Navigating the Twists and Turns of Value-Based Care in Private Practice and Wound Care 

Table of Contents

  1. Why VBC, and Why Now?
  2. Been There, Done That
  3. Confronting the VBC Challenges in Private Practice
  4. The Essentials: Private Practice Technology Features
  5. Documentation and Medical Necessity
  6. One Day, One Step at a Time
  7. It’s Time to Transition Your Private Practice to VBC

There are various monikers for wound care providers working outside of hospital settings. Whether you prefer the term private practice, wound care provider without walls, or contract provider, your responsibilities are the same. Between patient care, staffing, and a myriad of other activities, you have a lot on your mind and plate. 

One issue you may not have had time to think about over the last few years is value-based care (VBC). You may have told yourself, “Well, that doesn’t apply to me,” or “I’ll worry about that later; I’m too busy right now!” 

Well, it’s time to start thinking about it. As we noted in Chapter 1 of our value-based care series, Leveraging Technology to Reach Your Hospital Wound Care Goals, the Centers for Medicare and Medicaid Services (CMS) aims to transition all Medicare beneficiaries to some form of a value-based care payment solution by 2030. Medicaid and private payers will follow. And if you receive payments from any of those entities (and, of course, you do)—you need to get familiar with VBC. 

Embracing value-based care isn’t just about ticking boxes to meet regulations—it’s a game-changer for patients and the quality of care they receive.  

We know that wounds take a tremendous toll on patients—especially older and disproportionally affected populations. One of the more common conditions seen in wound care settings is pressure injury (PI). More than 2.5 million people will develop a PI this year. The AHRQ reports that the prevalence of PIs in long-term care settings is 7.5%, with an annual cost of $3.3B. Equally, or perhaps more troubling, is the rate of diabetic-related amputations. Those have increased by 50% in recent years, especially among disproportionately affected populations, a trend we must reverse. Statistics such as these are just some of the reasons CMS is championing the VBC model.  

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