Financial Implications of Pressure Injuries: An Actuarial Analysis of Healthcare Costs

Introduction: Pressure injuries impose a significant financial burden on healthcare facilities while also compromising patient well-being (Padula et al., 2019). These injuries often lead to extended hospital stays and increased utilization of healthcare services. Patients with pressure injuries typically experience prolonged hospitalizations due to complications and slower recovery rates, straining hospital resources such as bed occupancy, staffing, and supplies. Additionally, pressure injuries frequently result in readmissions, further escalating healthcare costs. Accurate assessment of the economic burden of pressure injuries is crucial for informed decision-making and resource allocation. The Business Impact Calculator (BIC), a tool described in this abstract, aids healthcare institutions in developing strategies to mitigate pressure injuries and improve cost-effectiveness.Methods:Data on hospital-acquired pressure injuries (HAPIs) were obtained from Optum Healthcare, focusing on Centers for Medicare & Medicaid Services (CMS) codes for HAPIs in the USA. The de-identified dataset included Commercial and Medicare members, and the CMS Limited Data Set (LDS), spanning the years 2019-2021 for both Medicare Advantage and Commercial members. The data encompassed national-level metrics such as admissions per 1,000, average length of stay, percentage of admissions with HAPI, and standardized allowed cost per admission of HAPI. DRGs with low admission rates were excluded. This data served as the basis for benchmarking HAPIs and their associated costs across Diagnostic Related Groups (DRGs) for Commercial and Medicare populations nationwide, forming the foundation for our actuarial analysis.Results:Data on hospital-acquired pressure injuries (HAPIs) were obtained from Optum Healthcare, focusing on Centers for Medicare & Medicaid Services (CMS) codes for HAPIs in the USA. The de-identified dataset included Commercial and Medicare members, and the CMS Limited Data Set (LDS), spanning the years 2019-2021 for both Medicare Advantage and Commercial members. The data encompassed national-level metrics such as admissions per 1,000, average length of stay, percentage of admissions with HAPI, and standardized allowed cost per admission of HAPI. DRGs with low admission rates were excluded. This data served as the basis for benchmarking HAPIs and their associated costs across Diagnostic Related Groups (DRGs) for Commercial and Medicare populations nationwide, forming the foundation for our actuarial analysis.Discussion: The Business Impact Calculator is a powerful tool for healthcare administrators, clinicians, and policymakers to evaluate the financial implications of hospital-acquired pressure injuries. By implementing this calculator, it is possible to quantify the costs of prevention and management strategies, along with the potential savings they offer.References: