Who Pays For Hospital Acquired Bed Sore?

I found out from a chatty RN at a cleint’s pre surgical appointment, that insurance companies will no longer pay for hospital acquired bed sores.  The RN told me, because she was very focused on my client’s skin integrity.  She must have checked her three times especially around a drain.  I had to ask her what she was doing, so she told me.

She said the hospital had new policies in place for all admissions whether through the  ER or surgery.  RNs at every stage needed to continually assess the skin integrity.  The new policy was because the major insurers had said no to bedsore care, if acquired during a stay.  This meant if you didn’t have that diagnosis on admission, the hospital was responsible.  No insurance reimbursement.

At first, I thought this is great.  The insurance companies are making the hospital be more observant of safety issues like skin breakdown.  Skin ulcers, especially in the elderly can be difficult to heal and cause bone or systemic infections.  It is important that bedridden patients are turned regularly, have good hygiene and the skin examined daily.  Any signs or symptoms of an ulcer, like  increased redness in a specific area, should be dealt with aggressively.

But then I got to thinking.  Is the hospital taking the hit for nonpayment of medical/nursing service and supplies for any skin breakdown?  I would think not.  What is probably happening is the hospital bills the insurance, then they refuse payment and the hospital passes along the cost to the patient.  Why not?  The general population doesn’t know the insurance companies have stepped back from being fiscally responsible for a hospital acquired skin ulcer.

This issue speaks to making sure any time a hospital admission occurs, to request an itemized bill.  On the bill, if there has been any skin breakdown and care was needed, it will be listed.  I don’t think the patient should be responsible for payment of anything caused by the hospital stay.  In the future, if I have a patient who gets a bed sore while hospitalized, I will make sure to check the bill and get those charges removed.