“The wounds with no name” (WWNN) are wounds that are due to trauma (not surgical complications) that never heal, PLUS the chronic ulcers that are NOT diabetic, arterial, venous or pressure related. These two groups (accidental wounds and ulcers which are not obviously related to one of the above conditions) are symptoms of the other diseases the patients have (e.g. malnutrition, heart failure, autoimmune disease on immunosuppressive therapy). The wounds/ulcers with no name (WWNN) cost Medicare annually more than Diabetic foot ulcers, pressure ulcers and venous. The WWNN are being completely missed by CMS and the cost models that payers are developing. This means there won’t be money for us to take care of these patients in the future.
Thanks to the paper we published in Value in Heath, we know that over 14.5% of Medicare beneficiaries (8.2 million people) had at least one type of wound/ulcer in 2014.

• The WWNN are never studied in a clinical trial and we do no research on them because we can’t decide what to call them.
  • WWNN are symptoms of the patient’s underlying diseases.
  • The overall healing rate for these wounds/ulcers is less than 50%.
  • They are excluded from outcome reporting by nearly every wound center and management company. They are our dirty secret.
    
• WWNN are related to the “trifecta” of Medicare’s most expensive conditions, and they may be the reason that Medicare’s most expensive medical conditions ARE so expensive which I call, “Medicare’s Cost Bermuda Triad”
• There are 5 conditions which, when a patient has any 3 of them, mean Medicare will spend >$60,000 per year on patient care. The problems are:

1. Stroke
2. Chronic kidney disease
3. Heart failure
4. Asthma or COPD
5. Depression

• The costliest triads include stroke and kidney disease
• Per capita Medicare spending is 7 times higher than the average Medicare spending
• Check out this table from my own Quality and Resource Use report. I only see wound care patients, but I practice only 2 days per week on average. Despite this, I had 17 patients with those chronic conditions, 8 of whom had heart failure, who were hospitalized during this particular year.
  
• Here’s how CMS saw my Medicare spending that year.
  • If cost has been factored into my quality score that year, I would have been penalized for the cost of care of these patients.
    
• The Average wound center patient is in service for almost 8 months (USWR data)
  • According to the US Wound Registry (USWR) data analysis for the Alliance of Wound Care Stakeholders:
    • We looked at 761,214 wounds and ulcers (all types) in 236,352 patients
    • The average wound center patient has 2.2 wounds
    • The average wound is >200 days old when the patient presents to the wound center.
    • Patients develop an average of 1.5 additional wounds/ulcers while still in treatment for the original (making the average number of wounds per patient >3)
    • The average wound is given an outcome within 10 weeks, but the PATIENT stays in service over 7 months because they have several wounds.
      

What’s the Bottom Line?

• Wounds are a chronic condition among Medicare patients
• They may be the unrecognized factor that increases cost among patients with Medicare’s dreaded “triad” conditions
• Wounds are a SYMPTOM of these terrible diseases.
• The healing rate of these patients is low.
• Wound centers avoid reporting on the outcome of these patients because they are so sick.
• Private payers are losing a lot of money on these patients and have not factored their costs in any cost models.
• Wound care practitioners could be held responsible for the cost of caring for these patients because we provide the plurality of their services each year.
• The average patient has >2 wounds and is in service nearly 8 months. WHAT DO YOU THINK THAT MEANS FOR MEDICARE’S BUNDLED PAYMENT FOR WOUND CARE THAT IS TENTATIVELY PLANNED TO LAST 12 WEEKS?

Caroline Fife, M.D.

Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos

The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.