I just got this letter by email from a physician emphasizing (in addition to the ethical issues) the need for clinical studies of Cellular Tissue Products / Skin Substitutes on pressure ulcers. Thoughts anyone?
–Caroline
Dear Dr. Fife,
I am writing to express a growing concern I have recently encountered in my wound care practice. In the last two weeks alone, I have evaluated two patients — aged 95 and 98 — both enrolled in hospice care, who were receiving amnion graft applications from mobile wound care companies.
While I am a strong supporter of the hospital-at-home model and innovative approaches to patient care, I am deeply troubled by the use of costly biologic products like amnion grafts in patients at the end of life. From both a clinical and ethical standpoint, it is difficult to justify such expensive interventions without clear indications or alignment with the principles of standard wound management, especially in hospice settings where the focus should be comfort and quality of life. This practice not only raises concerns about medical appropriateness, but also about the broader impact on our healthcare system. I have seen the comments by others on your blog that the fundamental problem is the payment system which enables this behavior, but surely the real problem is that some clinicians chose to abuse and overuse of high-cost products for financial gain. This behavior threatens to drain the Medicare Trust Fund — a resource that is vital for future generations, including our own as we age.
I would also appreciate it if you could share any data or guidelines you may have regarding the use of skin substitutes, particularly amnion products, in pressure ulcer management and especially for hospice patients. Reliable evidence would be critical as we work to protect both patient well-being and the sustainability of our healthcare system. I look forward to hearing your thoughts and discussing potential strategies to ensure wound care practices remain patient-centered, appropriate, and sustainable.
[Name withheld on request]
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.
