The wound care market is in the spotlight, and it is no wonder.
The cost of treating wounds is on the rise and is a significant
portion of health care expenses. According to a new report by
Epicom Business Intelligence, the advanced wound care market has
seen double-digit growth over the past five years. As the graying
of America continues, it is likely these numbers will increase
rather than decrease in the coming decades.
It is clear this trend will have an important impact on the home
care market through the introduction of new materials and
technologies that will enable patients to achieve the same outcomes
that were once only available in the acute care setting.
“Hospitals are trying to get people out of facilities as
soon as possible, which drives a decrease in the length of stay and
has resulted in people being discharged who are not as healed as
they have been in the past,” says Tom Dugan, U.S. president
of Smith & Nephew's advanced wound management division.
“Home care providers are challenged with more complex wounds,
and this has resulted in advanced dressings being used in the home
that were traditionally found in the acute care setting.”
The new possibilities allow patients to remain on the same
continuum, although in a different environment, adds Dugan. He
cites the shift from gauze to foam and the use of antimicrobial
products as examples of how protocols are changing.
“This shift allows the dressing to handle more exudate or
drainage from the wound, which decreases the need for dressing
changes,” he says. “Reducing and preventing infection
is a strong trend, and antimicrobial materials such as silver that
help manage the bacterial burden in the wound are on the
rise.”
Heather Raub Trumm, RN, BSN, CWOCN, The VGM Group's director of
wound care and bariatrics, says there are many trends in the wound
care market that are worth noting, including:
A growing number of negative pressure wound therapy companies
and products;
Support surfaces that are tailored to patients, such as those
that control microclimate;
The use of mist ultrasonic therapy;
An increase in advanced wound care dressings;
Sequential and gradient intermittent pneumatic compression
therapy for mobile patients; and
Increasing use of nutritional products to enhance wound
healing.
“Wound care companies are heavily invested in research and
the creation of new products due to the enormous cost to the health
care system,” says Raub Trumm. “Investing in advanced
wound healing products may be seen as initially pricey but they end
up saving money in the long run.”
The use of negative pressure wound therapy is growing
considerably — and creating increased interest as several new
products have recently been introduced.
“Negative pressure wound therapy has been used in the home
for a while. Now, the focus is on giving patients products that are
easier to use and less complex,” says Dugan. “[Products
are becoming] more user friendly with additional safety features.
It is critical for caregivers and patients to have a product that
is easy and efficient to use.”
Choice is also a factor.
“There is recognition that you need a certain breadth of
products and level of support to be able to support customers
effectively in the market,” adds Dugan. “The theory and
application of products, which are same technology for the most
part, now come with a choice.”
And, although the benefits of negative pressure have been
demonstrated, Dugan emphasizes there are options within the
clinical protocols.
“You can use negative pressure on the patient for a time
and then transition them off to a different type of dressing that
is less expensive in terms of cost per day,” he explains.
“A lot of research is going on in that area, and we want to
educate clinicians and help them make the appropriate
choice.”
Get Educated
As strong as the emphasis is on treatment of wounds, the push
toward prevention is seen as critical.
Marilyn Malone, Invacare Corp.'s product manager for therapeutic
support surfaces, says there are several organizations that are
conducting research that will influence the way the Centers for
Medicare and Medicaid Services approves and reimburses support
surface technology.
“These groups are trying to influence CMS to come up with
and support valid and reliable risk assessment tools that, based on
the rating these scales give the patient, CMS would then support
the patient going directly to a support surface without waiting for
a skin breakdown to occur,” she explains. “It is all
about prevention and changing Medicare policies to be more
efficient in preventing pressure ulcers rather than curing
them.”
According to Malone, there is also a movement in the industry
— and one she believes would be a good change — to
discontinue the use of innerspring mattresses with hospital beds
used in the home and to use support surfaces as the first line of
defense.
Malone is hopeful these initiatives will have positive
outcomes.
“New policies should not limit patients' access to the
proper pressure ulcer management technology or support
surface,” she says.
Get Educated
The advances in wound care and the shift from acute- to
home-based care offer new opportunities for HME providers. From
advanced wound dressings to negative pressure wound therapy to
support surfaces, there is a benefit to expanding or enhancing
product offerings. However, being knowledgeable is the first step
in determining success in this area.
“It is important for HME providers to be knowledgeable
about trends and what is going on in their field and to be
knowledgeable about what types of patients are coming out of the
acute care setting and what their needs are so they can be prepared
to fully service those needs, whether it is with clinical services
they can provide or the products they need to have treat the more
complex wounds,” says Dugan.
Raub Trumm advises providers to investigate their market to see
what their competitors are doing and whether there is a void for
referral sources.
“Sometimes it's as simple as when a case manager calls to
ask if he or she will also need a support surface for the
patient,” she says. “If that is the case, HME providers
should remind them that they offer [support surfaces] as
well.”
Malone agrees, reminding providers that if referral sources
don't know the HME company carries a certain product, they won't
ask for it.
For rehab providers, she adds, this is a perfect fit.
“For people who are already in the business, specifically
rehab, who are doing seating, it seems like it would be a natural
progression to ask what the person is sleeping on. Maybe it makes
sense to put them on a support surface from the get-go and give
them 24-hour support,” she says.
Dugan says it is both an economic and clinical opportunity to
expand product lines to include advanced wound care dressings and
negative pressure wound therapy “as appropriate.”
Additionally, HME providers have heard for years that
diversification, within reason, is a good thing. With wound care,
it can be an interesting option.
“Wound care entails more than just dressings. If someone
has a wound, also let them know you have nutritional products that
can help that wound heal faster, as well as advanced wound care
dressings, compression therapy, support surfaces and negative
pressure wound therapy,” says Raub Trumm.
She also advises offering products for caregivers.
With wound care, as with all areas of HME, referral sources are
the key to success. Having physicians and others understand what
your company does and how do you do it differently from your
competitors is instrumental in securing future referrals.
One of the first steps in establishing a referral source
marketing program is to rely on manufacturers for assistance. Many
provide educational, financial and marketing resources that can
assist providers in reaching out to referral sources to demonstrate
their ability to service patients. As technology increases and
products continue to become more effective, HME providers can be a
great educational resource for referral sources. If they are not
aware of the technology, they can't recommend it or approve it.
“Manufacturers offer a lot of training and in-service
educational programs. It is a good partnership that allows
providers to improve their ability to utilize the technologies
appropriately and improve their ability to deliver better care,
which at the end of the day is what it is all about,” says
Dugan.
Raub Trumm advises that providers be diligent in asking
questions and focusing on what the referral source's patient needs,
noting that improving the quality of care is the key priority.
Additionally, she says it is important to visit with referral
sources regularly to determine what their current needs are and
whether they have been satisfied with past experiences.
The HME industry is facing challenges from many sides. However,
experts advise providers to examine their businesses to see what
opportunities might lie ahead.
“In these uncertain times, there is so much emphasis on
coping and the retracting economy, but this is an industry where
the business is growing and providers should not be afraid but look
for the opportunities that exist,” says Malone.
And, it is certain that preventing wounds and treating wounds
that do occur in the home care setting is cost effective.
“The bottom line is that there are a lot of products that
are being utilized in acute care institutions that have equal
efficacy in a home care setting,” says Dugan.
“Increasing the awareness of the options and the appropriate
use of those products in the home is an important thing we can all
do.”
Crunching the Numbers
Treating wounds in the United States is costly. In fact, it is
very costly. To illustrate the prevalence and cost of some of the
most common wounds, Heather Raub Trumm, RN, BSN, CWOCN, The VGM
Group's director of wound care and bariatrics, offers these
statistics:
Venous Stasis Ulcers
Annual cost: $5 billion
Average charge per case: $2,000 to $10,000
This wound, which may be the most common, has an 80 percent
recurrence rate.
Pressure Ulcers
Annual cost: $12 billion
Average charge per case: $40,000
Pressure ulcers are most commonly seen in those 65 years and
older, with approximately 2.5 million patients treated yearly in
the acute care setting. Likewise, 24 percent of skilled nursing
patients develop a pressure ulcer at some time.
Diabetic Foot Ulcers
Annual cost: $5 billion
Prevalence: 15 percent of diabetes patients will have a foot
ulcer at some time in their life.
Diabetic foot ulcers account for 80 percent of wound care
costs.
Experts Interviewed
Tom Dugan, U.S. president, advanced wound management division,
Smith & Nephew, St. Petersburg, Fla.; Marilyn Malone, product
manager, therapeutic support surfaces, Invacare Corp., Elyria,
Ohio; and Heather Raub Trumm, RN, BSN, CWOCN, director of wound
care and bariatrics, VGM Group, Waterloo, Iowa.
