Retrospective Payor Claims Analysis of Patients Receiving Outpatient Negative Pressure Wound Therapy With Remote Therapy Monitoring

Introduction. Patient nonadherence to home care treatment poses an obstacle to wound healing that can lead to additional costs and prolong care. Objective. This retrospective pilot study examines the potential time and cost savings associated with a remote therapy monitoring (RTM) program designed to improve negative pressure wound therapy (NPWT) adherence in the home care setting. Materials and Methods. Payor claims data of patients receiving NPWT with (n = 199) or without (n = 232) RTM between January 1 and June 30, 2017 were analyzed. Results. The RTM patients were significantly older (P = .0401), had a higher percentage of Medicare Advantage plans (P = .0015), and had a higher mean Charleston Comorbidity Index score (P = .0115) than non-RTM patients. For both groups, chronic wounds had higher 90-day wound-related costs than acute wounds. The median length of treatment for RTM patients was shorter than non-RTM patients (P = .0394). Mean 90-day wound-related costs for RTM and non-RTM patients were $10 515 and $12 158, respectively. Conclusions. These results build upon previous studies of RTM-assisted outpatient NPWT and suggest an opportunity for wound care cost savings.

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Patient nonadherence to clinician-directed treatment in the home care setting is a significant problem in the US health care system costing $100 to 289 billion annually.¹ To address this problem, some health care providers have turned to digital solutions, such as telehealth and remote monitoring programs. One such program is the iOn PROGRESS Remote Therapy Monitoring (RTM) and Care Network (KCI, an Acelity Company, San Antonio, TX). The RTM is a proprietary system that collects adherence data for patients treated with negative pressure wound therapy (NPWT) in the home care setting. A network of virtual therapy specialists (VTS) monitors the data and interacts with patients to improve therapy adherence (ie, number of hours NPWT is used per day). When a patient is nonadherent for a certain number of hours, this system alerts the assigned VTS, who contacts the patient to address issues leading to low adherence. Previously published findings on a study of 510 patients receiving NPWT with RTM² reported that 74% of patients increased therapy use after receiving VTS support triggered by low adherence. The present pilot study aims to provide an initial evaluation of any potential time and cost savings associated with RTM.

A retrospective analysis was conducted of payor claims data from patients receiving NPWT (ACTIV.A.C. Therapy System; KCI, an Acelity Company) with or without RTM. Claims were selected based on those patients receiving NPWT between January 1 and June 30, 2017, and within 90 days of initial NPWT placement. Wound-related claims were identified using International Classification of Diseases 10 (ICD-10) coding. If a wound ICD-10 code appeared in the top 3 ICD-10 claim codes, the cost for the entire claim was included as “wound-related costs.” Wound type was determined using wound ICD-10 codes within 30 days of NPWT placement. Patient and group characteristics were extracted from the claims data and compared between non-RTM and RTM patients with t test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Nonparametric Wilcoxon signed-rank test was used to compare therapy durations and 90-day wound costs. To determine length of therapy, start and stop bill dates were collected from internal clinical progress reports between patients with and without RTM. These data were selected to match the same time frame as the payor claims data.

The analysis identified 431 claims in which NPWT was used; these were divided into patients with (n = 199) or without (n = 232) RTM (Table). The 2 groups did not significantly differ in sex or wound type. The RTM patients were significantly older (P = .0401) and had a higher percentage with Medicare Advantage plans (P = .0015). The Charlson Comorbidity Index (a predictive measure of 10-year mortality) also was significantly higher for the RTM patients (P = .0115).

The mean length of therapy for non-RTM patients was 40.6 days, compared with 37.1 days for RTM patients. Median length of treatment for non-RTM and RTM patients was 32 and 27 days, respectively (P = .0394). For both groups, chronic wounds ($16 751; n = 149) had a higher 90-day wound-related cost than acute wounds ($9015; n = 215). Wound-related costs for RTM patients averaged $10 515 compared with $12 158 for non-RTM patients (Figure). The 90-day cost of NPWT averaged $3856 for non-RTM patients versus $3622 for RTM patients. Non-NPWT 90-day wound-related cost averaged $8302 for non-RTM patients, in contrast to $6893 for RTM patients.

In this pilot study, the authors found a statistically significant decrease in median length of therapy in patients with RTM compared with patients without RTM. Although not statistically significant, there also was a decrease in 90-day wound-related costs in the RTM group.

As a preliminary investigation into cost savings with RTM, this study has several limitations. This was a retrospective study with a relatively small sample size. In addition, the information collected from claims data lacks clinical verification and does not control for the possibility of data entry errors. However, these data suggest an opportunity for wound care cost savings and build upon 2 recent studies that have reported on the use of NPWT with RTM.^2,3 The initial evaluation examined the relationship between the RTM system and patient adherence to NWPT in a cohort of 198 patients. The study reported that patients increased adherence by an average of 8.5 hours on the first day after phone calls made by the VTS to address impediments to adherence.² A second study expanded upon the first by including a larger cohort of 510 RTM patients in which those with higher adherence to NPWT demonstrated a more rapid reduction in wound area and volume.³

The results of this initial evaluation indicate that a wider implementation of RTM to the NPWT patient population might provide benefits, including a potential cost savings. A decrease in length of therapy potentially translates to a decrease in NPWT costs, with an additional opportunity for decreases in non-NPWT wound-related costs as well. Future prospective, controlled studies are needed to examine the direct relationship between RTM, wound reduction, and health care cost savings.

Authors: Leah Griffin, MS; and Mikaela M. Sifuentes, PhD

Affiliation: Acelity, San Antonio, TX

Correspondence: Leah Griffin, MS, KCI, an Acelity Company, 12930 W Interstate 10, San Antonio, TX 78249; Leah.Griffin@Acelity.com

Disclosure: The authors are full-time employees of Acelity. This manuscript was accepted for presentation as a poster at the 2019 Symposium on Advance Wound Care Spring/Wound Healing Society, May 7–11, 2019, San Antonio, TX.