The NPUAP serves as a resource to health care professionals, government, the public, and health care agencies.  The three mission committees of the NPUAP (Public Policy, Education, and Research) are active in a variety of endeavors including webinars, creation of a reference database, and a number of public policy initiatives.

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Proposed rule from CMS for Stage 2 Meaningful Use of Certified Electronic Health Records (EHR) Technology

The NPUAP Public Policy Committee would like to make the following comments on the proposed rule from CMS for Stage 2 Meaningful Use of Certified Electronic Health Records (HER) Technology. While we commend the inclusion of the current clinical quality measures proposed for eligible hospital and critical access hospitals (CAHs), we recommend the addition of quality measures of pressure ulcer risk and prevention.

The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research. NPUAP is an independent not-for-profit professional organization dedicated to the prevention and management of pressure ulcers. Formed in 1987, the NPUAP Board of Directors is composed of leading experts from different health care disciplines— all of whom share a commitment to the prevention and management of pressure ulcers. The NPUAP serves as a resource to health care professionals, government, the public and health care agencies, provides educational materials, conducts national conferences, and support of efforts in public policy, education and research.

NPUAP defines prevalence as “a proportion of persons who have a pressure ulcer at a specific point in time”.(1) It is estimated that the prevalence of pressure ulcers varies from 10% to 18% in acute care, 2.3% to 28% in long term care, and 0% to 29% in home care. Approximately 2.5 million patients are treated for pressure ulcers in U.S. acute care facilities each year and as many as 60,000 U.S. hospital patients die each year from pressure ulcer complications.(2) Development of a stage 3 or 4 pressure ulcer during a hospital stay is considered a Serious Reportable Event.(3)

Another serious concern is the increased incidence of pressure ulcers in hospitals. From 1993 to 2006, there was a 78.9% increase in the number of hospital stays during which pressure ulcers were noted. Stays with a secondary diagnosis of pressure ulcers increased by 86.4% during this period, while stays principally for pressure ulcers increased by 27.2%. Adult hospital stays noting a diagnosis of pressure ulcers totaled $11.0 billion in 2006.(4) Since Medicare was the most common payer of adult stays related to pressure ulcers, this represents a great financial burden on the US health care system.

The following initiatives and programs have listed pressure ulcer prevention and treatment as a priority concern:

• Partnership for Patients Areas of Focus(5)
• National Quality Forum’s Serious Reportable Events (SREs)(6)
• Joint Commission Pressure Ulcer Prevention Project(7)
• Center for Medicare and Medicaid serious Hospital Acquired Conditions(HACs)(8)
• Agency for Healthcare Research and Quality: Preventing Pressure Ulcers in Hospitals—A Toolkit for Improving Quality of Care(9)
• HL7 Patient Care Work Group Pressure Ulcer Standards for Assessment and Prevention(10)
• The 2010 National Patient Safety Goals (11) Goal 14: Prevent health-care associated pressure ulcers (decubitus ulcers)
• National Pressure Ulcer Advisory Council(12) Pressure Ulcer Stages
• Academy of Nutrition and Dietetics Evidence Analysis Library: Unintended Weight Loss (UWL) in Older Adults(13)

The Agency for Healthcare Research and Quality (AHRQ) and the National Quality Forum (NQF) have endorsed numerous quality measures relating to pressure ulcer prevention and treatment.(14,15)

Screening for pressure ulcer risk and appropriate intervention for treatment of pressure ulcers are important components in wound healing and maintenance of tissue integrity. It is important that the skin integrity and interventions are communicated as patients move across the continuum of care. Standardization of patient information exchange has the potential for improving patient safety and clinical outcomes

NPUAP recommends the addition of Clinical Quality Measures (CQM) for both prevention and treatment of pressure ulcers in the Stage 2 regulations under the domains of Patient Safety, Care Coordination, Efficient Use of Healthcare Resources and Clinical Process/Effectiveness.

NPUAP requests the following objectives:

1. Inclusion of interdisciplinary assessment and treatment goals for pressure ulcers as mandatory for both Eligible Professionals (EP) and Eligible Hospitals (EH).
2. The EP, EH or CAH that transitions a patient to another setting of care or provider of care or refers that patient to another provider of care should provide summary care records for each transition of care or referral.
3. EP: Provide clinical summaries for patients for each office visit.
4. Generate lists of patients who have documented pressure ulcers on admission to EH or CAH.
5. Documentation of appropriate stage of existing pressure ulcers, at admission and on discharge, using a formal wound classification guideline.
6. Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP or for the EH. Provide patients the ability to view online, download, and transmit information about a hospital admission.
7. Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
8. Document treatment plan of care for patients with existing pressure ulcers and those at high risk for developing pressure ulcers.
9. Document pressure ulcer risk assessment.

In summation, patient care suffers from incomplete, inaccessible and inconsistent use of pressure ulcer assessment and treatment plans. Inclusion of these as a component of the next iteration of EHRs will serve to improve patient care and communication among health care providers. This can also provide transparency and needed information for patients and caregivers once they are given access to the EHR. An additional benefit to the health system is an avenue to develop quality surveillance and initiatives. Thank you for the opportunity to offer comments on the CMS proposed regulations for Stage 2 Meaningful Use of Certified Electronic Health Records (EHR) Technology.

NPUAP Upcoming Webinar – Pressure Ulcer Documentation: Telling a Complete, Accurate and Legally Defensible Story

Stay tuned for more information for NPUAP’s Live webinar entitled Pressure Ulcer Documentation: Telling a Complete, Accurate and Legally Defensible Story presented by Dr. Joyce Black and Dr. Diane Langemo on July 19 at 2:00 PM EDT.

Save the Date for the 2013 NPUAP Biennial Conference

Please save the date for the National Pressure Ulcer Advisory Panel’s (NPUAP) 2013 Biennial Conference scheduled for February 22-23 (Fri-Sat), 2013, at The Woodlands Waterway Marriott in The Woodlands (Houston), Texas. Make plans now to attend this important pressure ulcer conference focused on DEEP TISSUE INJURY: The State of the Science. Stay tuned for more details and registration information in the next few months.

Dr. Barbara Braden’s Repositioning Webinar a Huge Success!

On April 12, 2012 more than 500 people tuned in to Dr. Barbara Braden’s webinar entitled Q 2 Hour Turning & 30 Degree Lateral Positioning – Science or Tradition?.  NPUAP was able to offer CEUs for this immensely popular webinar!  If you were unable to attend the webinar and would like to purchase the recording please click HERE to be redirected to our online store.

NPUAP announced the successful completion of its biannual meeting held in Tampa, Florida

Over 60 representatives from all facets of patient care and advocacy were represented. Participants were hopeful but guarded about the present healthcare environment. All were excited about recent accomplishments including new objective ways to test and compare specialty pressure redistribution mattresses, upcoming sponsored national and international meetings and successful outreach via webinars.

NPUAP congratulates CMS on putting consumers first

The NPUAP announced today that the recent decision by CMS to separate skin protective cushions from bundled competitive bidding is a victory for all Americans. NPUAP President Laurie McNichol, MSN, RN, GNP, CWOCN added, “We are pleased that the open forum process and opportunity for stakeholders to provide written commentary on a draft version of a CMS policy has driven change.” The comments received by CMS from NPUAP and others have resulted in policy makers at CMS realizing the importance of patient-focused care for Americans with disabilities and prompted revisions to the proposed policy.

Despite public concern about the fate of Medicare in the present political environment this announcement highlights that sound reasoning can prevail. CMS was responsive to the comments of the NPUAP and other professional organizations regarding the importance of customizable, pressure redistribution seat cushions for Americans requiring specialty care to prevent pressure ulcers and their devastating sequelae.


Winter 2011/2012 Newsletter

In this issue…

Page 2 QRG to be translated into Chinese
Page 4 NPUAP Educational Webinars
Page 4 NPUAP People on the Move
Page 5 Public Policy Update
Page 6 CAC Member Spotlight
Page 7 NPUAP Slide Sets

Please click HERE to view the Winter 2011/2012 newsletter.

Competitive Bidding for Seating and Group 2 Support Surfaces

Since forming in 1987, the National Pressure Ulcer Advisory Panel (NPUAP) has served as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research. After careful review and deliberation, the NPUAP Public Policy Committee recommends against including pressure redistribution surfaces (mattresses, mattress overlays and seat cushions) as part of the competitive bidding process at this time.

Pressure redistribution surfaces are the mainstay for the prevention of pressure ulcers in at risk individuals. Competitive bidding should reduce expenditures while insuring that beneficiaries have access to the goods and services that they need. To achieve this, products within a category must be similar in function. This requirement is not met in the current code classification structure for skin protection seating and group 2 support surfaces. As a result, we are concerned that bidding these products will reduce or eliminate beneficiaries’ access to the specific goods they need-in the end actually increasing health care costs associated with the treatment of pressure ulcers.

Last September, at a hearing of the Health Sub-committee of the House Energy and Commerce Committee concern regarding competitive bidding of adjustable skin protection seating was raised in both submitted statements and publicly during the hearing. The Independence through Enhancement of Medicare and Medicaid Coalition, a consumer-led coalition including the Paralyzed Veterans of America (PVA) and the Christopher and Dana Reeves Foundation, submitted a written statement specifically requesting that custom (adjustable) seating be exempted. In addition, Congressman Jim Langevin (Rhode Island), the first quadriplegic to serve in the US House of Representatives, has stressed the importance of a “properly fitted, adjustable skin protection seat cushion” to permanent wheelchair users and the risks to beneficiaries’ health and health care expenditures, should these individuals not continue to have access to items which meet their needs.

In 2009 (most recent available data) skin protection seat cushions cost Medicare and Medicare beneficiaries less than $400. Medicare’s total allowed charges for these products was approximately $6 million and Group 2 support surfaces cost $91 million. The total U.S. expenditure for wound care treatment is estimated at $11 billion annually; one wound can cost over $40,000 to heal.

CMS included skin protection cushions and Group 2 support surfaces in round one of competitive bidding. Since many individuals at high risk for skin breakdown already have pressure redistribution surfaces, the negative impact of this decision may not be apparent for some time. Sufficient time should be allowed to obtain adequate data and assess the effect on patient outcomes before expanding this program. We request that you contact Health and Human Services Secretary Sebelius to recommend that skin protection wheelchair seating and group 2 support surfaces be excluded from the second round of DMEPOS Competitive Bidding Program.

Spring 2011 Newsletter

In this issue…

Page 4 Biennial Conference “Best Posters”
Page 6 New NPUAP Directors
Page 7 New NPUAP Slide Sets Now Available
Page 8 NPUAP-Sentara Joint Conference

Please click HERE to view the April 2011 newsletter.

Winter 2011 Newsletter

In this issue…

Page 2 NPUAP Committee Reports
Page 3 Profile of WCET
Page 4 12th NPUAP Biennial Conference

Please click HERE to view the Winter 2011 newsletter.