHODS
  Pressure ulcer rates and hospital payment changes.
  
  
  RESULTS
  Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare.
  
  
  CONCLUSIONS
  The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meddings
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Heidi
authors.initials: H
authors.lastname: Reichert
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.|Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.|University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Laurence F
authors.initials: LF
authors.lastname: McMahon
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Kyle L
authors.initials: KL
authors.lastname: Grazier
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D006278:Medicare / Q000191:economics; D003668:Pressure Ulcer / Q000191:economics* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States
keywords: Medicare; hospital-acquired conditions; payment; pressure ulcer