Legal Issues in the Care of Pressure Ulcer Patients - Medline

sttttttttttttsWhy Do We Care?Pressure ulcers are a significant problem across allhealthcare settings in the United States. Annually, 2.5million patients are treated in acute-care facilities forpressure ulcers. Patients with pressure ulcers are threetimes more likely to be discharged to a long-term carefacility than those with other diagnoses. In addition,pressure ulcers are more likely to occur among thoseover age 65. 1 Since the U.S. population aged 65 andolder is expected to double within the next 25 years, 2the number of people with pressure ulcers probably willincrease exponentially. By 2030, almost one out ofevery five Americans – some 72 million people – willbe 65 years or older. The age group 85 and older is nowthe fastest growing segment of the U.S. population. 2Medicare has looked at opportunities to grow betterquality health care for the 90 million elderly, disabledand low-income Americans who use their programs.Faced with the financial situation that the Part Atrust fund is projected to potentially be depleted by2017, the challenge has been to improve quality forthose beneficiaries while avoiding unnecessary costs.This has resulted in review of Medicare paymentsand new coverage decisions. 3 In FY2007 alone, therewere 257,412 Medicare beneficiaries with pressureulcers, for which the average DRG payment per casewas $43,180. 4 The net cost of caring for pressureulcers is estimated at $11 billion per annum. 5 WithMedicare expenditures projected at $486 billion in2009, increased attention to pressure ulcers andthe impact they place on the healthcare system hasnecessitated changes in healthcare policy. 6As one of the largest purchasers of health care,Medicare desires quality for its beneficiaries.Several projects aimed at improving quality have beenrolled out over the past several years. Long-term carewas the first setting to have substantial regulationsregarding pressure ulcers. With the revision in 2004of guidance for surveyors – Tag F-314 – came renewedinterest in pressure ulcer prevention and treatment.In 2005, pressure ulcers became reportable in acutecare in certain states. With this increase in awareness,specific pressure ulcer collaboratives began tospring up as providers joined together to improve thepressure ulcer incidence within their locales. 7,8Transforming Medicare from a passive payer to anactive purchaser of higher quality, more efficienthealth care meant that the government needed tobuild policies that would support greater valuefor the costs associated with quality outcomes. Tofurther support Value-Based Purchasing, one of thedemonstration projects is the electronic health record(EHR), while another initiative is Hospital-AcquiredConditions and Present on Admission indicators. 9There is universal agreement that we want qualitymedical care. The challenge of delivering quality careto our aging population, some of whom have multiplecomorbid conditions, is highly complex. The FederalRegister states that pressure ulcers can “reasonably beprevented through the application of evidence-basedguidelines.” 10 While “reasonably preventable” does notmean “always preventable,” the potentially significantimplications of the statement “reasonably preventable”have been neither fully appreciated nor firmlyestablished. There remains a lot of legal uncertaintyabout the true impact of this new Federal Registerstatement in the medical liability context. Healthcareworkers and institutions are fearful of the increasedrisk of litigation, and fear for the financial viability oftheir organizations and their reputations as publicreporting becomes the norm. The monetary lossesresulting from litigation may be secondary to theloss of reputation and public scrutiny in the press,which can devastate staff morale and turn clientsaway at the door.sttttttttttttsLitigation—A legal action, also known as a lawsuit, brought by one party against another. It may be resolved in or out of court.Legal Issues in the Care of Pressure Ulcers: Key Concepts for Healthcare Providers2