And the award for most maligned part of long-term care goes to ...

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James M. Berklan
James M. Berklan

It took a while, but I might have finally found something that therapy providers can point to with righteous indignation and say, "That ain't right!"

Yes, there might be a sector of long-term care that is in store for more scrutiny and cluck-clucking than the beleaguered rehab leaders who have been found to upcode to prosecutable levels. Given the recent flow of accusations, settlements and convictions, that's no small feat.

The much maligned and neglected field? Wound care.

Yes, it literally stinks sometimes. But author Marisa Taylor has also figuratively affixed a stench to it. Bravo to her, I say.

A writer for the Kaiser Health Network, Taylor has deftly stitched together observations and background from key players that paint a bleak picture of the state of wound-care research today — and a worse picture of how it is paid for.

In a nutshell, she explains how the government and other insurers often don't know what they're paying for, or, worse, pay for products and services that just don't work.

As a long-term care professional, this must be concerning. See the gory details yourself, and I don't mean in the form of raw pressure-ulcer photos. No, this is my tip the hat from one journalist to another — and a caution to all readers, whether you're at the bedside, hiring staff or recruiting heads for beds.

Wound care is paid billions of dollars in this country alone, and much of it is based on bogus, insufficiently tested grounds, critics claim.

“It's an amazingly crappy area in terms of the quality of research,” Taylor relates from Sean Tunis, chief medical officer for Medicare from 2002 to 2005. “I don't think they have anything that involves singing to wounds, but it wouldn't shock me.”

Then there's the recent Health and Human Services review that found that only 0.6% of studies of venous ulcers — that's just 60 out of 10,000 — met basic scientific standards.

“Of the 60, most were so shoddy, that their results were unreliable,” Taylor wrote.

Mortality rates for some types of diabetic wounds can be 50% greater than breast and colon cancers, she added. THAT's why this topic should be so concerning to you and other healthcare advocates.

I personally know and have worked with many high-quality wound-care researchers and vendors in my role as McKnight's editor. So this is no blanket indictment of all who toil in the field.

But the observations in the Taylor article can't be ignored. Its even-handed portrayal of extreme weaknesses in the system is not to be missed.

One of the bottom lines, experts have concluded, is that there are no glamorous champions for wound care. No super models or ex-football players extolling the need for better wound care research and practices, unlike what can now be found for conditions ranging from depression to erectile dysfunction.

Of the billions of dollars spent on medical research each year, a pitifully small percentage goes to wound treatment. One researcher equated National Institutes of Health research spending on wound care to be the same as that for Lyme disease, whose treatments and affiliated costs are just one-tenth of the former's.

That leads to little incentive for companies to perform enough useful comparative studies, critics allege.

Taylor relates that Medicare beneficiaries successfully sued after the program declined to pay for electrical stimulation, a topic that might hit especially close to home for many readers.

“The ruling forced Medicare to reverse its decision based on the fact that the evidence was no crappier than other stuff we were paying for,” observed Tunis, who now heads The Center for Medical Technology. It's an independent nonprofit group dedicated to helping develop a health-delivery system based on evidence-based care.

After reading the Kaiser article on wound care research and practices, it would be hard to argue that it's not sorely needed more than ever.

Follow Editor James M. Berklan @ JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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