Wound care feature: Prevent defense
Better care, better products may prove to be a nursing facility's best weapons in the long-term fight against wound care expenses.
The world of wound care in the 21st century is a lot like other aspects of life in this hyper-tech age. While it is deeply affected by new procedures, ways of thinking and scientific breakthroughs, in a lot of ways it comes down to good old-fashioned common sense.
Many new products, equipment and research have helped push wound care to new heights. But maintaining good pressure surfaces and practicing regular assessments of residents are still often the best defense against emerging or worsening wounds.
Balancing good medicine and technological innovation can also be applied to the finances of wound care. In many cases, keeping costs down means investing heavily in capable products, as well as good nursing care, before a potential wound strikes.
The new government guideline regarding pressure ulcers – F-Tag 314 -- makes it even more imperative for facilities to focus on fighting wounds up front. That might mean hiring a wound care consultant to help establish sound protocols, buying pressure mattresses for residents upon their admission and paying a little bit more for the most effective ointments and dressings, experts say.
Wound care expenses pose some of the largest direct-care costs to long-term care facilities today.
Consider these figures from Ken Beckrich and Sharon A. Aronovitch in a 1999 article in Nursing Economic$: The costs of hospital-acquired pressure ulcers is between $2.2 billion and $3.6 billion annually. Each hospital-acquired Stage I and Stage II pressure ulcer costs $125, while each hospital-acquired Stage III and IV pressure ulcer costs around $14,000.
Chronic wounds -- those that afflict patients with comprised immune systems -- pose the greatest costs because they require a systematic approach to healing. That approach includes paying attention to proper nutrition, incontinence, dressing changes and pressure surfaces. Often, those costs are hidden.
While wound care includes direct costs such as dressing materials, caregiver time and operating room antibiotics, there are also indirect costs, such as extra inpatient days and lost workdays.
One of the biggest indirect costs is unrelated to treatment. Rather, the cost of litigation is one of the most daunting consequences of improper wound care. Costs of wound care also may include fines from surveyors. But most expensive is the cost of a battered reputation.
One way nursing homes could keep down their costs is by keeping their funding sources in mind, says attorney Lori-Ann Rickard of Rickard & Associates P.C., St. Clair Shores, MI.
"They need to stop acting like mom-and-pop nursing homes," she says. "Providers think their customer is the patient. That is not, in fact, the case. The customer is the payer (i.e., Medicaid, Medicare). That means you have to do what state and federal governments require."
Due in part to the threat of lawsuits and government fines, prevention has taken the front seat in the argument for wound care.
"They're willing to spend more for prevention because of the negative and monetary impact that the development of a pressure ulcer can cause a facility," said Rosalyn Jordan, senior clinical manager for Huntleigh Healthcare of Eatontown, NJ, a manufacturer of pressure-reducing mattresses. The Centers for Medicare & Medicaid has helped push forward prevention with the publication of
F-Tag 314 last November.
It introduced the idea that pressure ulcers can develop within two to six hours of the onset of pressure, and that a number of pressure ulcers develop within four weeks of admission. It also recognized that deep-
tissue damage could lead to the appearance of an unavoidable Stage III or IV pressure ulcer.
Costs of prevention
The policy not only has affected the way facilities view treatment, but it has also influenced the way facilities regard costs.
"There is a huge paradigm change going on in the industry," said Dr. Jim Spahn, chief executive officer of EHOB Inc., which sells a WAFFLEÂ® line of products for the preven