Pressure ulcers in the trauma population: Are reimbursement penalties appropriate?

Abstract

Trauma patients possess a unique set of risk factors for tissue damage and subsequent pressure ulcer (PU) formation which may, in fact, occur before admission to the hospital. Discussion regarding the utility of pay-for-performance penalties with regard to PU formation in the trauma population should take these risks in consideration. On October 1, 2008, the Centers for Medicare and Medicaid Services enacted guidelines under which eight medical conditions, if not documented as Present on Arrival (POA), will no longer be calculated in the hospital reimbursement of additional care expenses. 1 These medical conditions are now considered "preventable complications," with PUs included as one of the eight items. However, traumatic injury often leaves patients physiologically compromised and subsequently subjected to external factors inherent in the progression of acute trauma support, both of which increase the risk for PU development. Because of these factors, a PU may have, in f! act, begun to develop before admission to the hospital and yet not be documented as POA.