It would be the hope of any developed nation to provide adequate medical and wound care services to all of its denizens. Indeed, we’re fortunate to have modern medical practices to thank for the lives of many, and the dynamic combination of disciplines that makes up the modern health landscape is quite the spectacle, to say the least.
But what happens when some of these services are specialized?
The conditions experienced by many are not well understood and, as such, can be incredibly difficult to manage. Many experts even consider this dilemma a silent, unexpected, epidemic that doesn’t receive the attention it needs to procure the treatment that is necessary.
Chronic Wounds: A Silent, Unexpected Epidemic
Chronic wounds, or wounds that are slow to heal or sometimes non-healing, can include leg ulcers, pressure ulcers, and venous ulcers, among others still. Astoundingly, chronic wounds alone cost US Medicare $28 billion annually, and that’s considered a conservative estimate. Nearly 15% of Medicare beneficiaries, or 8.2 million patients, are affected by ongoing wounds, many of which will never fully heal.
A silent, unexpected epidemic, indeed.
As an example, diabetic foot ulcers have been estimated to cost between $6.2 and $6.9 billion annually. On an individual wound basis, this accounts for Medicare spending between $3,415 to $3,859 per wound. We can also look to arterial ulcers for another example – the most expensive wounds per beneficiary, arterial wounds cost $9,105 to $9,418 per patient. Just behind that, pressure ulcers cost $3,696 to $4,436.
Reflecting these high costs, the global market for wound debridement products has been estimated at $1.8 billion in 2020 and is projected to reach $2.5 Billion by 2027. As the population ages, rates of diabetes and obesity rise, along with poor circulation, less mobility, and an increased risk of underlying health conditions – and with all of these, the rates of chronic wounds also rise. In severe cases, when underlying conditions complicate treatment, these wounds can even lead to morbidity.
Avoiding Treatment: Slipping Through the Cracks
When the average person thinks about wounds, it may seem like they aren’t a big deal. But in the case of chronic wounds, complications can have a compounding effect which leads to ongoing needs and delayed healing. This can happen especially to those that tend to minimize the risk of their own chronic wounds – they may not know about the risks of leaving their wound untreated, or they may be hesitant to seek treatment at all.
When chronic wounds are not treated, several things can happen. First, the risk of localized infection increases. Localized infection occurs at and is confined to the wound site, and the longer a wound remains open and untreated, the larger the window of possibility for infection becomes. Sometimes, the mere presence of an infection can slow healing or make a wound even worse as the body fights the infection, rather than healing the wound.
If a localized infection is left untreated and the chronic wound remains open, the risk of systematic infection begins to rise substantially. A systematic infection is one that affects the whole body, traveling through larger blood vessels to various places not local to the wound site. It’s a very serious condition that requires immediate medical attention.
If a chronic wound is left untreated, it can become life-threatening, affecting surrounding muscles, tendons, and bones. When a wound becomes this severe, the risk of amputation becomes a very real possibility.
If a wound does not respond to treatment due to the presence of chronic disease and poor overall health, an amputation may be needed to save a person’s life. Even more, when a person has one amputation, further amputation on the same leg and/or other leg becomes much more likely.
Even amongst the COVID-19 pandemic, it was reported that many seniors avoided seeking healthcare for chronic issues, reflecting major public health needs for ongoing care and education regarding wounds, interdisciplinary treatment, and preventative practices.
The Nationwide Need for Wound Care
The significant burden of chronic wounds in the Medicare population illustrates the need for access to chronic wound care. Further, the Medicare Access and the CHIP Reauthorization Act of 2015 (MACRA) was signed into law to establish that wound-relevant quality measures are needed in all care settings. This includes healthcare measures, chronic care models, and reimbursement plans to drive better health outcomes and smarter wound care spending in the space.
Whether care is delivered in a hospital setting or through home health care, a multidisciplinary approach that coordinates health-related services and encourages people to seek services before problems become severe is necessary for the successful treatment of chronic wounds.
The idea is to move from costly, often ineffective care – and the subsequent costly nationwide burden – to a model that includes advanced illness and chronic wound management, and is more feasible and cost-effective.
Seniors with five or more chronic conditions account for less than a fourth of Medicare’s beneficiaries, but more than two-thirds of its spending. They are also the fastest-growing segment of the Medicare population, bearing great significance. The idea with ongoing wound care is to intercept those emergency room trips and unexpected hospital stays with more preventative and effective care through a multidisciplinary approach – and in doing so, to fill a nationwide need for more effective chronic wound care.
The views and opinions expressed in this opinion article are those of the author(s) and do not necessarily reflect the official policy or position of The Eastern Herald.