Pressure Points: What You Need to Know About HACRP in 2025

23 July, 2025
Miller Cordeiro

CMS compliance isn’t optional—it’s strategic. Under the Hospital-Acquired Condition Reduction Program (HACRP), CMS aims to reduce preventable harm by tracking metrics related to hospital-acquired pressure injuries (HAPIs).

The 2024–25 update retains pressure ulcers as one of the most heavily weighted components, second only to postoperative respiratory failure. This reflects their high incidence, significant patient harm, and central role in CMS’s value-based purchasing framework.

The cost of a single stage 3+ HAPI ranges from $21,000 to $152,000 per case

HAPI is the most frequent preventable event tracked in the National Database of Nursing Quality Indicators

CMS continues to treat HAPIs as a central measure for public quality reporting and reimbursement adjustments

Pressure ulcers are a “never event” with extreme regulatory scrutiny.

For hospitals, this means pressure ulcer prevention is not just a clinical priority—it’s a compliance imperative.

Yet, recent research reveals a troubling reality: HACRP penalties don’t always reflect true performance. Since 2014, CMS has penalized 25% of U.S. hospitals annually based on HAC rates, including HAPIs. These penalties can exceed $250,000 to $500,000 per hospital per year, often outpacing the cost of quality improvement initiatives.

New research reveals that only 15% of hospitals are consistently penalized year over year, with the remainder seemingly more random. In fact, more than 80% of hospitals that receive a penalty one year may escape it the next—even if their performance hasn’t changed. The result? A moving goalpost that makes it difficult for hospitals to plan, invest, and improve with confidence.

What’s driving this volatility?

Constant recalibration of PSI-90 component weights

Shifting definitions and inclusion of new metrics in Domain

Major changes in CMS scoring methods, including the use of Winsorized z-scores

Even with an unpredictable penalty methodology, lowering HAPI rates is the most controllable metric for decreasing penalty probability, reducing operating costs while improving reputation. One strategy is to focus on the most relevant component parameters, such as pressure ulcer reduction.

Investing in a motorized repositioning system, shown clinically to eliminate open pressure ulcers, such as the SideLyer™, is the most reliable avenue for hospitals to defend their bottom line. Recent studies in side lying technology demonstrate a greater than 10-fold reduction in pressure injury incidence for the facilities using the SideLyer.

Not only that, but clinical staff and direct service professionals are happier and feel supported.

For 2025 and beyond: Focus on prevention. Expect change. Build flexibility into your HACRP strategy. Pressure injury prevention programs return value, no matter what the HACRP methodology looks like next year.