The High Cost of HAPIs

The average-sized hospital will lose $10.4 mil plus litigation ...

"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." (1)

Healthcare Financial Management Assoc., Why investing in hospital-acquired pressure injury prevention technology makes financial sense, Feb 2021, Nickolas A. Vitale, LFACHE, David A. Dzioba

The human cost is immense. But the impact on the bottom line is also frustrating CFOs.

Health-related complications associated with Pressure Injuries (PIs) are high, yet there have been no comprehensive assessments of PI costs, including both direct and indirect costs, on an individual hospital basis. Hospital leaders should evaluate the costs associated with HAPIs and examine the savings possible through HAPI-specific prevention efforts. In the U.S., 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 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. (2)

•   Nearly 80% of hospitals are hit with some form of penalty resulting from HAPIs. (3) Hospitals with higher readmission rates and hospital acquired conditions (HACs), commonly seen in HAPI patients, are penalized by various CMS Quality Care Programs. 
  

CMS (Centers for Medicare and Medicaid Services) and most other commercial health plans consider HAPIs preventable and will not pay for incremental treatment costs for same.  

In a base case scenario, a medium-sized hospital would experience 644 HAPIs and 146 readmissions within 30 days due to HAPIs each year, with estimated costs totaling $10.4 million annually. 

Leaving all other variables constant, a 50% reduction in the HAPI rate would result in potential savings of over $5 million. 

The occupancy rate was fixed at 65% and the average initial PI incidence was set at 3.6%. (4)

At that level of reduction (322 HAPIs) is equivalent to preventing less than one HAPI per day on average. Even a small reduction in daily HAPI incidence can substantially impact a hospital’s costs, improve patient outcomes and reduce LOS for these patients, creating additional capacity for additional inpatient cases and revenue.

These hypothetical financial savings do not take into consideration the reduction of potential CMS penalties by the decreased HAPI rate. In addition, the impact of less institutional days and lost workdays would be dramatically impacted by addressing HAPIs.  

Footnotes

1. “By the Numbers: CHPSO Pressure Injury Data,” Aug. 4, 2017.

2. CMS Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates; payments for graduate medical education in certain emergency situations; changes to disclosure of physician ownership in hospitals and physician self-referral rules; updates to the long-term care prospective payment system; updates to certain IPPS-excluded hospitals; and collection of information regarding financial relationships between hospitals. Final rules. Federal Register, August 19, 2008, pp.48433-49084; and Brem, H., Maggi, J., Nierman, D., et al., “High cost of stage IV pressure ulcers,” American Journal of Surgery, Oct. 1, 2010.

3. Rau, J., “Medicare eases readmission penalties against safety-net hospitals,” Kaiser Health News, Sept. 26, 2018.

4. Bergquist-Beringer, S., Dong, L., He, J., Dunton, N., “Pressure ulcers and prevention among acute care hospitals in the United States,” Joint Commission Journal on Quality and Patient Safety, September 2013.