Clinical concerns, Home Health, Skilled Nursing Facility

Post-Acute Wound Management and Patient-Derived Reimbursement Models

By: Roger B. Schechter, MD, Fellow of American College of Wound Specialists; Chief Medical Officer, Synergy Wound Technology

Wound care has always been a considerable challenge in the post-acute setting.

Patients with skin breakdown usually have a plethora of chronic comorbid conditions. Chronic wounds themselves, including pressure injuries, diabetic foot ulcers, venous leg ulcers, severe burns and skin conditions, as well as surgical and traumatic wounds are highly labor and supply intensive. Severe skin breakdown is both a symptom of underlying illness and can also lead to an overall decline of a patient as a source of pain, indignity, infection and depletion of nutritional resources.

Given the frequent burden of hard to manage chronic conditions, as well as longer periods of time that patients will likely be under care in the post-acute setting, development or exacerbation of wounds is always a risk. Such patients are often a high-risk source of both regulatory sanction and costly litigation.

With the advent of Patient-Driven Reimbursement Models, such as PDPM for Skilled Nursing Facilities, and PDGM for Home Health Care, wound management presents an increased potential for lost or missed revenue and crippling repayments brought about by CMS recovery audits; yet at the same time it creates an opportunity for enhanced payment through development of a higher acuity case-mix.

Previously, for post-acute providers, the acceptance of patients with wounds was considered revenue neutral at best, and usually led to a net negative cash flow. Now, the consequences of NOT accepting wound care patients will likely lead to a lower acuity payer mix and therefore decreased revenues overall.

With PDPM, there is now an incentive for SNF’s to take higher acuity patients who often have a high burden of complex chronic wounds, since they can increase the NTA (Non Therapy Ancillary) component multiplier, a well as the Physical Therapy component (if properly utilized and documented).

With PDGM, there is an incentive to accept wound patients discharged from the hospital, because they provide considerable reimbursement in the first 30 days of care.

The higher reimbursements associated with chronic wound patients are enticing, but nevertheless demand a much higher level of documentation and outcomes tracking than previously required.

This will require digital health applications that streamline and enhance accuracy of documentation by requiring accurate anatomic location and etiology of wounds, digital measurement and an integrated photographic record, track outcomes accurately in a database, provide the bedside clinician with suggestions for optimal treatment to (leading to enhances outcomes), and expand the reach of expert wound clinicians who can thereby oversee bedside care remotely.

As an important side note, maintenance of a photographic record of wounds and skin breakdown was often previously avoided in post-acute care, since the images were considered discoverable with respect to litigation.

No defense attorney wants to have shocking appearing wounds projected onto a big screen in front of a jury. Nevertheless, wound photos are now essential, since they clearly depict the appearance of wounds at the time of admission from the acute care setting to either Skilled Nursing or Home Care, and provide a record of wound progress over time.

This enhances transparency and serves as a clear indication that the wounds were looked at, and not neglected, thereby avoiding the implication of a “cover-up” and/or “Elder Abuse”. Photos further promote accountability among the bedside providers, and allow the supervising expert clinicians to spot and respond to problems early through remote oversight.

InteliWound, a novel Value-Based Wound Management technology provides a solution to the problem of complex wounds in the post-acute setting via a mobile application and an integrated web-based platform. Inteliwound is the only application providing a comprehensive approach to wound management in the era of PDPM and PDGM.

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