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Viewpoints Blog

Through Member collaboration, MCRA helps drive performance improvements, deliver exceptional service, transform care, and champion the health and wellbeing of the communities we collectively serve.

Consistent Care: Reducing the Need for Inpatient Treatment for Wounds (Part 2)


The inpatient setting is not the best place to treat wounds. Too often in wound care, patients look to an acute care hospital to provide relief, ignoring myriad factors that make it an imperfect resource for wound care. 

Hospital Room

Regardless of perspective, treating wounds in the hospital is not ideal, especially in the light of the growth of population health initiatives designed to keep patients out of the hospital. Those programs have not done enough, at this point, to keep patients out of the hospital. Claims data shows that 80% of the wound patients with inpatient hospital stays have a primary wound diagnosis. We need to address this by finding ways to deliver consistent care while reducing the need for inpatient wound treatment. 


When we look at inpatient wound care, three areas of concern rise to the forefront: cost, readmission rates, and long-term outcomes. 


It’s Expensive

This should not come as a surprise to anyone, but a hospital stay is expensive. From the moment you step through the doors, the bill starts adding up. This is a hard pill for health plans to swallow, given that they are the ones who often foot the bill.


When we look at CMS data, we see that the average case cost per member with one or more chronic wounds is $10,600 annually. We can drastically lower that number by moving care away from the hospital to more appropriate outpatient settings—particularly the home.


Readmission Danger

While a hospital may give patients round-the-clock care, it is unsustainable. Once a patient leaves the four walls of the hospital, resources become limited and the care plan often reverts to a traditional outpatient model utilizing wound clinics or home health, which both have familiar barriers to delivering effective care.

Readmission drastically increases costs for health plans and has negative consequences on provider reimbursements from CMS. While the inpatient setting may seem like a good answer for patients, it comes with the danger of readmission.


Not Seeing Long-Term Success

Patients aren’t seeing the long-term results that they should expect from inpatient care. With the increased expense, it is not unreasonable for patients to expect better outcomes. However, CMS data doesn’t show that. Instead, it shows a care path that is fraught with barriers, challenges, and poor outcomes.


Instead of looking at the short-term treatment of wounds, providers need to look at the unique situation of each patient and take the social determinants of health into account. This can have a major impact on a patient’s ability to receive the needed care. For health plans, this means finding care models that address the social determinants of health in a way that makes sense for the patient, caregivers, and the health plan.

 

The bottom line—we need to reduce our dependence on inpatient wound care.


By taking wound care outside of the hospital, we can utilize an evidence-based, best practices care model. Most importantly, we can create a care model based on accountability that delivers sustainable results. For clinicians, hospitals can increase access to care for the rest of the community by freeing up beds that previously went to wound patients. Health plans can lower their wound spend, freeing up resources for other plan members.


Esperta Health’s model takes wound care out of the expensive inpatient setting and brings it into the home with wound-certified clinicians. Removing barriers and addressing the social determinants of health allows for patients to see the long-term results they need and allows them to get back to their lives. It’s about reducing our dependence on inpatient care and delivering a model that addresses the needs of an entire population.


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