The Lack of Wound Care Expertise and Its Implications
Updated: Oct 22, 2022
Joseph Ebberwein, Co-Founder and CFO
A study published in the Journal of the American Medical Association (JAMA) highlighted the cost of waste in the U.S. Health system (1) and estimated that the total annual cost of waste ranges from $760 billion to $935 billion in the following categories of waste:
Failure of care delivery, $102.4 billion to $165.7 billion;
Failure of care coordination, $27.2 billion to $78.2 billion;
Overtreatment or low-value care, $75.7 billion to $101.2 billion;
Pricing failure, $230.7 billion to $240.5 billion;
Fraud and abuse, $58.5 billion to $83.9 billion;
Administrative complexity, $265.6 billion.
In this blog, we will share some observations from a recent case study, “Stage 4 Pressure Injury in a High-Risk Patient with Multiple Comorbidities,” developed by Corstrata’s clinical team in conjunction with our VP of Quality.
We will focus on three of the categories of waste mentioned in the JAMA article - Failure of Care Delivery, Failure of Care Coordination, and Low-Value Care - all of which contributed to the development of a costly, preventable Stage 4 pressure injury (ulcer) in a high-risk, vulnerable patient.
Wounds are a 96 billion dollar problem in the U.S., with 15% of all Medicare beneficiaries living with a wound, many of which are preventable with the implementation of evidence-based interventions. Wounds are not an actual disease but are often the result of multiple comorbidities or various diseases such as diabetes, vascular disease, chronic kidney disease, etc. There are many factors that contribute to this large, growing problem, but the primary underlying reason is that No One Owns Wound Care Outcomes. Wound patients are cared for in various care settings by clinicians that are not wound-certified, often resulting in little or no care coordination, poor wound outcomes, higher costs, unnecessary patient suffering, and often death.
Our Corstrata wound team consults with home care agencies caring for patients who are part of the Medicaid I/DD (Intellectual and/or Developmental Disabilities) Waiver Program. Often these persons have multiple comorbidities, coupled with mobility limitations, putting them at the highest risk for pressure injuries (ulcers). Because only 10% of wound-certified nurses practice in post-acute care settings, care is often provided by clinicians lacking knowledge of prevention protocols, optimal treatment plans, and advanced wound dressings that optimize healing.
Recently, Corstrata received a referral for a 37-year-old patient with a stage 4 sacral pressure injury. In addition to the patient’s mother being the primary caregiver, he also receives regular home care aide assistance and is also receiving visits from a certified home health agency following a 2-week hospitalization and subsequent skilled nursing facility stay. Additionally, the patient is being seen by an outpatient wound center and is transported on a stretcher to avoid additional pressure on the sacrum from wheelchair usage.
There are a number of issues noted in reviewing this person’s case:
Could this sacral ulcer have been prevented with education to the caregivers for implementing pressure relief protocols and adequate pressure distribution with the correct hospital bed, wheelchair, and support surfaces?
Could education have helped to identify potential skin integrity issues and potentially prevented this pressure injury from progressing to a stage 4 infected pressure injury requiring hospitalization, a skilled nursing stay, home health services, and wound center treatments?
Suppose there had been adequate care coordination and management (i.e., someone owning the care of the patient, not just the care of the wound). Would the reasons that the wound developed have been identified and addressed with prevention education, appropriate DME - optimal hospital bed with a pressure relief surface and wheelchair with cushion, and referrals to physical or occupational therapy for transfer techniques and other strategies?
How much cost could have been eliminated by preventing the initial wound, preventing deterioration of the wound requiring hospitalization and an SNF stay, avoiding additional post-acute care, and applying the optimal advanced dressings for minimal dressing changes, etc.? Corstrata estimated a savings of $65 per week on dressing costs alone, exclusive of wound center treatments and related transportation costs.
We know that care is being shifted from acute care and long-term facilities to the home as the center of care. In this current era of increased litigation, government scrutiny regarding costs and outcomes, and focus on patient/caregiver satisfaction, this case study highlights that we can and should do better for this vulnerable population. Access to wound experts is critical for all the reasons that we have highlighted, and given the current staffing challenges and scarcity of board-certified wound care nurses, Corstrata provides a viable, cost-effective solution to support a highly coordinated team with optimal and comprehensive care plans for patients with a wound or at risk for wound development.
About Corstrata - Our senior-level, wound-certified nursing staff are some of the best and most experienced in the industry. We couple their expertise with the most advanced wound dressing technology, the latest evidence-based research, and our Telehealth infrastructure to ensure that we deliver the right patient support at the greatest point of need – the bedside.
Contact Us to learn more about how Corstrata can assist you with optimizing your @Home program for IDD and other patients with our board-certified wound and ostomy nurses.
1. Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978