Learning Objectives:

• Describe the concept of skin tone bias in wound care and its impact on clinical assessment. 
• Identify key signs of skin damage, infection, and inflammation in individuals with darker skin tones. 
• Explain why reliance on visual cues such as redness can lead to delayed diagnosis in darker skin. 
• Discuss the principles and recommendations from best-practice guidance on inclusive skin assessment. 
• Recognize the role of tools in supporting accurate and consistent assessment. 
   

Click here to register for the live webinar!

Executive Summary
The National Pressure Injury Advisory Panel (NPIAP) conducted a successful two-day advocacy visit to Capitol Hill on March 26–27, 2026. The delegation engaged with key health policy advisors from House leadership and legislative directors from member offices, culminating in a direct meeting with a Principal Deputy Director from the Centers for Medicare & Medicaid Services (CMS). All meetings were productive, with clear alignment on the clinical and economic rationale for updating CMS policies to encourage adoption of early detection technologies. The visit established a foundation for formal reimbursement and regulatory reform requests.

Delegates:
Dr. Samuel Nwafor
Dr. Joyce Black
Dr. Dave Brienza
Martin Burns
Nick McMurray

Day 1: Thursday, March 26, 2026 – Capitol Hill Engagement

Morning Briefing & Logistics
Breakfast Discussion: The delegation convened at The Capitol Hill Club (300 1st Street, SE, Washington, DC 20003) at 8:30 AM to finalize talking points and coordinate messaging on pressure injury prevention metrics.

Scheduled Congressional Meetings (All held on Capitol Hill)

10:15 am
Attendee: Drew Keyes
Role: Health Policy Advisor
Office: Speaker Mike Johnson

12:00 pm
Attendee: Riley Hambrick
Role: Legislative Director
Office: Rep. Neil Dunn, MD (FL-02)

1:00 pm
Attendee: Mathew Duglin, Esq.
Role: Legislative Director
Office: Rep. Don Bacon (NE-02)

Key Discussion Points (All Meetings):

• Current gaps in CMS reimbursement for pressure injury prevention technologies.
• Clinical evidence supporting the use of early detection technology in pressure injury monitoring.
• Cost avoidance potential: treating a pressure injury far exceeds the cost of early detection.
• Request for legislative support (letters, appropriations language) encouraging CMS to revise policies to encourage the use of early detection technology in pressure injuries.

Outcomes:

• Staff expressed strong interest in the clinical distinction between visual skin assessment (current standard) and physiologic/biomarker-based early detection.
• All meetings were characterized as productive, with follow-up materials promised.

Day 2: Friday, March 27, 2026 – CMS Engagement

9:30 am
Attendee: Alec Aramanda
Role: Principal Deputy Director
Agency: Centers for Medicare & Medicaid Services (CMS)

Key Discussion Points:

• Direct advocacy for CMS policy changes to explicitly cover and incentivize early detection technologies for pressure injury prevention.
• Adjust the current DRG:  IQR mandatory reporting is the most immediately actionable near-term mechanism. Hospitals already report IQR procedures as a compliance condition for receiving their full Medicare market basket update. Adding objective skin assessment procedure codes to IQR mandatory reporting creates clinical adoption without a separate payment authorization — hospitals adopt because their compliance and payment depend on it, not because they are paid separately to do it. It also generates the real-world utilization data CMS needs to support future DRG weight adjustments.

Outcomes:

• Mr. Aramanda engaged substantively, acknowledging CMS’s interest in prevention-focused payment models.
• He requested specific draft policy language and additional supporting data.
• A follow-up technical assistance meeting was discussed.
• He discussed NPIAP directly engaging the CMS Chief Medical Officer in further deliberations.

Advocacy Goal Status

Securing direct access to engage the Principal Deputy Director at CMS was indeed a significant accomplishment in NPIAP’S advocacy efforts.

Congressional staff were receptive to NPIAP’s request for CMS action and discussed potential legislative engagement and direct agency follow-up.

Recommended Next Steps

1. Prepare and send a follow-up letter within 10 business days to Alec Aramanda at CMS.
2. Schedule technical follow-up with Alec Aramanda’s office at CMS.
3. Plan a second Washington DC visit in 2026 to review progress and maintain momentum including a visit to the White House Legislative Director.

Samuel Nwafor MD FACP FAPWCA
Chair, Public Policy Committee, NPIAP.

Learning Objectives:

• Describe the impact of data to drive decision making around educational offerings
• Describe the how multimodal educational strategies can be used to for continuing education in pressure injury risk, identification and treatment
• Discuss how similar strategies can be used in their own care settings

Click here to register for the live webinar!

Among the updates are two SREs with significant implications for hospitals across the care continuum:

• SRE 21 – Patient Harm Associated with Severe Pressure Injury, and
• SRE 27 – Patient Harm Associated with Pressure Injury in the Neonate

These changes affect acute care hospitals, pediatric hospitals, birth hospitals, an any organization with a neonatal intensive care unit (NICU), underscoring the broad relevance of the updated reporting framework.

Pressure Injury-Related Reporting Updates

Pressure injury development is addressed under Care Provision Events.

SRE 21 is defined as “Patient Harm Associated with a Stage 3 Pressure Injury, Stage 4 Pressure Injury, Unstageable Pressure Injury or Deep Tissue Pressure Injury Acquired After Admission”.

• “NOT Present on Admission” is defined as greater than 24 hours after arrival, and, for Deep Tissue Pressure Injury, greater than 72 hours after arrival.
• These stages are considered largely preventable when accepted standards of care are in place.
• Reviewers are expected to report only instances of patient harm associated with these stages that are both serious and largely preventable.

The National Pressure Injury Advisory Panel has long recognized that not all pressure injuries [in hospitals] are avoidable. For the first time, TJC and NQF are formally recognizing that not all pressure injuries [in hospitals] are avoidable, aligning with long‑standing clinical evidence and expert consensus.

Recognized Exclusions for Unavoidable Clinical Circumstances

The updated SRE List outlines clinical circumstances in acute care settings that may be excluded from serious reportable events when appropriately documented. While not exhaustive, examples include:

• Progression of a present on admission pressure injury or deep tissue pressure injury (e.g., from Stage 2 to Stage 3, if Stage 2 was recognized and documented as present on admission)
• An Unstageable pressure injury documented as present on admission that is later debrided and determined to be a Stage 3 or 4 deep tissue pressure injury that requires minor or no intervention(s) (e.g., specialized mattresses, occlusive and nonocclusive dressings)
• Refusal of preventative measures in instances such as end-of-life care
• Skin changes identified during end-of-life care (i.e., Kennedy terminal ulcer, Trombley-Brennan ulcer)
• Circumstances occurring prior to admission that are known causative factors for pressure injuries or deep tissue pressure injuries (e.g., immobility after a fall, prolonged interfacility transport) and are documented in the medical record
• Pressure injuries associated with clinical circumstances where preventive measures are limited or restricted, which may include patients with the following:
  • Hemodynamic instability with turning despite implementation of small increasing incremental turns (e.g., patients requiring high doses of vasopressors, patients on extracorporeal membrane oxygenation treatment for whom cannula dislodgement is a high risk)
  • An unstable or unrepaired fracture (e.g., spinal, pelvic)
  • An open chest

Neonatal Pressure Injury Considerations (SRE 27)

The inclusion of SRE 27 recognizes the unique vulnerabilities of neonates, particularly those requiring intensive or life‑sustaining interventions. This clarification is especially relevant for birth hospitals and NICUs, where medical devices, immobility of the occiput, and critical illness significantly influence pressure injury risk. The updated framework reinforces the need for context‑aware evaluation rather than automatic classification as preventable harm.

Leadership and Collaboration

Joyce Black, RN, PhD, FAAN, CWS, past President of the National Pressure Injury Advisory Panel, collaborated with NQF and TJC to in developing these updates. Additional information regarding the procedural review and implementation process is forthcoming. This milestone represents a meaningful advancement in patient safety policy and clinical realism.

The National Quality Forum (NQF) is a not-for-profit, nonpartisan, membership-based organization that works to improve healthcare outcomes, safety, and affordability for all people. The Joint Commission enables and affirms the highest standards of healthcare quality and patient safety for all. Founded in 1951, it is the nation’s oldest and largest standards-setting and accrediting body in healthcare, evaluating more than 23,000 healthcare organizations and programs across the United States.

Education and Implementation Support

NQF is offering educational resources to support healthcare organizations during this transition, including a capstone webinar on March 3 and additional sessions available through the SRE updated resource page. These materials provide important context on the intent and application of the revised list.

Healthcare professionals can also learn more about these reporting changes at the upcoming NPIAP Annual Conference, where experts will discuss practical implications, documentation considerations, and differences in reporting expectations under the updated SRE framework.

Implementation Timeline

The Joint Commission will adopt the updated SRE List as part of the Sentinel Events (SE) List effective January 1, 2027, across all accredited organizations domestic and international. This timeline allows time for healthcare organizations to make the required changes, and will provide technical support to accredited organizations during the transition.

• Examine the role of nutritional status in influencing skin integrity and the wound healing process 
• Translate evidence-based guidelines into practical nutrition strategies that support patients with or at risk for pressure injuries and malnutrition 
• Evaluate how interdisciplinary collaboration enhances outcomes for patients across the continuum of care 

Click here to register for the live webinar!

This webinar is brought to you by Abbott Nutrition Health Institute  (ANHI). Connect with ANHI on LinkedIn here.

Join NPIAP for an engaging webinar on December 17th from 12 - 1 PM CT, where you will learn to:

• Describe how a patient sensor system aids in decreasing Hospital Acquired Pressure Injuries (HAPIs).
• Verbalize the functionality of the patient sensor system.
• Explain utilization of the patient sensor system for early mobility of patients.
• List the upcoming changes to the National Pressure Injury Advisory Panel International Guideline recommendations.
  
   

Click here to register for the live webinar!

This webinar is sponsored by Smith + Nephew. Connect with Smith + Nephew on LinkedIn here.

Join NPIAP for an engaging webinar on November 25th from 11 AM - 12 PM CT, where you will:

• Gain understanding of the magnitude of challenge in the treatment of pressure injuries, the core reason why near 100000 lives are lost for the proximate cause being a pressure injury.
• Discuss what the traditional methodologies have been to treat pressure injuries, that still occur inspite of much preventative efforts.
• Discuss what are the core treatment problems that impede optimal treatment in various settings.
• Discuss newer technologies that can be used to improve patient lives, particularly in the area of wound bed preparation, improvements to the reconstructive ladder, and debridement of slough and necrotic tissue. 

Click here to register for the live webinar!

This webinar is sponsored by the Urgo Foundation.

In the latest podcast episode, host Dr. Joyce Black and guest Dr. Lee Ruotsi dive into the challenges physicians face, including limited training, time constraints, and misconceptions about skin care responsibilities. They emphasize the importance of accurate skin assessments, especially with new electronic clinical quality measures relying on chart data. 

The conversation highlights the lack of wound care education in medical school curricula and the need for systemic change to better prepare future providers. Listeners will hear about successful educational initiatives and the importance of top-down support from healthcare leadership. This episode offers practical insights and a call to action for improving pressure injury care across all levels of healthcare.

Tune in to the latest NPIAP Podcast episode today!

Join NPIAP for an engaging webinar on September 24th from 12-1 PM CT, where you will learn to:

• Discuss the nutrition section of the 2025 International Guidelines (IG) for the prevention of PI
• Explain how malnutrition can negatively affect PI healing
• Identify which components of the IG to implement
• Describe how to implement the IG as it relates to the older adult

Click here to register for the live webinar!

Join NPIAP for an engaging webinar on August 17th from 12-1 PM CT, where you will gain the following:

• Understand the challenges with pressure injuries in the NICU.
• Learn differences in PI development in premature infants vs other populations
• Differentiate between PI and other skin concerns. 
  
   

Click here to register for the live webinar!

Join NPIAP for an engaging webinar on July 16th from 12-1 PM CT, where you will gain the following:

• Gain insight into how fluidized technology contributes to reducing pressure injuries related to the evidence.
• Explore the impact of positioners on minimizing pressure injuries.
• Understand how positioners can help in preventing staff injuries.
  
   

Click here to register for the live webinar!

In this episode Dr. Black is joined by NPIAP Treasurer and registered dietitian, Anna de Jesus, MBA, RDN, to discuss a critical and often overlooked issue in patient care: nutrition. This conversation, part of the NPIAP podcast series, dives into the complex reasons why patients may refuse food and how clinicians can approach these challenges with empathy and practical solutions.

With insights grounded in both clinical expertise and real-world experience, Anna sheds light on the importance of understanding patient behavior to promote healing and prevent injury.

Tune in to the latest NPIAP Podcast episode today!

Join NPIAP for an engaging webinar on June 25th from 12-1 PM CT, where you will gain the following:

• Increased knowledge of the design/construction features and capabilities of a full-body support surface for PIP
• Increased understanding of matching the patient's needs with a full body support surface
• The intention to change practice based on new knowledge
  

Click here to register for the live webinar!

The next NPIAP Quintet Quiz is available now: Pressure Injury on the Heels

This quiz features five expert-driven questions that utilize practical scenarios and real-life images to challenge your understanding of the latest practices, guidelines, and innovations in the field.

Click here to access the latest NPIAP Quintet Quiz and grow your expertise.

Join NPIAP for an engaging webinar on May 21st from 12-1 PM CT, where our expert speaker will:

• Review the goals and challenges of conducting skin assessments
• Identify clinical best practices for skin assessments
• Explore tools that can be used to assess diverse skin tones with confidence
  

Click here to register for the live webinar!

This webinar is sponsored by Medline.

In this episode, NPIAP President Dr. Joyce Black welcomes Michele Deppisch, PT, CWS, FACCWS, President-Elect of NPIAP, for an insightful discussion on Electronic Clinical Quality Measures (ECQMs) and Pressure Injuries. 

 As CMS implements new efficiency measures to enhance healthcare quality, understanding ECQMs is becoming increasingly crucial. Michele breaks down the basics, explores the technological challenges and processes involved, and provides practical takeaways for your team. While ECQM adoption isn’t mandatory yet, it will be by 2028—so now is the time to prepare. Tune in to gain valuable insights and stay ahead of the curve!

Tune in to the latest NPIAP Podcast episode today!

This quiz features five expert-driven questions that utilize practical scenarios and real-life images to challenge your understanding of the latest practices, guidelines, and innovations in the field.

Click here to access the April 2025 Quintet Quiz and grow your expertise.

Join NPIAP for an engaging webinar on April 23rd from 12-1 PM CT, where our expert speakers will:

• Propose strategies informed by physiology of movement to overcome hemodynamic instability in critical care patients.
• Compare and contrast the recommendations regarding moving the critically ill patient between the 2019 & 2025 guidelines.
• Discuss the various evidence based assessment tools for mobility readiness in the critically ill patient.
• Identify activity titration to move from turn and reposition to ambulation while ensuring prevention of skin injury.

Click here to register for the live webinar!*

*The webinar is a recap of the session "Moving the Critically Ill Patient" from NPIAP's 2025 Annual Conference. Please note that if you claimed CE for the conference session, you cannot claim CE for this activity.

In this episode, NPIAP President Dr. Joyce Black speaks with Kelly Moed, MSN, RN, NPD-BC, CSPHP and Charlotte Lisco, BSN, RN, CWON, to explore the close connection between safe patient handling and pressure injury prevention. 

Tune in to the latest NPIAP Podcast episode today!

This podcast is sponsored by EHOB.

This quiz features five expert-driven questions that utilize practical scenarios and real-life images to challenge your understanding of the latest practices, guidelines, and innovations in the field.

Click here to access the latest March 2025 Quintet Quiz and grow your expertise.

This quiz features five expert-driven questions that utilize practical scenarios and real-life images to challenge your understanding of the latest practices, guidelines, and innovations in the field.

Click here to access the newest February 2025 Quintet Quiz and grow your expertise.

Join NPIAP for an engaging webinar on March 19th from 12-1 PM CT, where our expert speaker will:

• Describe the risks of HAPIs in the operating room
• List strategies for pressure injury prevention in the OR arena
• Discuss risk assessment tools and prevention bundles
  

Click here to register for the live webinar!

This webinar is sponsored by Smith + Nephew. 

In this revisited episode, Dr. Joyce Black is joined by fellow NPIAP Board Member, Kathleen Vollman, MSN, RN, CCNS, FCCM, FCNS, FAAN, to discuss pressure injury development in the critically ill and how to properly turn said patients.

Elevate your knowledge in pressure injury development with this return to the the first episode in the NPIAP Podcast series today!

NPIAP is excited to introduce the inaugural Quintet Quiz series!

On a regular basis, you'll receive communications announcing a new quiz featuring five expert-driven questions to challenge your understanding of the latest practices, guidelines, and innovations in the field. Although this is not a CE-accredited activity, it's a fantastic way to:

• Assess your competence and stay current in the field
  
• Engage in friendly competition with your peers
• Grow your knowledge of pressure injuries
• Help shape the future of pressure injury management

Questions utilize practical scenarios and real-life images to test and grow your expertise. You will receive immediate feedback upon submitting your responses.

Click here to register for free and complete January 2025 Quintet Quiz: Can you stage this Pressure Injury?

What to Look Forward To:

• Be among the first to explore the prepublication 4th Edition of the Pressure Ulcer/Injury Prevention and Treatment Guidelines.
• Engage in in-depth discussions on acute skin failure, integrating guidelines, strategies for critical patient care, and much more!
• Earn CE credits through expert-led sessions tailored to help you stay ahead in your practice.

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