OBJECTIVES: Examine the effect of COVID-19 on chronic wound care service provision for Medicare beneficiaries in 2019, 2020, and 2021.

METHODS:

This retrospective analysis of Medicare claims data included beneficiaries who received care for diabetic foot ulcers and infections, arterial ulcers; skin disorders and infections, surgical wounds and infections; traumatic wounds; venous ulcers and infections, unspecified chronic ulcers, and others. We extracted all claims for each targeted beneficiary across all care settings and from the Medicare Beneficiary Summary File for 2019 to 2021. The outcomes were: 1) prevalence of each wound type, 2) Medicare expenditures by wound type, and expenditures by type of service.

RESULTS:

Over the 3-year period, the number of Medicare beneficiaries with a wound generally decreased in 2020, then increased in 2021 to a higher level than in 2019. In 2019, 16.4% of Medicare beneficiaries (10.6M) had at least one type of wound. In 2020, 14.9% of Medicare beneficiaries (9.8M) were diagnosed with wounds (a decrease of 7.1%), and in 2021, 16.1% of Medicare beneficiaries (10.8M) were diagnosed with wounds, an increase of 1.9% from 2019. In 2021, approximately 2.7% of beneficiaries had a claim with a wound diagnosis that had been added in FY2020, or 0.4% of all Medicare beneficiaries. The prevalence of COVID-19 among beneficiaries with chronic wounds was 896,198 (9.1%) in 2020, rising to 1.2M (11.1%) in 2021. Using our mid-range estimates of Medicare expenditures, wound care totaled $24.7B in 2019, $23.9B in 2020, and $26.3B in 2021.

CONCLUSIONS:

These results emphasize the ongoing prevalence of chronic wounds among Medicare beneficiaries and suggest the decrease in care during the pandemic contributed to a relative increase in care and expenditures in 2021. We found a shift in the site of care from skilled nursing facilities toward home health as individuals sought to avoid COVID-19 exposure.