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Hospitals around the country were scrambling to put new programs in place to prevent pressure ulcers after the federal Centers for Medicare and Medicaid Services announced in May 2008 that starting in October, 2008, it will no longer reimburse hospitals for treating eight "reasonably preventable" conditions. Pressure ulcers are among the most prevalent, costly and dangerous on the list. Pressure ulcers slow down or stop the recovery process, make hospital stays longer, cause extreme pain and discomfort, become infected and debilitate patients. Hospital acquired pressure ulcers have also led to nearly 60,000 deaths annually . The program describes pressure ulcers as a "medical error." Medicare states that the new policy will give hospitals a strong incentive to screen patients who may be at risk. If hospitals can document that the skin ulcer was present at admission, it will pay for treatment.

Acute-care hospitals treat about 2.5 million pressure ulcers each year, and as many as 15% of hospitalized patients may have pressure ulcers at any one time, according to the Institute for Healthcare Improvement. That is too many for a preventable condition. Estimates for the costs of treating all pressure ulcers in the U.S. range up to $11 billion annually. That must include nursing homes where the care is not designed to be as intensive as in-hospital care. But, there really is no reason for Medicare (or anyone) to pay nursing homes to care for pressure ulcers which developed under their watch either.

What has happened since the announcement by Centers for Medicare and Medicaid Services? Have the number of pressure ulcers decreased? Have payments to hospitals for treating acquired pressure ulcers actually stopped? Why did this past week, two potential clients come in to see me about pressure ulcers family members obtained in hospitals? Why am I hearing nursing home risk managers telling me they should not be blamed for pressure ulcers which originated in a hospital? Of course, they fail to mention how much worse the pressure ulcer became under the nursing home care- or lack of care. Or tell me how the resident had become so dehydrated or malnourished that they had to be sent to the hospital where the pressure ulcer started. We have medical doctor experts who have been telling us for years that absent a medical unavoidable condition –like terminal cancer or an immunological imbalance- pressure ulcers are preventable with good care. Apparently, Medicare and Medicaid agree.

There is a great quote from Primary Care Geriatrics: A Case-Based Approach, Third Edition, Richard J. Ham and Philip D. Sloane, published by Mosby. Chapter 34, “Pressure Sores” by Henry M. Wieman at p. 432, “Pressure sores are graphic, ugly, smelly evidence of health care providers’ failure to take good enough care of the elderly.” Amen!! So let’s make sure our loved ones are getting the care they should- no more pressure sores! Let’s also keep a look out for Medicare’s report on how this program is working.

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