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Claims Data Underreports Pressure Ulcers

John Commins, for HealthLeaders Media, October 17, 2013

"Frankly, the way the data is collected, if a physician in a hospital is actually very diligent about documenting these issues, then it is more likely to end up in the billing data, so you are actually having an unintended consequences of penalizing the hospitals that document better and reward hospitals with incomplete documentation. If you do an incomplete job of documenting these complications they will never show up in your billing data."

"The data we actually used to do this assessment was available when this policy was being implemented. These types of assessments could have been done before they chose the policy, but then it's a different approach for using the data and we prefer validating the data before using it for this purpose, rather than using it until somebody proves that it is wrong."

Meddings says Medicare and other payers need to adopt a more systematic reporting process that relies less on claims data. "We like the use of the surveillance data in California. We recognize it can be an expensive process, but probably something like a modification of what they're doing would standardize validated measures."


John Commins is a senior editor with HealthLeaders Media.

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