Negative pressure wound therapy in orthopaedic patients and the financial impact of delay in discharge for unfunded and Medicaid patients

Abstract

Background: Negative pressure wound therapy (NPWT) is a beneficial adjunct for wound management across multiple specialties. A potential barrier for NPWT use in the Medicaid or self-funded population is the limited ability for these patients to have home therapy. This article reviews the financial consequences for unnecessary inpatient hospital days in these patient populations when they could otherwise be managed with home NPWT therapy. Methods: With institutional review board approval, a retrospective medical record and billing database review was conducted on records from January 2006 to December 2009 to identify patients who received NPWT at an academic Level I trauma center. All NPWT was categorized according to medical service use, indication for use, length of therapy, and identification of patients who were hospitalized only because home NPWT was not available. The average daily charges for inpatient care were determined for patients who were identified as having prolonged stays due to NPWT availability as the reason for a delay in discharge. No statistical analysis was performed. Results: Twenty-five patients were identified who had prolonged inpatient hospital stays secondary to home NPWT availability. The average number of excess hospital days was 4.63, which translates into $148,375 of avoidable inpatient charges. Conclusions: More efficient “charity” care programs and Medicaid exemption processes could lead to substantial healthcare savings in self-funded and Medicaid patients who require prolonged NPWT.