Editor`s Opinion: The Pressure Is On

  The study findings reported in this issue of Ostomy Wound Management remind us, once again, that chronic wounds are universal, common, and painful. Fortunately for busy clinicians, diligent researchers continue to test clinically useful, noninvasive, and inexpensive assessment methods, such as instruments that facilitate recall of drug use history and quantify pressure ulcer pain, discussed this month. Most recent data from pressure ulcer prevalence studies conducted among 651 participating healthcare facilities and involving 85,838 patients, also reported in this issue of OWM, suggest that 14% of participants had a Stage III or Stage IV pressure ulcer – ulcers that another OWM article report to be distressingly or horribly painful.   For healthcare facilities and providers striving to reduce complication rates, including the incidence of nosocomial chronic wounds, the pressure is on. In addition to current and future quality-of-care issues and the Centers for Medicare and Medicaid Services (CMS) initiatives, healthcare systems and providers feel the pressure of ever-changing and diminishing reimbursement. At the same time, double-digit insurance premium increases are putting even more pressure on employers (including hospitals) and individuals. It has been estimated that during the past 6 years the average family in the US has seen its health insurance premiums grow nearly 90% while benefits have been cut.

  For better (or for worse?), these issues and concerns have captured the attention of US presidential candidates. The amount of detail they have provided varies greatly but all candidate platforms included plans to address healthcare quality and efficiency while reforming reimbursement and payment systems. Rudy Guillani (see www.joinRudy08.com) had proposed to improve and expand health savings accounts and increase visibility of healthcare prices, provider qualifications, and risk-adjusted procedure outcomes while “infusing incentives in the insurance market that promote wellness.” Mike Huckabee (www.mikehuckabee.com) has observed, “The healthcare system in this country is irrevocably broken, in part because it is only a ‘health care’ system, not a ‘health’ system”; he believes a focus on wellness programs and preventing chronic disease will turn the situation around.

  John McCain (see www.johnmccain.com) and Barack Obama (www.barackobama.com) both have included quality-of-care measures in their platform – the former focuses on the development of standards for measuring and recording outcomes and the latter wants to establish an independent institute to guide reviews and research on comparative effectiveness. Furthermore, John McCain wants to reform the Medicare payment system (including no pay for preventable medical errors or mismanagement –a recommendation seemingly endorsed by an increasing number of lobbyists and payors) and provide all individuals with a $2,500 tax credit for health insurance. Barack Obama wants to address the monopoly power of a small group of large insurance companies and increase competition through a National Health Insurance Exchange.

  John Edwards and Hillary Clinton have spoken frequently about healthcare access, quality, and cost; their detailed analysis and suggestions (accessible via www.johnedwards.com and www.hillaryclinton.com) are a must-read for every clinician. The stakes are high and the devil is in the detail – or in this case, the lack of detail – provided by some candidates to help all of us make informed decisions.

  Thankfully, our clinical choices continue to be informed through the on-going efforts of researchers, clinicians, and companies willing and able to provide and share the evidence we need. And that, at least, will help relieve some of the pressure.

This article was not subject to the Ostomy Wound Management peer-review process.