Why are we currently wasting about $15 billion each year to manage a problem that has a clear, permanent solution?
by Dr. Charles Mok
This accounts for about $15 billion per year in healthcare expenditures as outlined in this study published in the Journal of Medical Economics that is $15 billion to use dressings, medications, and skin flaps to treat a disease that has a clear, established cure. It is not just the $15 billion that health insurers pay a year to manage something that can be resolved, there about 600,000 production days of work lost by these people who have to go get wound care.
To put that into perspective, the entire United States health care expenditures on all the vein reflux, venous insufficiency, and varicose vein treatment last year was right around $2 billion. Only a small percentage, about 1%, of those was for the treatment of venous stasis ulcers.
If doctors recognized that what they been doing (for years) does not work very well, and that there is a good alternative, they’d save the healthcare industry over $10 billion year by taking that action alone.
But of course, there are vested interests in maintaining the status quo. I’ve read position papers from various wound care groups as well pharmaceutical groups that outline the management of venous ulcers in terms what medications, dressings, and support garments to use and what future trends to look out for. The interesting thing is that they barely mention the fact that this is totally curable disease.
One wound care group had a position paper making the case for surgery to treat the reflux in patients with chronic wounds and it argued that there is better evidence to use a complex surgery than the more modern radiofrequency and laser treatment. They went on to state that the evidence favored surgery despite this being false. The most recent paper supporting the traditional surgical method of cutting the perforator veins is about a decade old, and before that, there were studies showing that lasers and radiofrequency worked. Over the past 10 years, there been reams of information and numerous studies that unequivocally prove that laser and radio frequency procedures that are very easy to perform, inexpensive, and easy on the patient are superior. This group published this in their 2016 guidelines; they are 10 years behind the times. Their entire article was for wound care physicians and practices about how to continue managing these chronic non-healing wounds versus how to cure them.
I have seen this throughout my practice. By nature, I love learning new things and innovating and implementing. For that reason, my practice has taken on that same personality. We constantly look for ways to do things better, more efficiently, less expensive, and most importantly, safer for the patient. For example, we treat knee arthritis with fat-derived stem cells instead of doing a knee replacement. Not one of my patients has had to go on to get a knee replacement, yet they were all candidates for it before we treated them. This simple procedure consists of removing fat while the patient is awake with the use of a little numbing medication. We take the stem cells and inject them into the knee. This is an easy, inexpensive alternative to a knee replacement and is much safer than surgery. The problem is, health insurance doesn’t cover stem cell therapy for the knees but they will pay for a $25,000 operation.
There are countless examples of the healthcare system being out of touch with modern advances. I think this is largely due to the fact that there are so many people with a vested interest in maintaining the status quo. I’m giving an example of how we could save over $10 billion year by changing our thinking around how we manage chronic wounds.
One school of thought is “we’ve established a wound care center, half our patients are venous stasis ulcers, and they will be our patients for life. This is a good business. It gives us job security, and this is what we know”.
Another school of thought is one that I follow. “Venous ulcers are a huge problem. It is a horrible condition for the patient and a tremendous economic burden for the US taxpayer. There is a simple, easy, and safe way to treat these and then they’re gone for good. Forget managing chronic wounds, make them go away.”
Life is abundant. It is not a zero-sum game where there has to be a winner and a loser. Yes, if my school thought is followed by physicians across the nation, we will cut out over $10 billion year in healthcare waste which will have effect on jobs due to the diminishing number wound care centers and specialists that would be needed. On the other hand, this will free them up to do other things that are actually necessary instead of just creating job security for themselves.
I don’t think this is in any way deliberate, or because of people’s ethics, this is just how we are as people. I think in the future, things like artificial intelligence will help us make better decisions. When the doctor goes to write a prescription or to send the patient for wound care center, artificial intelligence will redirect them into the course of action that will most benefit the patient that is the, least expensive, safest, and most effective treatment available.
When I was prompted to write this article I had to do some reflection on how I was leading our business. I’m generally not seeing patients anymore, and I’m in more of a leadership role. I was involved in the original studies looking at ways to cure venous ulcers instead of just putting a Band-Aid on them and our offices, I have performed over 70,000 vein procedures. Recently, I was visiting one of our facilities and I heard the staff say they were using something called an Unna boot for a few of the patients that had leg ulcers. I asked the surgeon why this was chosen, and was told that this is what they were trained on in their residency years earlier. To put it in perspective, Unna boots were developed in 1910 by a German dermatologist named Paul Unna. Changing from Unna boots to modern compression alone is 400% more effective in the time it takes for wounds to heal. In our practice, our approach to curing venous ulcers involves ablation of the reflux, which is not only 400% more effective than modern compression (and a world away from Unna boots from 1910) on healing speed, but is also generally permanent. Needless to say, I directed the office to stop using Unna boots. It is amazing that Medicare still pays for them.
In summary, the healthcare crisis is definitely real. But I think of it in the same way that I think of running my business. Our business needs be consistently profitable in order provide good jobs with high paying wages and one way to make that happen is to eliminate waste. We look at this all the time. What things are we doing that can be automated? What things are we doing that create no value? What things do we do that are very difficult and expensive that we could potentially innovate upon and create something which is easy and less wasteful? We don’t think of this as saving money or cutting back. We think of this as eliminating waste to create more value for our business and ourselves.
With a third-party payer system, the largest third-party payer is the government and waste continues to be rampant. There is talk of things like rationing healthcare, bigger deductibles, bigger co-pays and other cost saving techniques done by the health care companies are thought leaders. But in reality, the answers are right in front of us. We need to be thoughtful about what we’re doing, remove our vested interest to maintain a business model, system, treatment that benefits the doctor, the hospital, or the wound care center, and think of this from a different standpoint. What is best for the healthcare system and its customers? Managing conditions for years that are curable is an absolute waste of money.