Why Wound Care?

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.