Is Cheap Really Better?

Dear Readers,   Today, it seems that everyone is enamored with shopping online and at discount stores in an attempt to get the things they want at the cheapest price. There is no question that there are some great deals to be had if one looks hard enough, but is cheap always a deal? It calls to mind the old adage, “You get what you pay for.” Is a cubic zirconia as good as a real diamond? They look the same, don’t they? But what about the quality? What about health care, especially wound care? Is cheaper just as good as expensive? According to some, it is.   In 2003, researchers at Dartmouth University seemed to imply that US medical care was so ineffective that greater spending actually resulted in poorer care.^1,2 Many have used these papers to declare that we can improve health care by cutting costs! This is a classic example of using information that says one thing and claiming it says the opposite. According to Dr. Joynt and Dr. Jha, these studies show that “dysfunctional systems produce expensive, poor-quality care.”³ Several recent publications have, indeed, shown that hospitals that spent more on nursing care, medical specialist visits, indicated procedures, and physician follow-up visits had greater patient satisfaction and better outcomes.^4–6   What does this mean for us in wound care? Obviously, it means that quality will suffer as reimbursements continue to be cut below what it costs us to provide the care. When we are held to high standards to provide high quality wound care and reimbursement does not cover the cost to provide that care, one of two things will happen. The quality of that care will decrease or the care cannot be provided. We have already seen this with some of our medical colleagues who are unable to provide care to certain patients because of the poor reimbursement. Compression therapy is suddenly becoming difficult to provide, as the reimbursement for compression bandaging is reduced to below the cost of the bandages without any consideration for the time and skill required to apply them. If this persists, substandard compression bandages or no compression bandages may soon be the norm, and patients will suffer. We must fight, as individuals and organizations, a directed and prolonged battle against this attitude.   Dr. Seth Powsner from Yale University has a tongue-in-cheek (I hope) observation about the cost of health care: “People do want some things repaired—usually, their friends and family. Human repair is often expensive and is entangled with emotions and feelings, values, hatreds, and loves. If limiting costs is the goal, consult our veterinary colleagues who routinely confront pet repair costs that families cannot afford or will not pay.” I think everyone understands the implications of that.   It is our goal to make everyone understand that quality patient care results in better outcomes. Practicing efficient, evidence-based, high-quality wound care should be the goal of every wound care practitioner. Unfortunately, this care may be expensive, but if we can close a wound, salvage a limb, get someone back to work, or improve a life, is it not worth the cost? Is cheap really better?

References

1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273–287. 2. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288–298. 3. Joynt KE, Jha AK. The relationship between cost and quality: no free lunch. JAMA. 2012;307(10):1082–1083. 4. Jha AK, Orav EJ, Dobson A, Book RA, Epstein AM. Measuring efficiency: the association of hospital costs and quality of care. Health Aff (Millwood). 2009;28(3):897–906. 5. Jha AK, Orav EJ, Epstein AM. Low-quality, high-cost hospitals, mainly in South, care for sharply higher shares of elderly Black, Hispanic and Medicaid patients. Health Aff (Millwood). 2011;30(10):1904–1911. 6. Stukel TA, Fisher ES, Alter DA, et al. Association of hospital spending intensity with mortality and readmission rates in Ontario hospitals. JAMA. 2012;307(10):1037–1045.