ConvaTec USA - The Challenge of Skin Breakdown

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The Challenge of Skin Breakdown

Looking for solutions to manage perianal skin injury?
Use Flexi-Seal™ FMS to reduce the risk of skin breakdown.

Starting October 2008, Medicare will no longer pay for
hospital acquired pressure ulcers¹, since they can “reasonably be prevented through the application of evidence based guidelines.”

Fecal Incontinence and Pressure Ulcer
Medicare Policy FAQ

Fecal incontinence can create skin breakdown

Fecal incontinence causes moisture on the skin²
Digestive enzymes in feces can cause incontinence-associated dermatitis³
Bacteria comprise approximately 60% of dry fecal matter⁴

Skin breakdown may increase risk of infection

Hospitalized patients are most likely to develop a pressure ulcer in the sacral area⁵
The risk of contracting a nosocomial infection is greater for patients with pressure ulcers than for patients without pressure ulcers⁶

Preventing and Managing Hospital-Acquired Pressure Ulcers

Q. What about unavoidable pressure ulcers?⁷
A. CMS only recognizes “unavoidable” pressure ulcers in the long-term care setting.⁷

In the acute hospital, CMS believes that pressure ulcers are reasonably preventable if guidelines (such as those available from the National Pressure Ulcer Advisory Panel) are followed.⁸
The only exception is for pressure ulcers that are documented as present on admission to the hospital. ⁸

Q. What does “present on admission” mean?
A. Present at the time the order for inpatient admitting occurs – conditions that develop during an outpatient encounter, including ED, observation, or outpatient surgery.⁹

Q. Where do hospitals document that an ulcer was present on admission?
A. The POA indicator is reported by hospital coders along with a secondary diagnosis of pressure ulcer on the UB-04 claim.¹⁰

For supporting documentation, hospital coders will only refer to the physician’s notes, so the record that an ulcer was present on admission must be contained in the patient’s medical record.⁸
Nursing notes are not a substitute for the patient’s medical record.⁸

Q. What is the timeline for reporting and payment changes?
A. Hospitals were required by law to begin reporting POA indicator information for pressure ulcers beginning October 1, 2007.¹¹

Beginning October 1, 2008, Medicare payments to hospitals will be impacted. Patients with a secondary diagnosis of pressure ulcer at discharge will not be assigned to higher-paying MS-DRG unless the ulcer was present-on-admission.¹²
What’s Changed? Hospitals are now required by law to report POA information for pressure ulcers.¹³

Flexi-Seal™ Fecal Management System

Flexi-Seal™ Fecal Management System is designed to:¹³

Safely and effectively divert fecal matter
Protect wounds from fecal contamination
Reduce skin breakdown
Reduce the spread of infection
Improve patient care
Save nursing time

Clinically Proven

92% of patients had their skin condition improved or maintained in a clinical study (n=42)¹³
83% to 90% of the reports caregivers stated reported Flexi-Seal™ FMS improved fecal incontinence control, it was practical, caregiver and patient-friendly, time efficient, and efficacious.¹³

References [+]

Centers for Medicare and Medicaid Services, Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates: Final Rule, 72 Federal Register 62 (August 22, 2007), 47201-47206.
Dolynchuk K, Keast D, Campbell K, et al. Best practices for the prevention and treatment of pressure ulcers. Ostomy Wound Manage. 2000;46:38-54.
Buckingham KW, Berg RW. Etiologic factors in diaper dermatitis: the role of feces. Pediatr Dermatol. 1986;3(2):107-112.
Fiers SA. Breaking the cycle: the etiology of incontinence dermatitis and evaluating and using skin care products. Ostomy Wound Manage. 1996;42(3):32-34,36,38-40, passim.
Meehan M. National pressure ulcer prevalence survey. Adv Wound Care. 1994;7(3):27-30, 34, 36-38.
Warren DK, Guth RM, Coopersmith CM et al. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2006;27(10):1032-1040.
CMS Online Manual System Publication 100-07: State Operations Manual, Transmittal 4 (Appendix PP). November 19, 2004. Centers for Medicare and Medicaid Services Web site. Available at: www.cms.hhs.gov/transmittals/Downloads/R4SOM.pdf. Accessed: September 19, 2007.
Centers for Medicare and Medicaid Services, Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule, 72 Federal Register 162 (August 22, 2007), 47205.
Centers for Medicare and Medicaid Services, Fact Sheet: Present on Admission (POA) Indicator Reporting by Acute Inpatient Prospective Payment System (IPPS) Hospitals, available for download at: www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp (accessed February 13, 2008).
Centers for Medicare and Medicaid Services, Hospital-Acquired Conditions (Present on Admission Indicator): Coding, www.cms.hhs.gov/HospitalAcqCond/05_Coding.asp (accessed December 5, 2007).
Centers for Medicare and Medicaid Services, Hospital-Acquired Conditions (Present on Admission Indicator): Reporting, www.cms.hhs.gov/HospitalAcqCond/04_Reporting.asp (accessed December 5, 2007).
Centers for Medicare and Medicaid Services, Hospital-Acquired Conditions (Present on Admission Indicator): Overview, www.cms.hhs.gov/HospitalAcqCond/01_Overview.asp (accessed December 5, 2007).
Padmanabhan A, Stern M, Wishin J, Mangino M, Richey K, DeSane M. Clinical evaluation of a flexible fecal incontinence management system. Am J Crit Care. 2007;16(4):384-393.

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