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Claims Data Underreports Pressure Ulcers

John Commins, for HealthLeaders Media, October 17, 2013

"The surveillance data found 10 times more pressure ulcers than the billing data. That is a big problem. We expected the surveillance data to be a little bit higher but not dramatically higher," she says. "The one thing we had hope for was 'are we still able to track the same hospitals that are bad performers. Are the same hospitals with high rates in surveillance data the same hospitals we would have identified by the billing data?' Unfortunately this was not the case."

Meddings says the process by which claims data is collected is not conducive to accurate reporting of HAPUs.

"Hospital coders are not clinicians and they are basically restricted by federal rules as far as what types of papers they are even allowed to look at to get the pressure ulcer diagnosis," Meddings says. "The surveillance data is quite different and generated by a team of nurses and other specialists who are trained specifically on how to examine a patient head to toe, a full skin exam to look for pressure ulcers, how to stage them correctly, how to figure out if they were hospital-acquired or not, and how to differentiate bed sores from other types of skin problems."

Specialized clinical surveillance teams in California examined every patient in the hospital at least once every quarter or more frequently and detailed their findings through a standardized public reporting process with the state.

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