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 coming with PDGM. A lot of what we hear is around how disruptive it will be, how therapies are not going to be reimbursed as highly, and how as many as 20%-30% of providers will shut their doors or be acquired. In short, this is the biggest Medicare reimbursement change in 20+ years and everyone in the industry is scrambling to figure out how this impacts their agency. We recently presented a webinar about Improving Your Wound Management Program hosted by CMS’s Home Health Quality Institute (HHQI) and had over 900 home health leaders participate. To say it is a concern is an understatement.

On the other hand, why? Home health is going to receive up to 25% higher reimbursement for the wound patient clinical grouping; in fact, the wound clinical grouping represents the highest potential reimbursement. It should be a no-brainer to say “give us all your wounds, we can handle it” as this is a great source of revenues. Right…

Wounds are complex, chronic, and exacerbated by the patient’s multiple comorbidities. They are an area that requires a significant level of expertise to get correct – staging, etiology, formulary, dressing change frequency, consistent measurement, progression monitoring, legal defensibility, etc. Couple that with an elderly population dealing with skin integrity issues, pressure-related wounds, diabetes-related foot ulcers, prevention considerations, etc. on top of a shortage of wound certified nurses, and it is no wonder that many home health agencies don’t want to deal with these patients and have historically avoided them when possible. The more complicated wound patients have been considered a “loss leader,” with a reliance on therapy to offset wound patients’ losses. Until PDGM. Now, wound care will have to be a more critical component of the service line mix.

Some organizations are embracing the challenge and are staffing up to handle these patients. Hospital and physician referral sources are aligning with post-acute providers to prevent readmissions, to minimize wound recurrences, and to ensure a good plan for healing. CMS has begun tracking wound outcomes and eventually will penalize providers for underperformance (i.e. Impact Act, post-acute bundles, etc). With this shift towards value-based reimbursement, wound management is a required competency due to the increases in the aging, chronically ill patient populations. Besides, no one wants to see patients suffering needlessly from chronic wounds that are merely maintained but aren’t being healed. 

It is also difficult to successfully transition patients into different care settings with radically different sets of protocols, dressing change orders, supply vendors, and transportation issues, so those referrals are not taken lightly.

Also, staffing up isn’t really that easy and usually isn’t the complete answer. What can you do when you have had a vacant position for a certified wound nurse open for over a year? Even organizations with WOCNs still struggle with a repeatable, programmatic approach to wound management that drives consistent care, staff productivity, and profitability. It is a pervasive problem and a struggle for everyone providing Post-Acute care where less than 10% of wound-certified nurses work. Even the best certified wound care nurse often lacks the strategic experience required to build a comprehensive wound management program. The right expertise is hard to find and hard to keep. 

Yet, you and your home health peers 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 for wound care? 

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 “okay.” But, “okay” could be “great” with the right help.

Imagine if you could partner with a company that could provide wound management expertise to support your team and take on the difficult parts of managing wound patients – measurement and documentation, accurate etiology identification and staging, formulary selection, evidence-based treatment planning, mentoring bedside nurses on changes in the care plan, educating staff on best practices, utilizing advanced dressings to reduce the frequency of dressing changes, and monitoring patient outcomes– AWESOME 

How about doing it in a 30-day capitated episodic payment model that aligns with PDGM and provides a framework for outcomes benchmarking and continuous process improvement – FANTASTIC

What if you could do it in a way that you can control costs, drive better outcomes, significantly improve staff productivity, while actually managing the wound better, meeting all the documentation and reporting requirements of PDGM, all at a significantly higher margin – PRICELESS

Now, what if you could do it in a way that you can actually make a margin within the new reimbursement framework so that you want to market to your Wound Program of Excellence to your referral sources – SIGN ME UP

Wound management is complicated and requires extensive expertise to manage these patients to achieve the best clinical and financial outcomes. Wounds need to be managed as a specialty with the right people, processes, technology, and systematization that ensures maximum quality, outcomes, and profitability.

In short, you need a Wound Management Partner that will drive the results that your organization, your referral sources, and your patients want to manage the complicated wound healing process. 

Corstrata enables Post-Acute Providers to develop Wound Programs of Excellence with its Proprietary Wound Program Benchmarking Scorecard, operational consulting, and Nurse2Nurse wound consults for the management of complex and chronic wounds for Post-Acute Providers in home health, hospice, rehab hospitals, and nursing homes. Our senior-level, wound-certified nurse leaders are some of the best and most experienced in the industry. We couple their expertise with the most advanced wound imaging 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 about how we can help you make your wound management program easier and more profitable.