Updated: Sep 22, 2020
Why Can’t Wounds Be A Positive For Home Health With PDGM Rather Than A Source Of Frustration?
Everyone in Home Health is preparing for the changes in PDGM and a lot of what we hear is around how disruptive it will be, how therapies are not going to be reimbursed as highly, and that as many as 20% of providers will go out of business or be absorbed. In short, it is the biggest Medicare reimbursement change in 20+ years and everyone in the industry is freaking out. We put on a seminar for CMS and had 300 nurses register. To say it is not a concern is an understatement.
On the other hand, why? You are going to get up to 25% higher reimbursement as a category for wounds. Wounds are the highest reimbursable category. It should be a no-brainer to say “give us all we can handle” as this is a great source of revenues. Right…
Wounds are complicated, chronic, and usually made worse due to co-morbidities. They are an area that requires a significant level of expertise to get correct – staging, etiology, formulary, dressing change, measurement, progression, etc. Couple that with elderly populations with skin integrity issues, pressure wounds, prevention, etc. on top of a shortage of wound certified nurses and it is no wonder that many providers don’t want to deal with these patients and have avoided them if possible. The more complicated ones are a loss leader and comparable to therapies, why would you want to lose money on these patients. Hence, why therapy was so pervasive. Until PDGM. Now, wounds will have to be a more critical component of your service line mix.
Some organizations embrace the challenge and are staffing up to handle these patients. The Acute referral sources need good provider follow up to prevent readmissions and reoccurrences. CMS is preparing to track the outcomes and eventually build in penalties for underperformance. With the shift towards value-based medicine, wound management is a required competency, especially for aging populations. Besides, no one wants to see patients suffering from chronic wounds that you merely maintain, but can’t get healed.
It is also difficult to transport and transition patients into different care settings with the different sets of protocols, order changes, supplier changes, and transportation issues so those referrals are not taken lightly.
But, staffing up isn’t really that easy and usually isn’t the complete answer. What can you do when you have had an open job req. for a certified wound nurse open for the last year? Even organizations with WOCNs still struggle with consistency and a programmatic approach to wound management that drives consistency and profitability. It is a pervasive problem that is a struggle for everyone in Post-Acute. Less than 2% of wound-certified nurses work in Post-Acute. Many are clinicians who don’t really know how to build a wound program. The right expertise is hard to find and hard to keep.
Yet, you do the best you can by your patients.
But, does it really have to be this difficult? Can’t it be easier, simpler, better, and more profitable? Where is the EASY button, right?
PDGM doesn’t have to be the Apocalypse that everyone is worried about. It should be 25% higher reimbursement rates. For many providers, they are doing ok. But, ok could be great with the right help.
If you could couple that with a partnership that could bring the wound management expertise to work over you team’s shoulders and take the difficult parts of managing wound patients – measurement and documentation, staging and etiology, formulary selection, evidence-based treatment planning, coaching bedside nurses on changes, educating staff on best practices, advanced dressing to reduce frequency of changes, and patient outcome monitoring – AWESOME.
How about doing it in a 30-day capitated episodic payment model that aligns with PDGM and provides a framework for benchmarking and continuous process improvement – FANTASTIC
What if you could do it in a way that we can control costs, drive better outcomes, and significantly lower staff time while actually managing the wound better and at a significantly higher margin coupled with all of the reporting requirements for PDGM – PRICELESS
Now, do it in a way that we can actually make money within the reimbursement framework sufficient that we want to market to our referrers that we have an excellent wound patient program – SIGN ME UP
Wound management is complicated and requires extensive expertise to manage those patients with the best clinical and financial outcomes. It needs to be managed as a specialty with the right people, process, technology, and systematization that ensure maximum quality, outcomes, and partner profitability.
In short, you need a Wound Management partner that will drive the results your organization and your patients want to manage your complicated wound patients healing process.
Corstrata enables Post-Acute Providers to develop Wound Programs of Excellence with its Proprietary Wound Benchmarking Scorecard, operational consulting, and Nurse2Nurse wound consults for the management of complex & chronic wounds for Post-Acute Providers in home health, hospice, rehab hospitals, and nursing homes. Our senior-level, wound-certified nursing staff are some of the best and most experienced in the industry. We couple their expertise with the most advanced wound dressing technology, latest evidence-based research, and our telehealth infrastructure to ensure that we deliver the right patient support at the greatest point of need – the bedside. To learn more, contact Corstrata for a conversation to see how we can help make your wound management program easier and more profitable.