CMS Now Counts Stage 2 Pressure Injuries as a Reportable Hospital Harm: What It Means for Texas Patients

For years, a hospital could let a pressure injury (also known as a “bedsore”) develop on a patient's skin during a stay, and unless it reached Stage 3 or worse, it never had to show up anywhere in the hospital's federal quality reporting. That gap was closed under a rule the Centers for Medicare & Medicaid Services finalized back in 2023. Since then, hospitals must report new Stage 2 pressure injuries and not just Stage 3, Stage 4, deep tissue, and unstageable wounds, as a formal hospital harm tied to Medicare's payment update calculation. The change matters most to patients and families who assumed an early-stage bedsore was too minor to count as anything for which a hospital had to answer.

What Changed in CMS's Hospital Harm Reporting Rules for Pressure Injuries?

CMS finalized a new measure in its FY 2024 hospital payment rule, expanding what counts as a reportable hospital-acquired pressure injury/bedsore to include new Stage 2 wounds, not just Stage 3, Stage 4, deep tissue, and unstageable injuries. 

On August 1, 2023, CMS issued the FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule, CMS-1785-F and CMS-1788-F. Among the changes, CMS adopted the Hospital Harm – Pressure Injury electronic clinical quality measure, which tracks inpatient hospitalizations in which a patient age 18 or older develops a new Stage 2, Stage 3, Stage 4, deep tissue, or unstageable pressure injury. CMS said the addition was partly a health equity measure, citing research showing that patients with darker skin tones face a higher prevalence of pressure injuries and a higher risk of the injury reaching a more advanced stage, which suggested to the agency that existing skin assessment protocols may be missing lower-stage injuries in some patients. 

Why Does Adding Stage 2 Pressure Injuries to This Measure Matter?

A Stage 2 bedsore is a partial-thickness wound, meaning the skin has broken open but the damage has not reached the deeper layers of tissue, muscle, or bone the way a Stage 3 or Stage 4 injury does. Adding it to a formal federal reporting measure means a hospital can no longer treat an early-stage bedsore as something that simply doesn't count.

Before this measure existed, hospitals were already required to track Stage 3 and Stage 4 pressure injuries, along with deep tissue and unstageable wounds, as hospital-acquired conditions. A Stage 2 injury generally was not captured in the same way, even though it represents a real breakdown in skin integrity that reflects the same underlying failures, inadequate repositioning, poor nutrition and hydration support, or delayed skin assessment, that produce the more severe stages. 

Some wound care physicians have raised a separate concern about how narrowly a Stage 2 injury is now clinically defined, arguing that the current staging criteria can classify even a superficial ruptured blister as a reportable Stage 2 wound. Whatever the clinical debate over precision, the practical effect for patients and families is the same: a hospital now has a documented, federally tracked incentive to prevent and catch these injuries earlier, rather than waiting until a wound has progressed to a more severe and more obviously preventable stage.

What Federal and Texas Rules Govern Hospital Reporting and Care Standards for Pressure Injuries?

This new measure operates through the Hospital Inpatient Quality Reporting Program, a federal payment mechanism, not a state licensing standard. Texas hospitals remain separately subject to Texas licensing law that requires them to meet minimum standards of patient care regardless of what they report to CMS.

The federal reporting mechanism is codified at 42 C.F.R. §412.140, which governs hospital participation, data submission, and validation under the Hospital Inpatient Quality Reporting Program. A hospital that fails to meet the program's requirements is subject to a one-fourth reduction in its annual Medicare payment update. 

On the Texas side, Texas Health and Safety Code §241.026 requires the state to adopt rules and minimum standards for hospitals licensed in Texas, including standards addressing staffing and compliance with other state and federal laws affecting patient health and safety. 

Together, these two authorities mean a Texas hospital's pressure injury practices are accountable on two separate tracks: what it reports to CMS for payment purposes, and what the state requires as a baseline of care under its own licensing law, independent of federal reporting.

Does a Hospital-Acquired Pressure Injury Automatically Mean Malpractice?

No. A pressure injury being reportable to CMS, or even classified as a hospital-acquired condition, is not the same as a legal finding of malpractice. A Texas family pursuing a claim still has to establish the applicable standard of care, a breach of that standard, and that the breach caused the injury.

Texas Civil Practice and Remedies Code §74.351 requires a Claimant asserting a health care liability claim to serve an expert report within 120 days of a Defendant's answer, explaining the standard of care, how the Defendant departed from it, and how that departure caused the harm. A hospital's own federal reporting data, including whether it flagged a Stage 2 injury as hospital-acquired under this measure, can become useful supporting evidence once litigation is underway. It does not replace the expert report Texas law requires, and a hospital's failure to report an injury correctly is a separate issue from whether the underlying care fell below the standard owed to the patient.

What Should a Texas Family Do If a Loved One Developed a Pressure Injury During a Hospital Stay?

Ask for the wound care documentation directly. A hospital's nursing notes, skin assessments, and repositioning logs are the records most likely to show whether staff caught a Stage 2 injury early or missed it until it worsened.

Request copies of the skin assessment records completed at admission and throughout the stay, since a documented baseline skin assessment is what allows anyone to determine whether a wound was present on admission or developed during the hospitalization. Ask specifically whether the hospital's electronic health record flagged the wound under its pressure injury quality reporting measures, since that internal classification can be relevant later even though it isn't a substitute for a legal claim. Photograph the wound's appearance and location as soon as it's noticed, and note the date. Finally, act promptly. Texas's statute of limitations for health care liability claims generally requires a claim to be filed within two years of the negligent act, and wound care evidence, including turning and repositioning logs, is not always preserved indefinitely.

We Can Help

At The Borah Law Firm, PLLC, we only handle medical malpractice cases, nothing else. As part of our practice, we represent patients and families across Texas in cases just like the one discussed in this blog. If you believe a loved one received substandard pressure injury care, whether in a nursing home, assisted living facility, or hospital, we can help you understand whether a case exists and what your options are.

Contact us today so you can tell us your story.

Frequently Asked Questions

What is a Stage 2 pressure injury?

A Stage 2 pressure injury is a partial-thickness wound where the skin has broken open, forming a shallow open sore or a fluid-filled blister, but the damage has not reached the deeper tissue, muscle, or bone that characterizes a Stage 3 or Stage 4 injury.

Does a hospital have to report a Stage 2 bedsore to Medicare?

Reporting is currently voluntary for hospitals that select the Hospital Harm – Pressure Injury measure, though CMS has been moving hospital harm measures toward mandatory reporting over time. A hospital that participates in this measure and fails to meet program requirements can face a reduction in its Medicare payment update.

Can I sue a hospital for a pressure injury/bedsore that developed during my stay?

It depends on the facts. A pressure injury/bedsore being reportable under federal quality measures does not by itself establish malpractice. A Texas claim requires proof of the standard of care, a breach of that standard, and that the breach caused the injury, typically supported by an expert report under Texas Civil Practice and Remedies Code §74.351.

About the Author: J.T. Borah is a Texas-licensed medical malpractice attorney and Texas Super Lawyer at The Borah Law Firm, PLLC in Austin, Texas. He has testified before both the Texas House and Senate on patient safety issues and focuses exclusively on medical malpractice cases statewide.

About this article: AI writing tools assisted Mr. Borah in drafting this article. All legal analysis reflects his independent professional judgment. This article is for general informational purposes only. It is not legal advice and does not create an attorney-client relationship.

Link: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0