How to Implement the Pressure Injury eCQM

CMS has added a new voluntary eCQM to its 2025 Inpatient Quality Reporting (IQR) program: Hospital Harm - Pressure Injury (HH-PI).

While pressure injury measures are not new, this is the first one that’s been developed as an eCQM for acute care hospitals. And although it’s being rolled out as a voluntary measure, that doesn’t mean you should ignore it. CMS has been rapidly adding hospital harm measures to the IQR program’s list of required measures, and the HH-PI measure is scheduled to be mandatory in calendar year 2027. (Check out our recap of the 2025 IPPS Proposed Rule for these requirement updates and more.)

That means it's important that you consider adding this measure to your roster now. Below, we’ve broken down the essential takeaways that you need to get the HH-PI eCQM up and running at your hospital. But, as always, be sure to read the full CMS specification as well—and don’t hesitate to reach out to us with additional questions. Ready? Let’s get started!

What does the Pressure Injury eCQM measure?

The HH-PI eCQM measures the proportion of inpatient hospitalizations for patients aged 18 and older who develop a new stage 2, stage 3, stage 4, deep tissue, or unstageable pressure injury while under your care. This is an inverse measure, so the lower your rate, the better.

Why is CMS adding a Pressure Injury eCQM now?

Pressure injuries continue to be one of the leading hospital-acquired conditions in the U.S.—hence the reason why it’s categorized as a “hospital harm” or “HH” eCQM. Nearly 10% of inpatient hospitalizations lead to pressure injury, and more than 50% of reported cases are stage 2 or higher.

On top of that, pressure injury rates in the U.S. vary dramatically from hospital to hospital, even when risk-adjusted for factors such as age and comorbidities—meaning our standard of care as a nation is all over the place.

With the introduction of the HH-PI eCQM, CMS hopes to incentivize hospitals to adopt commonly accepted best practices around pressure injury prevention and treatment and improve patient safety outcomes.

Because pressure injuries can lead to many complications, a reduction could have a significant cascading effect on patient care. Lower rates of pressure injury will likely lead to lower rates of pressure injury-induced infections, osteomyelitis, anemia, and sepsis, as well as lower rates of patient depression, pain, and discomfort.

It's also worth noting that CMS provided a very distinct health equity rationale when it announced the HH-PI measure in the 2024 IPPS final rule. CMS cited research that shows that people with “darker skin tones” experience a higher prevalence of and higher risk for pressure injuries, and thus it’s time to evaluate the effectiveness of “current skin assessment protocols.”

Pressure Injury eCQM Populations

Let’s review the measure specifications to help you understand how a patient makes his or her way into the measure population.

Initial Patient Population

Layman’s description:

The Initial Patient Population (IPP) for the HH-PI eCQM is all patients ages 18 and older who were inpatient hospitalizations during the reporting period. This includes patients who started in the ED and/or observation, as long as the last ED/observation encounter and the first inpatient hospitalization encounter are within one hour of each other.

Simplified logic:

• Inpatient encounter
• Age > or = 18 years

Workflow:

Denominator Exclusions

Layman’s description:

First things first, CMS does not plan to track stage 1 Pressure Injuries with this measure. Secondly, CMS only wants to track hospital-acquired Pressure Injuries. So, the denominator exclusions are designed to weed out any Pressure Injuries that were likely out of your control.

Therefore, you can exclude any Pressure Injury diagnoses classified as present on admission, clinically undetermined, or found within 24 hours of the start of the encounter. You can also exclude deep tissue PIs (DTPIs) found within 72 hours of the start of the encounter, as well as any patients with a COVID-19 diagnosis during the encounter.

Simplified logic:

If a patient is coded in any of the following ways, he or she will be excluded from the measure:

• DTPI, stage 2, 3, 4, or unstageable Pressure Injury diagnosis where Present on Admission = Y
• DTPI, stage 2, 3, 4, or unstageable Pressure Injury diagnosis where Present on Admission = W
• Stage 2, 3, 4, or unstageable Pressure Injury found on exam =< 24 hours from first encounter
• DTPI found on exam = < 72 hours from first encounter
• COVID-19 diagnosis code

Workflow:

Numerator

Laymen’s description:

The numerator is any patient from your denominator who is not excluded and develops a new DTPI or a stage 2, stage 3, stage 4, or unstageable Pressure Injury while under your care. If a patient has multiple Pressure Injuries, only one new qualifying Pressure Injury is counted toward your numerator. Remember that this is an inverse measure, so you are striving for a low numerator!

Simplified logic:

Any of these will land your patient in the numerator:

• Stage 2, 3, 4 or unstageable Pressure Injury diagnosis with a Present on Admission indicator = N
• Stage 2, 3, 4 or unstageable Pressure Injury diagnosis with a Present on Admission indicator = U
• DTPI diagnosis with a Present on Admission indicator = N
• DTPI diagnosis with a Present on Admission indicator = U
• DTPI found on exam > 72 hours from first encounter
• Stage 2, 3, 4 or unstageable pressure injury found on exam > 24 hours from first encounter

Workflow:

Tips for Getting Started with the Pressure Injury eCQM

• CMS has provided a number of best practices in the measure specification's Clinical Recommendation Statement. Review these with your quality team and your clinical stakeholders to make sure they are being implemented, can be implemented in the next 12 months, or there is a good reason why they can’t be implemented.
• Evaluate your hospital’s pressure injury risk assessment tool. Evidence-based tools like the Braden Scale are a big help but are rarely 100% perfect. Identify your blind spots and how you can minimize them. This article from Wounds International can help.
• Educate your frontline staff on the importance of preventing pressure injuries. It is important for all clinicians to understand their role in the prevention process. Provide education and training on proven strategies, such as repositioning patients, using pressure-relieving devices, and maintaining skin integrity.

More Tools to Help You Manage Your IQR Requirements

• Article: How to Prioritize Your Quality Reporting Requirements in 2024
• eBook: 2024 IQR Program Requirements
• eBook: How to Improve Your Sepsis Compliance
• FAQs: Getting Started with the THA/TKA PRO-PM
• Article: How to Implement the Inpatient ExRad eCQM