Ensuring optimal skin health outcomes while also lowering cost per case poses several challenges for healthcare organizations, especially given the increasing need of skin and wound care, increasing complexity of wound care management, and the industry's changing reimbursement structure.
“To ensure cost-effective wound care management, healthcare organizations must carefully balance clinical and financial priorities, while also placing a greater emphasis on prevention strategies,” explained Maria Kotula MSN, BSN, BA, RN, CWON, clinical operations manager for wound care at Dublin, Ohio-based Cardinal Health.
Prior to joining Cardinal Health, Ms. Kotula worked as a Certified Wound Ostomy Nurse at Charlotte, N.C.-based Atrium Health, formerly Carolinas Medical Center.
Here, Ms. Kotula discusses the importance of optimal skin health, explains the main challenges associated with skin and wound care and shares how healthcare organizations can provide effective care while also addressing potential financial burdens.
Editor's Note: Responses have been lightly edited for length and clarity.
Question: When it comes to balancing financial needs and clinical priorities for wound care, what are the biggest challenges healthcare organizations face?
Maria Kotula: It's no secret that the healthcare industry is under tremendous pressure to improve patient outcomes while reducing costs. Wound care is no exception. This demand affects the entire spectrum of wound care, whether traditional staples of wound care like Kerlix, Xeroform, etc… or more advanced therapies like Negative Pressure Wound Therapy. This push to lower costs, coupled with the increasing complexity of wound care — which requires clinicians to treat the whole patient, not just the hole in the patient — is what creates tension between financial and clinical decisions.
Having the correct combination of wound care essentials is key to achieving the right balance between financial and clinical priorities. It's what will ensure healthcare organizations are meeting the needs of each patient, no matter what those needs are. It's about having advanced dressings or therapies for the patient who has an infection or a chronic wound, while also having enough traditional wound care products. Having the right balance will keep costs in check.
Q: What are some specific examples of financial challenges related to wound care?
MK: Negative pressure wound therapy is usually the largest bill for a facility's wound care budget. Today, negative pressure is being used in hospitals, extended care facilities and home health services. Not only is the therapy expensive, but it can also delay discharges because it can take days for the hospital to get approval to use negative pressure for the patient. When hospitals are looking at ways to cut costs in the wound care category, they most look at negative pressure because that's one of their biggest items on the bill.
Another major cost challenge in wound care is infection control. Healthcare-associated infections can significantly decrease CMS reimbursement dollars. Many clinicians consider silver dressings as the gold standard. However, silver can also cause adverse reactions. To help cut costs, hospitals must shift their focus to prevention and ensure they are treating a wound before it becomes infected so there won't be a need to use as many silver dressings. For patients at risk of infection, clinicians should consider Polyhexameylene Biguanide (PHMB) which is a mild, yet broad-spectrum kill antiseptic. PHMB has been proven to resist bacterial colonization and reduce bacterial penetration within the dressing without negatively impacting epithelization and with low/minimal cytotoxicity.
Q: How can clinicians and healthcare organizations overcome these challenges to achieve optimal skin health?
MK: There's a saying that goes, "an ounce of prevention is worth a pound of cure." That rings true here. A great suggestion is to start with prevention, which includes three cornerstones.
- The first cornerstone is a broad skin care line that can keep healthy skin healthy and treat a wide scope of issues ranging from dryness to incontinence-associated dermatitis. This also means making sure the ingredients are simple to avoid unintended allergic skin reactions.
- The second cornerstone is an incontinence portfolio that has clinical thought behind it. The portfolio should include products like premium underpads that are designed to keep the patient dry, help reduce friction and neutralize pH to stop incontinence-associated dermatitis in its tracks.
- The third cornerstone is infection control. The goal is to prevent the infection before there is a need for advanced wound care dressings.
It is important to note that there's just no way healthcare organizations can prevent every wound or skin care issue from occurring. But by establishing consistent prevention practices, they can begin to taper off the wound issues that morph into bigger problems, which is where the skyrocketing costs come in.
Another recommendation is educating staff. Making sure nurses can easily find the right skin care product, wound dressing, or incontinence products for the right patient at the right time is vital to overcoming some of these challenges.
Q: How frequently should healthcare organizations update and review their formularies?
MK: At least yearly but more often if your facility is seeing specific trends in wound care or patient outcomes. For example, wound care teams often keep track of their pressure injury scores and the types of wounds they're seeing in the hospital. If they see an uptick of a certain etiology, this should also trigger a review.
Q: How can healthcare organizations determine if they are purchasing clinically appropriate skin health products?
MK: Leaders can ensure they are intelligently purchasing skin health products by making a list of clinical priorities for each dressing category. For example, for incontinence underpads, the list may include wicking, absorbency, managing the microclimate, reducing friction and neutralizing pH. Once clinical priorities are identified, leaders should compare product solutions with costs. It helps providers make clinically appropriate decisions with cost in mind.
Another suggestion is for healthcare facilities to find an industry partner that has the same goals, understands the need to care for the whole patient, and is able to arm clinical staff with all the necessary tiers of wound care. This includes a portfolio that promotes skin health, prevents skin breakdown and infection, and treats incontinence.
Q: Why should skin health be a priority for healthcare organizations?
MK: It's often forgotten or dismissed that skin is the body's largest organ. The skin has so many functions, but its main priority is to protect us from infection. Any opening in the skin, from a paper cut to a giant surgical wound, breaks the barrier to the outside world, which allows pathogens to enter.
If a heart failure patient comes to the hospital with wounds of all different etiologies, clinicians must not only treat heart failure, but also those wounds. If they don't, a stage 2 pressure injury could evolve to a stage 3 or 4, which can significantly threaten reimbursement dollars. The average cost of treating a PI is $43,000, and can go significantly higher if there’s a risk of liability.
Q: What will the skin and wound care market look like in the future?
MK: Spend on skin and wound care is projected to increase dramatically. Some studies estimate that the wound care market will triple within the next 10 years, and the U.S. already spends more than $25 billion annually on skin and wound care. Three big healthcare issues are driving the costs of wound care up: diabetes, obesity and an aging population. The increasing incidence of obesity and diabetes, coupled with an aging population, will greatly change the wound care landscape. We will need to accommodate patients with a variety of different wounds and comorbidities in all healthcare settings.
Learn more about Cardinal Health's skin health and wound management portfolio here.