Most of us are familiar with the saying “you get what you pay for.” And when it comes to the cost of wound care products, there is definitely truth to that.
However, when considering the overall treatment plan, spending more doesn’t always equate to best practice or best results.
Cost-effective wound care means providing the most successful treatment to heal the wound at the least amount of cost. And with annual treatment costs of wound care in the billions in the U.S. alone, there’s plenty of reason to be cost conscious when choosing treatment strategies. Let’s take a look at some of the basic concepts behind this approach.
Keep Patients’ Financial Interests in Mind
First, we should always strive not to put a financial burden on the patient. The cost of individual patient care ranges from $20,000 and $150,000 for pressure injuries alone. We should work within the limits of the patient’s insurance coverage whether that is Medicare, Medicaid, or private insurance. Being aware of what their insurance covers and doesn’t and the amount of copays and deductibles are great places to start as we put together the treatment plan.
When a product is not covered, look for similar alternative options, and if none are available, then informing the patient of the potential costs is crucial. The patient may choose to forgo that treatment due to the cost, and we will need to go back to the drawing board to come up with another more affordable option.
Facility Costs Are Important Too
Second, our treatment plan should not put an undue financial burden on the facility. Facilities should not be expected to absorb the cost of wound care treatments ordered by prescribing clinicians when the use of a product is not appropriate or cost effective. If a treatment is medically necessary and there isn’t a more cost-effective alternative, that is a different story.
I frequently hear from my students about treatment orders for daily dressing changes of foam dressings. Although foam dressings are an excellent product, they are not meant to be changed daily. They are an extended wear dressing and should only be changed every three to seven days to be cost effective.
Even Medicare recognizes this, as it will only cover the cost of 12 dressings per month. This stands to reason with chronic wounds affecting 8.2 million Medicare beneficiaries (about 15%) annually, inappropriate use and overuse of products can unnecessarily cost facilities (and patients) thousands of dollars.
Are Third Parties Paying Too Much?
Third, our treatment plan should not put an undue burden on the third-party payor. Just because a product or treatment is covered, doesn’t mean we should use it. We should first ensure that the product or treatment is appropriate to use at this point in the wound healing process.
For example, negative pressure wound therapy generally is covered by insurance; however, placing it on a largely necrotic wound will produce little benefit and goes against the idea of “cost-effective care”. We should then analyze if there is a less expensive similar product that will produce equivalent results.
And finally, we should maximize the wear time of the product. If a dressing doesn’t need to be changed every day, then it shouldn’t be. Product usage (frequency and indication) should be based on manufacturer guidelines and clinical evidence, not on our personal feelings of how we think wound care should be done.
The idea that throwing more money at the wound will make it heal faster is not based on common sense, logic, or even science and clinical evidence. We have so many excellent products to address the different issues that wounds present, and our goal is to match those needs with the most effective product at the lowest cost to everyone.
A great way to think about this is to pretend you had to pay for the treatment yourself (put some skin in the game so to speak). I am willing to bet we would make more sound financial choices when we have something to lose.
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What do you think?