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New Study Demonstrates the Economic Costs; Medicare Policy Implications of Chronic Wounds

10/12/2017 8:59 AM | Anonymous

With quality measure-based payment models now driving Medicare reimbursement under MACRA (the Medicare Access and CHIP Reauthorization Act), wound care practitioners have faced a unique challenge: few reportable quality measures relevant to wound care.

A study recently published in the International Society For Pharmacoeconomics and Outcomes Research's Value in Health journal shows the full burden and cost of wound care in the US Medicare population, highlighting the need for CMS health policy makers to develop more appropriate quality measures, episode of care measures and reimbursement models for wound care. The findings - particularly the insights regarding the costs of diabetic foot ulcers and diabetic infections - are of particular interest to the podiatry community.

The study "An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds" analyzed 2014 Medicare data and determined the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by setting. The findings are compelling:

  • Chronic nonhealing wounds impact nearly 15% of Medicare beneficiaries (8.2 million).
  • A conservative estimate of the annual cost is $28 billion when the wound is the primary diagnosis on the claim. When the analysis included wounds as a secondary diagnosis, the cost for wounds is conservatively estimated at $31.7 billion.
    • Surgical wounds and diabetic foot ulcers drove the highest total wound care costs (including cost of infections).
    • On an individual wound basis, the most expensive mean Medicare spending per beneficiary was for arterial ulcers followed by pressure ulcers.
    • Hospital outpatient services drove the greatest proportion of costs - demonstrating a major shift in site-of-service costs from hospital inpatient to outpatient settings.
    • Surgical infections were the largest prevalence category, followed by diabetic wound infections.

This documentation of the economic impact of nonhealing wounds can be meaningful from a policy perspective moving forward. "The true burden of wound care to Medicare has remained relatively hidden and have not been a focus from a public policy standpoint in the U.S. We are hopeful that documenting the significant economic cost and impact of chronic wounds can influence priorities for Federal research funding in this space and for innovative payment approaches by the CMS, including quality and performance measures within MACRA," noted lead study author Dr. Samuel Nussbaum, Schaeffer Center for Health Policy and Economics, University of Southern California.

National quality measures have not been developed for use under MACRA's Merit-based Incentive Payment System (MIPS) that are relevant to the broad spectrum of wound care. With quality measure-based payment models driving Medicare reimbursement under MACRA, this is a problem for practitioners. "CMS needs to recognize the cost and prevalence of chronic wounds in the development of chronic care models and episodes of care. Chronic wounds can't be forgotten about if we want to drive better health outcomes and smarter wound care spending," said co-author Caroline Fife, MD, Medical Director, CHI St. Luke's Hospital (The Woodlands, Texas) and Executive Director, U.S. Wound Registry.

The study was funded by the Alliance of Wound Care Stakeholders, an association of clinician associations and medical specialty societies focused on promoting quality care and access to products and services for people with wounds and the providers who treat them. The Alliance has been leading advocacy initiatives to educate policy makers and regulators about the importance of more meaningful quality measures for the wound care space. The American Professional Wound Care Association is a member of the Alliance.

The full study is available online; the Alliance's comments to CMS seeking performance measures more relevant to wound care are posted on www.woundcarestakeholders.org.

Downloads: Full Article (PDF) / Fact Sheet / News Release

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