A new CMS quality measure is changing how hospitals are held accountable for pressure injuries, and the financial stakes are real. Here is what clinical and quality leaders need to understand before it becomes mandatory in 2028.
Why This Matters
Pressure injury prevention has always been central to good nursing practice. Now it is also directly connected to your hospital’s financial performance in a way that cannot be ignored.
CMS has introduced a new quality measure, the eCQM Hospital Harm – Pressure Injury, as part of its Inpatient Quality Reporting program. Hospitals that fail to meet IQR requirements risk losing a meaningful portion of their annual Medicare payment increase. This is not a distant concern. Data from calendar year 2025 is already being used to determine payment adjustments in 2027, and from 2028, participation becomes mandatory for almost all acute care hospitals.
There is also a health equity dimension that makes this measure significant beyond its financial implications. Patients with darker skin tones face a substantially higher risk of developing pressure injuries, partly because early skin changes are harder to detect visually. CMS has stated that advancing health equity is part of the rationale for this measure, and hospitals that take it seriously have a real opportunity to improve outcomes for some of their most vulnerable patients.
What It Actually Is
The eCQM Hospital Harm Pressure Injury is a way for CMS to track hospital-acquired pressure injuries using data pulled directly from your hospital’s electronic medical records, rather than relying on self-reporting alone.
When a patient is admitted, CMS uses information from your EMR to determine whether a pressure injury developed during that stay. If it did, it is recorded against your hospital. The measure captures Stage 2, Stage 3, Stage 4, unstageable, and deep tissue pressure injuries, which is a wider scope than many teams expect.
The documentation requirements are stricter than they first appear. Your team has a defined window after admission to document any pressure injuries found on arrival, so they can be recorded as present on admission rather than hospital-acquired. That window depends on how the patient came in, and understanding the rule is essential to protecting your hospital from avoidable penalties.
For Stage 2, Stage 3, Stage 4, and unstageable pressure injuries, your team has 24 hours to complete that documentation. Deep tissue pressure injuries carry a slightly longer window of 72 hours, reflecting the fact that they can take up to three days to become visible after the pressure event occurs. However, if a patient arrived via the emergency department and was admitted to inpatient within one hour of ED discharge, that clock does not start at the moment of inpatient admission. It reverts to the beginning of the ED encounter, meaning your nursing team may have significantly less time than they realise. Without a system in place to flag it, they may not know.
CMS pulls all of this data electronically, which means the way your team documents a wound, and where in the system they document it, determines whether it is picked up at all. Incomplete documentation or documentation in the wrong field is treated the same as no documentation.
Getting your practices right now gives your team the best foundation before mandatory reporting begins.
Watch the video below for a full walkthrough of the eCQM requirements, documentation rules, and what your hospital should be doing today.
To find out how Bruin Biometrics can support your team with pressure injury prevention, documentation, and eCQM preparation, contact us at info@bruinbiometrics.com to learn how we can support your team.