{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:59:20Z","timestamp":1762196360036,"version":"build-2065373602"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,7,3]],"date-time":"2015-07-03T00:00:00Z","timestamp":1435881600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","award":["1R01HS018334","1K08HS019767"],"award-info":[{"award-number":["1R01HS018334","1K08HS019767"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the financial effect of the 2008 Hospital\u2010Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective before\u2010and\u2010after study of all\u2010payer statewide administrative data for more than 2.4\u00a0million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nonfederal acute care California hospitals (N\u00a0=\u00a0311).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults discharged from acute\u2010care hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Pressure ulcer rates and hospital payment changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hospital\u2010acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present\u2010on\u2010admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital\u2010acquired Stage\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      hospital\u2010acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital\u2010Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present\u2010on\u2010admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present\u2010on\u2010admission pressure ulcers other than Stages\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      . The removal of payment for hospital\u2010acquired Stage\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      ulcers by implementation of the\n                      <jats:styled-content style=\"fixed-case\">HACI<\/jats:styled-content>\n                      policy was 1\/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital\u2010Acquired Conditions Initiative.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.13475","type":"journal-article","created":{"date-parts":[[2015,7,3]],"date-time":"2015-07-03T14:14:53Z","timestamp":1435932893000},"page":"1407-1412","source":"Crossref","is-referenced-by-count":28,"title":["Under Pressure: Financial Effect of the Hospital\u2010Acquired Conditions Initiative\u2013A Statewide Analysis of Pressure Ulcer Development and Payment"],"prefix":"10.1111","volume":"63","author":[{"given":"Jennifer","family":"Meddings","sequence":"first","affiliation":[{"name":"Division of General Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Reichert","sequence":"additional","affiliation":[{"name":"Division of General Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary A. M.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of General Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy P.","family":"Hofer","sequence":"additional","affiliation":[{"name":"Division of General Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan"},{"name":"Veterans Affairs Ann Arbor Healthcare System Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Laurence F.","family":"McMahon","sequence":"additional","affiliation":[{"name":"Division of General Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan"},{"name":"University of Michigan School of Public Health Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle L.","family":"Grazier","sequence":"additional","affiliation":[{"name":"University of Michigan School of Public Health Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,3]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"National Pressure Ulcer Advisory Panel.NPUAP Pressure Ulcer Stages\/Categories[on\u2010line]. Available athttp:\/\/www.npuap.org\/resources\/educational-and-clinical-resources\/npuap-pressure-ulcer-stagescategories\/Accessed October 21 2014."},{"key":"e_1_2_7_3_1","first-page":"263","article-title":"Hospital\u2010acquired pressure ulcers: A comparison of costs in medical vs. surgical patients","volume":"17","author":"Beckrich K","year":"1999","journal-title":"Nurs Econ"},{"volume-title":"Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care (AHRQ Publication No. 11\u20130053\u2010EF)","key":"e_1_2_7_4_1"},{"key":"e_1_2_7_5_1","first-page":"16","article-title":"Pressure ulcer pain: A systematic literature review and National Pressure Ulcer Advisory Panel white paper","volume":"55","author":"Pieper B","year":"2009","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.12.1549"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2009.12.021"},{"key":"e_1_2_7_8_1","first-page":"24","article-title":"Pressure ulcers: Avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference","volume":"57","author":"Black J","year":"2011","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_7_9_1","unstructured":"The Patient Protection and Affordable Care Act Section\u00a03008: Payment adjustment for conditions acquired in hospitals. Pub L No. 111\u2013148 124 Stat 122 [on\u2010line]. Available athttp:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-111publ148\/html\/PLAW-111publ148.htmAccessed October 21 2014."},{"key":"e_1_2_7_10_1","unstructured":"U.S. Department of Health & Human Services and the Centers for Medicare & Medicaid Services Hospital\u2010Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals.Prepared by the Medicare Learning Network Official CMS information for Medicare fee\u2010for\u2010service providers[on\u2010line]. 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Available athttp:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/HospitalAcqCond\/Hospital-Acquired_Conditions.htmlAccessed October 21 2014."},{"key":"e_1_2_7_12_1","first-page":"48434","article-title":"Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates","volume":"73","author":"Centers for Medicare and Medicaid Services","year":"2008","journal-title":"Fed Regist"},{"key":"e_1_2_7_13_1","first-page":"32816","article-title":"Payment adjustment for provider\u2010preventable conditions including health care\u2010acquired conditions","volume":"76","author":"Medicaid Program","year":"2011","journal-title":"Fed Regist"},{"key":"e_1_2_7_14_1","first-page":"23547","article-title":"Medicare program; proposed changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates","volume":"73","author":"Centers for Medicare and Medicaid Services, Department of Health and Human Services","year":"2008","journal-title":"Fed Regist"},{"key":"e_1_2_7_15_1","unstructured":"Centers for Medicare and Medicaid Services.Fact sheet: incorporating selected National Quality Forum and Never Events into Medicare's list of hospital\u2010acquired conditions. Press release: April 14 2008[on\u2010line]. Available athttp:\/\/www.cms.gov\/Newsroom\/MediaReleaseDatabase\/Fact-sheets\/2008-Fact-sheets-items\/2008-04-142.htmlAccessed October 21 2014."},{"key":"e_1_2_7_16_1","unstructured":"Agency for Healthcare Research and Quality.Healthcare cost and utilization project overview and description of state inpatient databases[on\u2010line]. Available athttp:\/\/www.hcup-us.ahrq.gov\/sidoverview.jspAccessed March 3 2014."},{"key":"e_1_2_7_17_1","unstructured":"American Hospital Association.Data collection methods. Health Forum LLC; 2012 [on\u2010line]. Available athttp:\/\/www.ahadataviewer.com\/about\/dataAccessed October 21 2014."},{"volume-title":"Blue Cross and Blue Shield Announces System\u2010Wide Payment Policy for \u201cNever Events","year":"2010","key":"e_1_2_7_18_1"},{"key":"e_1_2_7_19_1","unstructured":"ICD\u20109\u2010CM Official Guidelines for Coding and Reporting. 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