Hospital-acquired pressure injuries (HAPIs) affect 2.5 million patients per year in the United States. With the cost of treating a single instance as high as $70,000, and because many payers, including Medicare and Medicaid, are not covering them, the business case for prevention is apparent.a HAPIs also are the second most common hospital lawsuit claim after wrongful death, claiming 60,000 patients each year, according to a study published by Ostomy/Wound Management.b Although the health-related complications associated with PIs are high, there have been no comprehensive assessments of PI costs, including both direct and indirect costs, on an individual hospital basis.
The Financial Case for Prioritizing Prevention
In the United States, PIs are scored by stage, and nearly half of all PIs can be categorized as late-stage (Stages 3, 4 or unstageable), according to the Ostomy/Wound Management study. Late-stage PIs take months or longer to heal and require additional resources to treat infectious complications. Some consequences that lead to additional cost include readmissions, increased lengths of stay (LOS) and clinical resources like antibiotics, diagnostic tests, procedures (e.g., debridement) and use of wound care disposables. In 2007, CMS estimated that each late-stage PI added $43,180 in costs to a hospital stay, while other estimates exceed $100,000.c
Hospitals also face financial burdens due to CMS regulations around HAPIs. They may receive no payment for incremental treatment costs of HAPIs, which CMS and many commercial health plans consider preventable. Hospitals with higher readmission rates and hospital acquired conditions (HACs), commonly seen in HAPI patients, are penalized by various CMS Quality Care Programs. Nearly 80% of hospitals receive some form of penalty.d
Modeling the cost of HAPIs
In order to fully address the risk of HAPIs, hospitals need to develop novel preventive solutions to augment current treatment approaches. To assess the cost effectiveness of any HAPI prevention or treatment protocol, an assessment of the financial impact of HAPIs on an individual hospital or hospital system is needed.
A model of the annual costs associated with HAPIs at the individual hospital level, using actual hospital characteristics, HAPI-related costs and outcome variables obtained from literature sources is evident in the exhibit below. Input variables included bed size, occupancy rate, high-risk beds, PI incidence and the incremental cost of late-stage HAPIs (See the exhibit for a complete list of model inputs used to calculate the figures below).