Attendees at a recent webinar, presented by Net Health VP and Chief Clinical Officer Cathy Thomas Hess, BSN, RN, CWOCN and Dr. Lisa Gould, MD, PhD, FACS, gained new insights and strategies into best practices for optimizing wound care management and outcomes. If you missed the webinar, or want to hear it again, check it out on this link for “Working Smarter, Not Harder: Strategies for Wound Management Success”.1
It’s important information for today’s wound care providers to hear. Our profession is gaining a higher profile in the world of healthcare due to innovative therapies designed to treat the growing number of challenging cases. These include new topical solutions, bioengineered tissues, and gene therapy, all of which come with a hefty price tag.
For the Medicare population alone, annual costs for wound care range widely from $28.1billion to 96.8 billion,1 reflecting the estimated 15% of Medicare recipients having at least one type of wound or wound-related infection. In addition, the number of wound cases keeps rising.2
6 Best Practices from Industry Experts to Ensure a Thriving Wound Care Business
Why This Matters
The emerging landscape is encouraging wound care providers to optimize strategies to improve operations and outcomes for the devastating and costly consequences of chronic wounds, such as amputation and loss of work productivity, as well as the psychological impact of depression and loneliness.3 Some best practices that busy wound care facilities should consider include:
- Product formulary
It all starts with engaging the clinical team—the heart of a successful wound care practice—as they get on board with evidence-based treatment workflows meant to improve clinical outcomes. Using diabetic etiology evidenced-based treatment as an example, this process begins with an initial assessment of the patient’s disease history, cardiovascular risk factors, footwear, impediments to healing, and information on psychosocial factors.4
In addition to determining the effectiveness of workflows, the clinical team should develop a competency checklist as part of a formal process to boost clinical outcomes. This best practice could entail incorporating accurate assessment, documentation, and intervention processes based on validated guidelines. These should be updated annually, along with policies, procedures, and facility practices. As part of this effort, competency validation testing for staff should occur at least annually.
This Best Practice refers to a multi-step operational process, starting with learning which products the clinical team prefers, and aligning their Healthcare Common Procedure Coding System codes within an organization’s Charge Description Master (CDM). The CDM refers to a comprehensive list of items that could be billed to a patient, payer or healthcare provider.
Also important is defining the clinical and financial outcomes data, and documenting information to achieve the following steps:
- Streamline critical pathways
- Improve product formularies
- Validate contract fees with payers
- Improve patient and clinician satisfaction
- Comply with federal mandates
Additional processes involve designing a supply management system to control product use, costs, and waste. Managers should work with the revenue cycle team to account for these products at least once a year.
For Medicare practitioners, there is an array of compliance utilization guidelines that define acceptable standards of practice within a local medical community,5 plus national coverage determinations. For wound care specifically, there are acceptable standards for treatments such as debridement; negative pressure wound therapy; and non-contact, non-thermal ultrasound (MIST) therapy.
Medicare guidelines require documentation of medical necessity for these procedures and others to be clearly spelled out in the patient’s medical record. When data analysis reveals that these services are performed in excess of peer norms, they may be subject to prepay or post-pay medical review.
The Social Security Administration maintains a list of payment exclusions for Medicare Parts A and B. It states that no payments will be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a so-called “malformed body member.”6
Given the importance of reimbursement, familiarity with payment guidelines is critical.
A best practice for achieving compliance entails implementing processes that pull together documentation, staff efficiency and productivity, as well as payment. Facilities need to define the specific needs of the wound care practice including the following “CORE” workflows:
Why documentation? It is the basis for providing the details of medical necessity, compliance, and payment.
A few of the many items on a detailed documentation checklist would include:
- Meeting with departments to review updates for preregistration, coding, billing, medical records, and denial management
- Reviewing and updating product formulary and technologies
- Knowing hospital accreditation standards and department and documentation workflows
- Establishing and identifying the need for an internal audit
- Conducting periodic external audits as part of the organizational compliance auditing process
Embracing best practices enables wound care facilities to implement processes and documentation that boost the quality of wound care treatment, and ultimately, outcomes, while minimizing lost revenues. This comprehensive approach will become increasingly vital as the market expands use of much needed new technologies.
Get More Insights Today
If you are looking for more information and real-world tips on improving wound care performance, in addition to the webinar, check out these resources from Net Health® Wound Care.
1Nussbaum SR, Carter MJ, Fife CE, Haught R, et al. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value in Health. 2018;21(1):27-32.
2Sen CK, Gordillo GM, Roy S, Kirsner R, et al. Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy. Wound Repair and Regeneration. 2009. 17(6):763-71. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810192/. Accessed December 13, 2022.
3Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Advances in Wound Care. 2019;8(2):39-48. Available at: https://www.liebertpub.com/doi/pdf/10.1089/wound.2019.0946. Accessed December 9, 2022.
4Hess CT. Clinical Guide to Skin and Wound Care, 7th edition. Lippincott Williams & Wilkins. 2013.
5HCFA Rulings. Ruling 95-1(V). 1995. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/Downloads/HCFAR951.pdf. Accessed December 12, 2022.
6Social Security, Section 1862. Exclusions from Coverage and Medicare as Secondary Payer. Available at: https://www.ssa.gov/OP_Home/ssact/title18/1862.htm#ftn547. Accessed December 12, 2022.