The Politics of Wound Care

  For this month’s editorial, TWC board member Des Bell, DPM, CWS, discusses his support of Dr. Lee Rogers’ run for the US House of Representatives.

  I think of myself as an eternal optimist — a mindset I believe is an important part of the makeup of anyone who has dedicated even a portion of his/her career to the specialty of wound care. One of the most gratifying aspects of being a wound care provider to me is the ability to offer hope for healing in situations where none has previously been achieved or offered. But I fear for the survival of our industry as we’ve come to know it. And I can only hope that I’m wrong about that.

A Perilous State for Wound Care

  I recently returned from the Symposium on Advanced Wound Care (SAWC), the largest gathering of wound care professionals and members from industry in the US, as you are likely aware. I feel compelled to offer my impressions of this most recent SAWC because I felt something there that I have never felt at any other conference. Instead of a “buzz” being created about a topic pertaining to medicine, the common discussions among many attendees had to do with reimbursement, the impact of Medicare reimbursement changes, the Affordable Care Act, health reform, physician audits, electronic health records, quality measures, Meaningful Use, and, in general, the growing frustration and despair surrounding delivery of care. For an eternal optimist, the content was rather heavy. These issues are not exclusive to wound care, although we are feeling a major brunt of the changes and I believe wound care as we know it is in great peril.

  Cutting reimbursement for wound care-related services has gained momentum over the years. First, it was debridement and perceived “overuse” of its codes. Most recently, skin substitutes have come under fire. Next up, hyperbaric oxygen. I think we will also see a marginalization of wound specialists in favor of, once again, the primary care physician. Not that most of them will want to manage wounds, but specialists such as nurse practitioners will get dinged for unnecessary or duplication of service determinations. The Centers for Medicare & Medicaid Services (CMS) and the insurance companies are further marginalizing wound care — a fact that is not open for debate. “Divide and conquer” among our relatively small community is the M.O., and an effort to cut costs pertaining to our segment of medicine is reality.

  I’m not pretending to be psychic here, I just worry that our collective focus on providing the best care to our patients in need has long given way to disgust, outrage, and fear as well as a real concern for the long-term survivability of wound care as a specialty. Why will companies invest in wound care if they will never see reimbursement beyond a few basic products like alginates and hydrogels?

The Politics of Wound Care

  I must also disclose that politics and the politicians who “represent” us, on both sides of the aisle, have increasingly jaded me. Where I once followed politics quite closely I now find that I experience very little individual integrity by immersing myself in it. Political debates today seem to have the substance of professional wrestling interviews. Determining who the “good guy versus the bad guy” is depends on which side you align yourself. These points being stated, I feel compelled to ask you to support the campaign of Dr. Lee Rogers, DPM, as he seeks election to the US House of Representatives from California. As a colleague and friend, I know that he understands what is at stake in both healthcare and wound care among providers and patients. If anyone can answer a committee member’s question, for example, as to whether amputation of a diabetic leg is cost effective, he would be the one. A few years ago, the president stated that doctors were paid $30,000 to amputate a leg (which is erroneous). Does the government want us to prevent amputations or do they feel it more cost effective to sweep these people under the rug? They seemingly want to reduce the cost of the services provided, but they are not comprehending the complexity of what treating a wound entails. But, as a medical director at a California-based amputation prevention center, Lee does. An author of more than 100 scientific papers, articles, and book chapters, Lee has been advancing our understanding of health policy and medicine for years. He’s been named one of America’s “Most Influential Podiatrists” by Podiatry Management magazine, chosen for the Rising Star Award from the American Podiatric Medical Association, and authors a blog for TWC’s sister publication Podiatry Today. His state medical association named him Educator of the Year in 2012 and he has served as chairman of the foot care council for the American Diabetes Association, where he once led on national education and advocacy for preventing amputations.

  As we collectively feel beaten down by the legislative changes that have already begun, Lee promises to be our “Voice in Washington.” The decision-makers with CMS and the insurance companies do not respect what wound care specialists have meant to countless patients. They see only how much money is spent and want to put unqualified doctors, nurses, and allied staff in charge of managing complex wounds among even more complex patients. “Turn back the clock” is a phrase that is not going to be limited to baseball teams wearing throwback uniforms.

What We Can Do

  Just knowing we could have someone like Lee to speak up for us as well as to educate and persuade others would be a huge asset to wound care as well as healthcare delivery. It doesn’t matter where you live or practice, your party affiliation, or what role you have in wound care, having Lee representing us — his constituents who have been without a real advocate — is a critical step if wound care is to survive as a specialty.

  I know unequivocally Lee would represent each of us with his extreme intelligence, compassion, empathy, and determination. His understanding of the issues that are impacting our patients and us is unique. His election to Congress would provide us with a great opportunity to be heard and to bring an end to the lack of understanding and even contempt that our specialty is viewed with by those whose decisions directly impact our fate and the fate of countless others.

  For the sake of patients everywhere as well as our specialty, please support Lee as he offers us our own needed version of hope for healing and optimism for a better future that includes the validation of wound care, not its demise. To learn more about Lee and his campaign, visit www.LeeRogersforCongress.com. –Des Bell, DPM, CWS