Financial Impact of Improved Pressure Ulcer Staging in the Acute Hospital with Use of a New Tool, the NE1 Wound Assessment Tool Daniel L. Young, PT, DPT; Jay J. Shen, PhD; Nancy Estocado, PT, BS, CWS; and Merrill R. Landers, PT, DPT, OCS INTRODUCTION Despite ongoing efforts to reduce the occurrence of pressure ulcers (PrUs) in acute care hospitals, the problem persists. In acute care hospitals, the average prevalence is more than 10% but may be as high as 38% in some cases. 1–3 Current data suggest that new PrU cases per year are in the range of 1 to 2.5 million people. 1,4,5 PrUs are not only a significant health issue for the individual sufferer, but also a financial concern for the entire healthcare system. In the United States, annual costs associated with PrUs approach $11 billion, with the cost for each PrU ranging from $500 to $70,000, depending on the individual circumstances. 3,4 Because PrUs are often a prevent- able condition, this represents a tremendous burden to indi- viduals, hospitals, and the nation. As the majority of patients with PrUs are older than 65 years in the United States, Medicare has become the largest payer for the care of individuals with a PrU. 1 Medicare has recently made changes to its reimbursement policy for PrUs to incentivize good care. In the acute care hospital, it provides an additional payment, called a Medicare Severity – Diagnosis Related Group (MS-DRG), for the care of more severe PrUs that are present on admission (POA). However, the MS-DRG is not available if the PrU was a hospital-acquired condition (HAC). 6 Thus, it has become financially important for hospitals to correctly identify and define PrUs on admission and then prevent the development of PrUs during the patients’ stay. Correct identification of PrU severity involves assignment of one of the stages defined by the National Pressure Ulcer Advisory Panel (NPUAP). 7 The NPUAP has defined 4 separate stages of PrU depending on the severity. To summarize, Stage I presents as nonblanchable skin redness; Stage II is partial- thickness loss of the dermis; Stage III is full-thickness skin loss without exposure of bone, tendon, or muscle; and Stage IV is ADVANCES IN SKIN & WOUND CARE & VOL. 25 NO. 4 158 WWW.WOUNDCAREJOURNAL.COM ORIGINAL INVESTIGATION Daniel L. Young, PT, DPT, is Assistant Professor, Department of Physical Therapy, School of Allied Health Sciences, and Jay J. Shen, PhD, is Associate Professor, Department of Health Care Administration and Policy, School of Community Health Sciences, both at the University of Nevada, Las Vegas. Nancy Estocado, PT, BS, CWS, is Program Supervisor/Rehab Therapy, Sunrise Hospital and Medical Center, Las Vegas, Nevada. Merrill R. Landers, PT, DPT, OCS, is Associate Professor, Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas. Dr Young has disclosed that he is/was a consultant/advisor to Medline Industries, Inc. Dr Shen has disclosed that he has no financial relationships related to this article. Ms Estocado is the owner of NE Solutionz, LLC, and the NE1 Assessment Tool. Dr Landers has disclosed that he has no financial relationships related to this article. ABSTRACT OBJECTIVE: The NE1 Wound Assessment Tool (NE1 WAT; Medline Industries, Inc, Mundelein, Illinois), previously called the N.E. One Can Stage, was shown to significantly improve accuracy of pressure ulcer (PrU) staging. Improved PrU staging has many potential benefits, including improved care for the patient and better reimbursement. Medicare has incentivized good care and accurate identification of PrUs in the acute care hospital through an additional payment, the Medicare Severity–Diagnosis Related Group (MS-DRG). This article examines the financial impact of NE1 WAT use on the acute care hospital relative to MS-DRG reimbursement. DESIGN: PrU staging accuracy with and without use of the NE1 WAT from previous data was compared with acute care hospital PrU rates obtained from the 2006 National Inpatient Sample. Hill-Rom International Pressure Ulcer Prevalence Survey data were used to estimate the number of MS-DRG–eligible PrUs. MAIN RESULTS: There are between 390,000 and 130,000 MS-DRG – eligible PrUs annually. Given current PrU staging accuracy, approximately $209 million in MS-DRG money is being collected. With the improved staging afforded by the NE1 WAT, this figure is approximately $763.9 million. Subtracting the 2 reveals $554.9 million in additional reimbursement that could be generated by using the NE1 WAT. CONCLUSION: There is a tremendous financial incentive to improve PrU staging. The NE1 WAT has been shown to improve PrU staging accuracy significantly. This improvement has the potential to improve the financial health of acute care hospitals caring for patients with PrUs. KEYWORDS: pressure ulcer staging, wound assessment tool, reducing pressure ulcers ADV SKIN WOUND CARE 2012;25:158 – 66 Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.