The Alliance of Wound Care Stakeholders sponsored an updated analysis of the cost chronic wounds among Medicare beneficiaries and the paper, “Chronic Wound Prevalence and the Associated Cost of Treatment in Medicare Beneficiaries: Changes Between 2014 and 2019,” just published in the Journal of Medical Economics.
We analyzed the complete Medicare claims dataset to compare the cost of chronic wounds in 2019 with our previous analysis of 2014 data. (We chose 2019 to avoid the impact of COVID-19.) This retrospective analysis of Medicare claims data included beneficiaries who experienced episodes of care for diabetic foot ulcers and infections; arterial ulcers; skin disorders and infections; surgical wounds and infections; traumatic wounds; venous ulcers and infections; unspecified chronic ulcers; and others.
It won’t surprise anyone that the number of Medicare beneficiaries with a wound/ulcer increased from 8.2 million to 10.5 million between 2014 and 2019. Wound prevalence also increased with a staggering 16.4% of Medicare beneficiaries being affected by a wound or ulcer. Interestingly, over the 5-year period the Medicare beneficiaries with the largest increase in chronic wound prevalence were those aged less than 65 years (presumably, these are disabled individuals).
Just as we saw in 2014, surgical wounds remain the most expensive wound. (I find this particularly frustrating, given the fact that there is almost no research on directed at this wound type.) And, just as we saw in 2014, most of the cost of wound care continues to be in OUTPATIENT settings. Why? Because wounds are often present for months, so the majority of their care occurs in the outpatient setting. (Dressing manufacturers, most of your dressings are being used in the outpatient setting – not the inpatient setting!) The prevalence of arterial ulcers increased more than other ulcer type (0.4% in 2014 to 0.8% in 2019) but arterial ulcers also had the largest cost decrease ($9,651 to $1,322) (explaining this would take a lot more analysis of the data). Interestingly, venous ulcer costs per Medicare beneficiary increased from $1,206 to $1,803 per patient.
The big surprise is that, despite the fact more Medicare beneficiaries were impacted by wounds and ulcers, Medicare expenditure for wound care has DECREASED since 2014. That’s particularly surprising since overall Medicare costs increased substantially over the same time frame. It’s challenging to measure the specific cost of a wound in a patient with many other medical conditions, so we calculated the minimum cost (those which were clearly related to the wound) and the maximum possible cost which includes estimates of the contribution of a wound to any hospitalization. Regardless of the cost calculation method used, wound care expenditures went down ($29.7 billion in 2014 compared to $22.5 billion in 2019 – using the most conservative method). Hospital outpatient fees saw the largest reduction ($10.5 billion down to $2.5 billion) although home health agency expenditures decreased from $1.6 billion to $1.1 billion. Physician offices saw an increase from $3.0 billion to $4.1 billion and durable medical equipment increased from $0.3 billion to $0.7 billion. (I will have a lot to say about that later.)
The timing of this analysis could not be better, given the project currently underway by the Centers for Medicare and Medicaid Services (CMS) to calculate the cost of treating chronic, non-pressure ulcers. I will discuss the importance of this Medicare chronic ulcer “cost measure” in a lot of detail in the months to come. Meanwhile, check out the paper just published in Journal of Medical Economics on the cost of wound care.