Wounds not a priority for managed care companies

Janice Stanfield, RN, CETN, has seen many cases in which a dollar of prevention could have saved tenfold needed for a cure. Managed care companies often call on Stanfield, an ET nurse and independent wound care specialist in Los Angeles, to remedy obstinate chronic wound cases.

Many times, the patient has been severely mismanaged and the medical bills have added up to a respectable annual salary. "Almost every patient we see who is under managed care has been mismanaged," she says. "The physicians who treat them are often good physicians, but their knowledge about wound care isn’t very up-to-date, and they’ve been providing inappropriate treatment for patients for long periods. So the wounds don’t heal. The managed care company finally sends the patient to us."

Caring for the whole patient

In one poignant case, a managed care company assigned Stanfield and her associates to assume the care of a diabetic patient with a troublesome neuropathic foot ulcer. Treatment had been ongoing for more than a year and a half, but to no avail. One of the problems was that the patient insisted on walking a lot, a barrier to healing that the physician seemed to ignore. The physician had been directing all of his attention to the ulcer itself and failed to address the fact that the patient wasn’t compliant and loved to walk, says Stanfield.

"We weren’t going to get this patient to stop walking, so we brought in an orthotist to supply a special shoe; we brought in a dietitian to counsel the patient about nutrition and help understand that he needed to take some responsibility for getting this ulcer healed," Stanfield recalls. "Then we aggressively debrided the wound and stayed on top of it. In four and a half weeks, the ulcer had completely healed."

Prior to Stanfield’s intervention, treatment costs had exceeded $35,000. During her month-long watch, costs totalled less than $2,000. As usual, Stanfield submitted a report on the case to the patient’s managed care organization, including a cost study that clearly documented the savings that had been realized — and the even greater savings that could have been realized had the payer initiated adequate treatment sooner.

Managed care companies make mistakes like this habitually, Stanfield adds. "They don’t address the underlying issues but spend all of their time putting out fires and avoiding the real source of a problem. They forget that health care professionals must take care of the whole patient and that it requires a whole team of professionals to do that properly. When we see the patient, we look at the whole picture. One person can’t do it all. We have so many wonderfully knowledgeable people in the field of medicine, why can’t we use them to solve problems?"