Stage III/IV pressure ulcers are serious wounds that are very expensive to treat, some cases costing upwards of $70,000. Not only have Centers for Medicare & Medicaid Services (CMS) refused to pay for the treatment of these events, private insurers have followed suit as well. Additionally, hospitals are prohibited from passing the costs on to the patients of their families.
Compounding the high costs, late stage Bed sores, pressure sores and decubitus ulcers occur relatively frequently. The National Pressure Ulcer Prevalence Survey showed that late stage bed sores, pressure sores, and decubitus ulcers occurred in approximately 0.65% of all patients in US acute care hospitals on average.
Are Bed Sores, Pressure Sores and Decubitus Ulcers 100% Preventable?
The source of the controversy is from the concept that some experts believe that not all bed sores, pressure sores, or decubitus ulcers are preventable, regardless of the usage of best practices and technology.
‘Avoidable Conditions’ Exclude Some Clinical Causes
In the long term care setting, CMS states, “a resident who enters the facility without pressure sores [must] not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable.”
According to CMS, “unavoidable” means: “the resident developed a bed sore, pressure sore or a pressure ulcer, even though the facility had evaluated the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of interventions; and revised the approaches as appropriate.”
Obviously, this seems to conflict with CMS’s policy regarding reimbursement of never event bed sore, pressure sores and decubitus ulcers. However it must be noted that this ruling is for long-term care facilities, and it may well be that CMS is holding acute care facilities to a higher standard of care.
Incidentally, should CMS decide to change its stance on bed sores, pressure sores and decubitus ulcers in acute care hospitals, there is a good chance it will place the burden of proof regarding the avoidability of a bed sore, pressure sore or a decubitus ulcer incident on the hospitals.
Regardless of the setting, experts agree that bed sores, pressure sores, and decubitus ulcer prevalence can be reduced significantly using best practices and technology. Also, although experts disagree on the topic of unavoidable pressure ulcers, most agree that they are very rare if they exist.
About the Author
Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.