Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE, et al.
Journal of medical economics. Date of publication 2023 Jan 1;volume 26(1):894-901.
1. J Med Econ. 2023 Jan-Dec;26(1):894-901. doi: 10.1080/13696998.2023.2232256.
Chronic wound prevalence and the associated cost of treatment in Medicare
beneficiaries: changes between 2014 and 2019.
Carter MJ(1), DaVanzo J(2), Haught R(2), Nusgart M(3), Cartwright D(4), Fife
CE(5)(6).
Author information:
(1)Strategic Solutions, Inc, Bozeman, MT, USA.
(2)Dobson DaVanzo & Associates LLC, Vienna, VA, USA.
(3)Alliance of Wound Care Stakeholders, Bethesda, MD, USA.
(4)Integra Lifesciences, Princeton, NJ, USA.
(5)Baylor College of Medicine, Houston, TX, USA.
(6)The US Wound Registry, TX, USA.
OBJECTIVE: To determine the cost of wound care and prevalence of chronic wounds
for Medicare beneficiaries in the aggregate, by wound type, and by setting
between the years 2014 and 2019.
METHODS: This retrospective analysis of Medicare claims data included
beneficiaries who experienced episodes of care for diabetic foot ulcers and
infections; arterial ulcers; skin disorders and infections; surgical wounds and
infections; traumatic wounds; venous ulcers and infections; unspecified chronic
ulcers; and others. The 2014 data were based on a Medicare 5% Limited Data Set
whereas for 2019 the data used were for all fee-for-service Medicare
beneficiaries. Three methods were used to generate expenditure estimates: (a) a
low (Medicare provider payments when the wound was a primary diagnosis,
excluding any kind of deductible); (b) mid (primary plus secondary diagnosis
with weighted attribution); and (c) high (primary or secondary diagnosis). The
main outcomes were the prevalence of each wound type, Medicare expenditure for
each wound type and aggregate, and expenditure by type of service.
RESULTS: Over the 5-year period the number of Medicare beneficiaries with a
wound increased from 8.2 million to 10.5 million. Wound prevalence increased by
13% from 14.5% to 16.4%. Over the 5-year period, the Medicare beneficiaries with
the largest increase in chronic wound prevalence were those aged <65 years
(males: 12.5% to 16.3%; females: 13.4% to 17.5%). The largest changes in terms
of wound prevalence were increases in arterial ulcers (0.4% to 0.8%), skin
disorders (2.6% to 5.3%), and decreases in traumatic wounds (2.7% to 1.6%).
Expenditures decreased regardless of the three methods used with a reduction of
$29.7 billion to $22.5 billion for the most conservative method. Except for
venous ulcers in which costs per Medicare beneficiary increased from $1206 to
$1803, cost per wound decreased with surgical wounds remaining the most
expensive to treat (2014: $3566; 2019: $2504), and the largest decrease for
arterial ulcers ($9651 to $1322). Hospital outpatient fees saw the largest
reduction ($10.5 billion to $2.5 billion) although home health agency
expenditures decreased from $1.6 billion to $1.1 billion. Physician offices saw
an increase from $3.0 billion to $4.1 billion and durable medical equipment
increased from $0.3 billion to $0.7 billion.
CONCLUSIONS: It appears that chronic wound care expenditures have shifted to the
physician's office from the hospital-based outpatient department. Given that the
prevalence of chronic wounds is increasing, especially among the disabled under
65, it will be important to know whether these shifts have positively or
negatively affected outcomes.
Plain Language Summary: HighlightsIn 2014 chronic wounds impacted 14.5% of
Medicare beneficiaries but this increased to 16.3% by 2019. The group of
Medicare beneficiaries most affected in terms of chronic wound prevalence over
the 5-year period were those aged <65 years (males: 12.5% to 16.3%; females:
13.4% to 17.5%). The largest changes in terms of prevalence were increases in
arterial ulcers (0.4% to 0.8%), skin disorders (2.6% to 5.3%), and traumatic
wounds (2.7% to 1.6%)Over the 5-year period, regardless of the method used,
there was a decrease in chronic wound-related costs ($29.7 billion in 2014 to
$22.5 billion in 2019 for the most conservative method: Medicare provider
payments when the wound was a primary diagnosis, excluding any kind of
deductible). Surgical complications still represent the largest wound category
of costs with a small decrease from 2014 to 2019 of $6.1 billion to $5.9
billion. Based on the most conservative method, there was a very large cost
reduction observed for outpatients from $10.5 billion to $2.5 billion with a
correspondingly smaller decrease for inpatients of $5.3 billion to $4.2 billion,
but an increase from $3.0 billion to $4.1 billion for physician offices. In
addition, while durable medical equipment increased from $0.3 billion to $0.7
billion, home health agency expenditures decreased from $1.6 billion to $1.1
billion.Our data suggest that while most of the cost remains in the subacute
setting it has shifted to the physician's office from the hospital-based
outpatient department. Given the increasing prevalence of chronic wounds,
especially among the disabled under 65, it will be important to know whether
these shifts have positively or negatively affected outcomes.
DOI: 10.1080/13696998.2023.2232256
PMID: 37415496 [Indexed for MEDLINE]
