Legal Issues in the Care of Pressure Ulcer Patients - Medline

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sttttttttttttsWhy Do We Care?Pressure ulcers are a significant problem across allhealthcare settings in the United States. Annually, 2.5million patients are treated in acute-care facilities forpressure ulcers. Patients with pressure ulcers are threetimes more likely to be discharged to a long-term carefacility than those with other diagnoses. In addition,pressure ulcers are more likely to occur among thoseover age 65. 1 Since the U.S. population aged 65 andolder is expected to double within the next 25 years, 2the number of people with pressure ulcers probably willincrease exponentially. By 2030, almost one out ofevery five Americans – some 72 million people – willbe 65 years or older. The age group 85 and older is nowthe fastest growing segment of the U.S. population. 2Medicare has looked at opportunities to grow betterquality health care for the 90 million elderly, disabledand low-income Americans who use their programs.Faced with the financial situation that the Part Atrust fund is projected to potentially be depleted by2017, the challenge has been to improve quality forthose beneficiaries while avoiding unnecessary costs.This has resulted in review of Medicare paymentsand new coverage decisions. 3 In FY2007 alone, therewere 257,412 Medicare beneficiaries with pressureulcers, for which the average DRG payment per casewas $43,180. 4 The net cost of caring for pressureulcers is estimated at $11 billion per annum. 5 WithMedicare expenditures projected at $486 billion in2009, increased attention to pressure ulcers andthe impact they place on the healthcare system hasnecessitated changes in healthcare policy. 6As one of the largest purchasers of health care,Medicare desires quality for its beneficiaries.Several projects aimed at improving quality have beenrolled out over the past several years. Long-term carewas the first setting to have substantial regulationsregarding pressure ulcers. With the revision in 2004of guidance for surveyors – Tag F-314 – came renewedinterest in pressure ulcer prevention and treatment.In 2005, pressure ulcers became reportable in acutecare in certain states. With this increase in awareness,specific pressure ulcer collaboratives began tospring up as providers joined together to improve thepressure ulcer incidence within their locales. 7,8Transforming Medicare from a passive payer to anactive purchaser of higher quality, more efficienthealth care meant that the government needed tobuild policies that would support greater valuefor the costs associated with quality outcomes. Tofurther support Value-Based Purchasing, one of thedemonstration projects is the electronic health record(EHR), while another initiative is Hospital-AcquiredConditions and Present on Admission indicators. 9There is universal agreement that we want qualitymedical care. The challenge of delivering quality careto our aging population, some of whom have multiplecomorbid conditions, is highly complex. The FederalRegister states that pressure ulcers can “reasonably beprevented through the application of evidence-basedguidelines.” 10 While “reasonably preventable” does notmean “always preventable,” the potentially significantimplications of the statement “reasonably preventable”have been neither fully appreciated nor firmlyestablished. There remains a lot of legal uncertaintyabout the true impact of this new Federal Registerstatement in the medical liability context. Healthcareworkers and institutions are fearful of the increasedrisk of litigation, and fear for the financial viability oftheir organizations and their reputations as publicreporting becomes the norm. The monetary lossesresulting from litigation may be secondary to theloss of reputation and public scrutiny in the press,which can devastate staff morale and turn clientsaway at the door.sttttttttttttsLitigation—A legal action, also known as a lawsuit, brought by one party against another. It may be resolved in or out of court.Legal Issues in the Care of Pressure Ulcers: Key Concepts for Healthcare Providers2
sttttttttttttsFor all of these reasons, it is no exaggeration to statethat it is more important now than ever for healthcareproviders to fully understand, appreciate and adaptto the legal issues that arise from the care of patientswith pressure ulcers. The interrelationship betweenmedical decision-making, reimbursement and legalissues relating to pressure ulcers has never beengreater. The medical-legal landscape itself hasnever been more treacherous or subject to change. Thefinancial and personal risks from ignorance ormisunderstanding of these legal issues have neverbeen higher. Simply put, in today’s legal, regulatoryand medical environment, no healthcare practitionercan both provide quality care to patients withpressure ulcers and provide financial and legalsecurity to himself and his employees without fullknowledge and accurate understanding of the legalissues inherent in that undertaking.Lawsuits over pressure ulcers are increasinglycommon in both acute and long-term settingswith judgments as high as $312 million in asingle case. 11 Why is this? The readily apparentnature of pressure ulcers is important because itmeans that, unlike many other medical complications,they never go unnoticed by patients and theirfamilies. The uniquely disturbing visuals that pressureulcers create add to the financial potential of even themost medically meritless claims – and make even thefrivolous ones appear to have some financial worthto the plaintiffs’ attorneys. One basis for the implicityet incorrect assumption that pressure ulcers developexclusively from improper care is the fact that many,if not most lay people do not appropriately view theirskin as an organ. People understand and appreciate thatindividuals, particularly the elderly, can suffer fromheart failure or kidney failure without there having beenany medical negligence. “Skin failure” is not looked uponwith the same degree of understanding. Implicit is theincorrect assumption that the development of pressureulcers must have resulted from the lack of quality care.Individuals and institutions can become targetsbecause of factors unrelated to the quality of patientcare. A lawsuit is a revenue-generating device for theplaintiff’s lawyer. While patients may perceive thatthey engage in litigation to pursue justice or obtainanswers, attorneys take cases based on contingency,and it is an economic necessity that they generaterevenue. The patient or patient’s family member maycontinue to think it is simply a search for justicethroughout the process of litigation. However, theadditional important point is that once the plaintiff’sattorney is involved, he or she controls the directionof the litigation.AttorneyWhat you see is dependenton your perspective…POLICY MAKERFAMILYPAYERPATIENTCAREGIVERSHEALTHCAREPROVIDERHEALTHCAREORGANIZATIONsttttttttttttsLegal Issues in the Care of Pressure Ulcers: Key Concepts for Healthcare Providers3
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Legal Issues in the Care of Pressure Ulcer Patients - Medline

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