Betty Fout, PhD, and Michael Plotzke, PhD, are Principal Associates, Abt Associates, Cambridge, Massachusetts. Acknowledgments: The funding for this project was provided by the CMS under contact number HHSM-500-2016-00090G, "Home Health Prospective Payment System (HH PPS), Hospice and Home Infusion: Analysis Support and Monitoring" starting on September 30, 2016, and contract number GS-00F-252CA, "Home Health Prospective Payment System (HH PPS), Hospice and Home Infusion: Analysis Support and Monitoring" starting on September 30, 2019. The authors have disclosed no other financial relationships related to this article. Submitted November 5, 2020; accepted in revised form February 27, 2021.
Adv Skin Wound Care. 2022 Jan 1;35(1):37-42. doi: 10.1097/01.ASW.0000801536.61163.e5.
Since 2017, home health agencies (HHAs) have received reimbursement for the provision of negative-pressure wound therapy (NPWT) using disposable, portable devices to eligible Medicare fee-for-service beneficiaries. This study aimed to describe the use of disposable NPWT (dNPWT) versus traditional, durable medical equipment-based NPWT (tNPWT) in the home health setting over time and compare the types of beneficiaries using and associated Medicare payments for NPWT separate from the home health payment bundle.
Medicare fee-for-service claims were used to identify beneficiaries receiving NPWT from HHAs during home health stays. Assessment and Medicare administrative data were linked to compare characteristics between those receiving tNPWT or dNPWT and to calculate and contrast average Medicare payments for NPWT provided during the home health episode.
In 2019, the vast majority of NPWT used was tNPWT (>99%). Beneficiaries using dNPWT had fewer health risk factors and used substantially less medical care than beneficiaries using tNPWT ($47,187 vs $60,440 in annual total Medicare payments per beneficiary). However, the average Medicare payments for dNPWT exceeded that of tNPWT ($1,624 vs $899) during a home health episode.
Although dNPWT is well-suited for the home, its uptake has been slow. This may be attributable to HHAs' confusion in billing for dNPWT or differences in the wound types appropriate for dNPWT versus tNPWT. Policymakers should continue to monitor the use of dNPWT in the home health setting, especially given the greater average Medicare payment of dNPWT per episode.
自 2017 年以来，家庭保健机构（HHAs）已开始为符合条件的 Medicare 按服务收费受益人的一次性便携式设备提供负压伤口治疗（NPWT）服务以获得报销。本研究旨在描述在家庭保健环境中，一次性 NPWT（dNPWT）与传统耐用医疗设备为基础的 NPWT（tNPWT）的使用情况随时间的变化，并比较使用 NPWT 的受益人的类型，以及与家庭保健付款包分开的 NPWT 的相关医疗保险支付情况。
使用 Medicare 按服务收费的索赔来识别在家庭保健期间从 HHAs 接受 NPWT 的受益人的情况。评估和医疗保险管理数据被链接起来，以比较接受 tNPWT 或 dNPWT 的患者的特征，并计算和对比家庭保健期间提供的 NPWT 的平均医疗保险支付。
2019 年，使用的 NPWT 绝大多数是 tNPWT（>99%）。使用 dNPWT 的患者健康风险因素较少，使用的医疗服务也明显少于使用 tNPWT 的患者（每位受益人的年总 Medicare 支付分别为 47187 美元和 60440 美元）。然而，在家庭保健期间，dNPWT 的平均医疗保险支付高于 tNPWT（1624 美元对 899 美元）。
尽管 dNPWT 非常适合家庭使用，但它的使用率仍然很低。这可能是由于 HHAs 在为 dNPWT 计费方面的困惑，或适合 dNPWT 与 tNPWT 的伤口类型的差异所致。政策制定者应继续监测 dNPWT 在家庭保健环境中的使用情况，特别是考虑到每次 dNPWT 的平均医疗保险支付更高。
