Pressure ulcers (also known as pressure injuries or bedsores) are localized areas of damage to the skin and underlying soft tissue, typically over a bony prominence. These injuries are a significant concern in healthcare settings because they often signal a lapse in patient care quality. Government agencies use “quality measures”—standardized metrics—to evaluate the performance, safety, and effectiveness of healthcare institutions. The time a pressure ulcer remains on an official quality measure timeline is generally far longer than the time it takes for the wound to heal clinically. This duration is determined by regulatory requirements, not by the biological healing process.
Understanding Pressure Ulcers in Quality Reporting
The inclusion of a pressure ulcer in an institution’s negative quality reporting depends on whether the injury was present upon the patient’s arrival. This distinction uses the Present on Admission (POA) indicator. If the ulcer is documented as “N” (Not Present on Admission), it is classified as facility-acquired, triggering accountability measures.
Only facility-acquired pressure ulcers categorized as Stage 3, Stage 4, or Unstageable count against a hospital’s performance metrics. These advanced-stage ulcers are included in federal oversight initiatives, such as the Hospital-Acquired Condition (HAC) Reduction Program. The HAC program encourages better patient safety by financially penalizing hospitals that rank in the lowest-performing quartile nationally. This framework holds the hospital accountable for preventing new, severe injuries that develop during the patient’s stay.
The Duration of Accountability: Reporting Cycles
The duration an acquired pressure ulcer remains part of a facility’s accountability varies significantly between acute care hospitals and Skilled Nursing Facilities (SNFs). In acute care hospitals, accountability is tied to the patient’s discharge, as the event is captured in the inpatient claim data for that specific stay. This data is aggregated into quarterly reports that inform the annual HAC Reduction Program penalty assessment. The hospital’s performance score uses data that can span multiple years before the penalty is applied.
Skilled Nursing Facility Reporting
For SNFs, accountability is tracked through the Minimum Data Set (MDS 3.0), a comprehensive assessment tool. The pressure ulcer status is captured at regular intervals, including the initial 5-day assessment and subsequent 30, 60, and 90-day assessments. The ulcer is continually documented until it is fully healed, meaning the negative data point remains active throughout the resident’s stay. SNF quality measures also distinguish between “short-stay” (100 days or less) and “long-stay” residents, tracking the development or worsening of ulcers over these defined periods.
The acquired ulcer contributes to the facility’s Quality Measure (QM) score, which is used for internal monitoring and regulatory compliance. Data from the resident’s stay, including the history of the acquired pressure ulcer, persists in the database even after discharge. This historical data is used for public reporting systems. The full impact of the injury on the facility’s score does not end until that specific assessment data falls outside the regulatory look-back window.
Documentation Requirements for Measure Removal
Healing an acquired pressure ulcer is the clinical goal, but removing it from quality measures requires specific, timely documentation. The formal process relies on precise and consistent record-keeping. Wound care specialists must assess and document the injury’s status at regular intervals, often weekly, to track progression.
Facilities must record objective findings, including the ulcer’s length, width, and depth in centimeters, and describe the tissue type in the wound bed. Although clinical staff may use “reverse staging” to describe healing, regulatory reporting recognizes only the original stage until the wound is completely resolved. To be officially removed from the negative count, the pressure ulcer must be documented as fully epithelialized, meaning the skin surface is completely closed.
Accurate documentation must clearly show the date of resolution, proving the facility successfully treated the acquired condition. If documentation is incomplete or inconsistent, the facility cannot formally prove resolution. This documentation gap can cause the pressure ulcer to remain on the active quality measure, negatively affecting the facility’s performance score long after the wound has healed clinically.
Long-Term Institutional Impact and Public Reporting
Even after a facility documents the full resolution of an acquired pressure ulcer and removes it from the immediate active measure count, the event continues to influence the institution’s public profile. Historical data from the patient’s stay contributes to public reporting platforms, such as the Medicare Star Ratings found on Nursing Home Compare. These ratings use a look-back window that aggregates performance data over many months, often 12 months or more.
The single instance of an acquired pressure ulcer is factored into the facility’s overall star rating for the duration of that look-back period. While immediate accountability might end with the patient’s discharge and documented healing, the event’s influence on institutional ranking can last up to three years, depending on the specific metric’s calculation cycle. The data point remains in the historical record, shaping the facility’s reputation for an extended time.