DAL NH 15-08: Subject: Pressure Ulcer Care

October 28, 2015

DAL NH 15-08: Pressure Ulcer Care

Dear Hospital, Nursing Home and Home Care Agency Administrator:

This letter is a call to New York State's hospitals, nursing homes and home care agencies for a sustained commitment to pressure ulcer performance improvement. Ongoing focus in this area presents opportunities in the context of the State's Delivery System Reform Incentive Payment (DSRIP) program, and is timely as the State's Value Based Payment Reform efforts are being implemented. In addition to alignment with the State's health care delivery system reforms, pressure ulcers have also been identified as a cross-setting quality measure as part of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act).

Meaningful change takes time and dedicated effort. In 2007, the Department of Health (the Department) declared "War on the Sore" and established improving pressure ulcer prevention and treatment in nursing homes as a Statewide priority initiative. The Department also focused attention on this issue across the continuum of care by encouraging collaborative projects involving hospitals, nursing homes and home health care agencies that focus on improving communication, cross-provider training on standards of practice and standardizing data collection and reporting.

Over the past eight years, we have made great progress in responding to this serious patient and resident safety issue. As the National pressure ulcer rate among high risk residents in nursing homes has shown a steady decline, New York State's rate decreased dramatically from 14.2% (in 2010) to 7.4%* by the beginning of SFY 2015. In addition, based on New York State Medicaid claim information, the number of hospital and home care residents with a primary diagnosis of pressure ulcers has also been significantly reduced. These declines translate into over $67 million in Medicaid savings. More important, however, is the improved quality of life for our patients and residents.

The Gold STAMP (Success Through Assessment, Management and Prevention) Program is a coalition of organizations convened in New York State to provide resources and education across the continuum of care to improve the assessment, management and prevention of pressure ulcers. Gold STAMP was developed in 2008 and expanded in 2011 through Governor Cuomo's Medicaid Redesign Team. The Gold STAMP Program utilizes a cross-setting provider association and community partnership model to build regional level collaboration among hospitals, nursing homes and home care agencies, with a goal of reducing the incidence and improving treatment of pressure ulcers in New York State. The Gold STAMP mission and goals, as well as a wealth of education and other resources to improve the assessment, management and prevention of pressure ulcers, are available at www.goldstamp.org.

The Department is committed to sustaining its efforts in this area and achieving even greater success in the future. In SFY 2015, we are striving to bring the percentage of high risk residents with pressure ulcers in New York State's nursing homes at or below the National percentage of 5.9%, and continue to decrease the number of patients with a primary diagnosis of pressure ulcers in hospitals and home care agencies. While nursing staff have been prominent in these efforts to date, physicians are a key factor in the prevention and treatment of pressure ulcers. In SFY 2015, special emphasis is being placed on the pivotal role that physicians play. This effort is a targeted follow up to the Guidelines on Medical Direction and Medical Care in Nursing Homes that were issued by the Department in 2012. These process guidelines were intended to help provide optimal medical care in nursing homes, leading to better health and quality of life outcomes for residents. The Department's surveillance will also continue to focus in this area.

An effective pressure ulcer prevention and treatment program requires an interdisciplinary approach. We urge you to continue to promote a culture of appropriate care throughout your facility and engage all involved staff as members of your health care team to ensure and maintain the most effective pressure ulcer prevention and treatment program and help us achieve our goal in SFY 2015 and beyond. If your facility/agency is not already involved in the Gold STAMP Program, please visit www.goldstamp.org.

Should you have any questions, please contact (518) 402-1004 (Hospitals), (518) 408-1267 (Nursing Homes) or (518) 408-1638 (Home Care). Thank you for your leadership and being a part of the solution to this very important patient and resident safety issue.


Ruth Leslie
Division of Hospitals and
Diagnostic & Treatment Centers
  Shelly Glock
Acting Director
Division of Nursing Homes and
ICF/IID Surveillance
  Rebecca Fuller Gray
DirectorDivision of Home and
Community Based Services

*Source: Centers for Medicare and Medicaid Services (CMS)