Spring Advertiser’s Index
May 12, 2008 | Leave a Comment
We would like to thank all of our advertisers for continuing to bring our readers the valuable content featured in the journal. Please view Today’s Wound Clinic’s Advertisers Spring Ads in TWC’s new digital edition, by clicking on the direct links.
Advertisers
Arobella Medical……………………………………………………34
See their ad here: Arobella Medical
Coloplast……………………………………………………………….7
See their ad here: Coloplast
Comprehensive Healthcare Solutions.……………………37
See their ad here: Comprehensive Healthcare Solutions
Convatec……………………………………………………………….32
See their ad here: Convatec
DermaRite……………………………………………………………..19
See their ad here: DermaRite
DermaSciences………………………………………………………Cover 3
See their ad here: DermaSciences
Hollister Wound Care…………………………………………….3
See their ad here: Hollister Wound Care
Johnson & Johnson Wound Management……………….Cover 2
See their ad here: Johnson & Johnson
KCI…………………………………………………………………………41
See their ad here: KCI
Med Efficiency………………………………………………………..39
See their ad here: Med Efficiency
Milliken & Company………………………………………………..47
See their ad here: Milliken & Company
Mölnlycke Health Care…………………………………………….5
See their ad here: Mölnlycke Health Care
Net Health……………………………………………………………….23,24,25
See their ad here: Net Health
Organogenesis………………………………………………………….Cover 4, 48
See their ad here: Organogenesis
Wound Care Strategies……………………………………………..29
See their ad here: Wound Care Strategies
Northern California’s Mecca of Wound Care
May 12, 2008 | Leave a Comment
O’Connor Hospital’s Wound Care Clinic
San Jose, California
According to the current Medical Director, Peter Schubart, MD, PhD, it began when the hospital agreed to sign a contract with Curative Health Services (Nashua, NH) allowing the clinic to open its doors in 1992.
One patient was seen on the first day. Currently, the clinic averages 35–55 patients a day and offers 13,000 sq ft of space and 20 treatment rooms, with approximately 7,000 visits and 600 new patients per year.
The original clinical staff consisted of Dr. Schubart, vascular surgeon; Dr. Bruce Lerman, podiatry; and Dr. Jude Roussere, general surgeon. All of these physicians currently remain with the clinic. The facility currently employees 24 people including, two of the first RN staff.
For a free look at this complete article in the TWC digital edition visit:
InCentive Article
Industry News
May 12, 2008 | Leave a Comment
AAWC News
The Association for the Advancement of Wound Care (AAWC) announced a new clinic/healthcare facility membership category and the 2008 “Wound Care Clinic and Facility” directory.
AAWC clinic/facility membership is reserved for wound care clinics and other healthcare facilities. One contact person, usually the facility owner/director or an appointed person, maintains control over the membership account and receives benefits and important updates to share with colleagues, patients and caregivers. This category receives all the benefits of an individual member, but also receives a free, highlighted listing in the “Wound Care Clinic and Facility” directory, published annually and provided as a free benefit to AAWC members. Each facility may have an increased possibility of being selected first for referrals and by patients with a special listing that signifies that the facility receives access to the latest education, information, and news. To find out more about all of AAWC’s membership types, rates, and benefits; or to learn more about adding a listing to or purchasing the clinic/facility directory, visit www.aawconline.org.
For a free preview of this complete section in the TWC digital edition visit:
More News
Capturing the Essence of the Wound Evaluation
May 12, 2008 | Leave a Comment
Pam Unger PT, CWS; Caroline Fife, MD, FAAFP, CWS; and Dot Weir, RN, CWON, CWS
ocumentation in wound care is critical for reimbursement. To ensure payment, a comprehensive individualized plan, indicating the wound problem and goal of treatment must be in the medical record. The American Physical Therapy Association’s (APTA) “Guide to Physical Therapist Practice” recommends the five-stage management system; examination, evaluation, diagnosis, prognosis, and intervention.
Wound care is usually best performed by a team of experts. Your team may consist of any combination of diabetic educators, dieticians, nurses, nurse practitioners, occupational therapists, orthotists, pedorthists, physical therapists, physicians, physician assistants, and podiatrists. The physician or advanced practice nurse will function as the coordinator of care, utilizing the expertise of other team members to accomplish the wound care goals. The team members conduct evaluations within their specific scope of clinical practice.
The examination phase of a wound consultation is assumed to be the most important aspect, particularly identifying any pre-existing signs or symptoms, relevant systems review and tests and measures. It is very important to identify all risk factors.
Crucial to the evaluation of the wound is identifying the cause of the wound to establish a diagnosis and prognosis. This allows the clinician to identify the class and severity of the wound by stage, thickness, or colors. In broad terms, wounds are lesions caused by trauma or surgical interventions, and all other lesions would fall into some sort of ulcer classification. However, the ICD-9 diagnosis coding system is a poor one when it comes to proper coding of ulcerations. Using ICD-9, it is not possible to properly designate mixed arterial/venous or inflammatory ulcerations, for example. In addition, a lesion, which began traumatically but persists in a non-healing state for many months, could be classified as a chronic ulcer. Medicare provides no guidance as to how to deal with these issues. For the rest of this article, the term wound to refer generically to all skin lesions, whether they would be classified as a wound or an ulcer in the ICD-9 coding system. Ironically, using the term wound and ulcer interchangeably in clinic notes can be cause of confusion and even lead to coding errors and should be avoided in clinic documentation.
For a free look at this complete article in the TWC digital edition visit:
InStruction Article
Utilizing Data for Effective Marketing
May 12, 2008 | Leave a Comment
Heidi Mueller, sales and marketing consultant for wound care companies
While repetition and communication may be the cornerstones of effective marketing; it is the use of relevant, focused data that relates to specific target markets that provides results. There are literally thousands of giveaways that will help referring practitioners with name recognition and contact information. Answer these questions: What do referring physicians remember about a clinic or its services? Do they remember the case study information and clinic services?
For most wound clinics and wound specialists, marketing budgets tend to be relatively small. Billboards, radio spots, newspaper ads, and television spots do not typically fall within the allotted dollar amounts for the budget. To focus a large portion of the budget on giveaways is not practical. While some are necessary, it is impossible for clinics to compete with the amount of swag distributed by medical companies. More importantly, the author has found that direct-to-physician marketing provides the largest number of patient referrals for the wound care specialty. The greatest challenge is the retention of referring physicians. This becomes crucial as the specialty of wound care takes a larger presence in most communities. Competition for patients and physicians is more difficult with the number of facilities and physicians increasing. Focusing resources in this area will allow your marketing dollars to stretch further.
For a free look at this article in the TWC digital edition visit:
InFluence Article
In Focus: The Photography Forecast
May 12, 2008 | Leave a Comment
Val Sullivan, PT, MS, CWS
Photography is a subject that most wound care professionals are usually eager to discuss. Many in the field realize that photography is a valuable asset to the industry. However, some are frustrated at having to use two separate photography systems; one for monitoring a patient’s care, and another for protection against litigation in court. Others are unsure which of these two areas the facility should be focusing more energy and funds into.
There are several types of options available when it comes to wound care photography, each offering unique advantages. Despite trends that show a move towards the extinction of Polaroid instant photography and a strong move towards digital, instant images still have value in the courts. The industry is also facing Centers for Medicare & Medicaid Services (CMS) changes, which further complicates the role of photography. In the interest of simplifying things, clinics would naturally prefer to be able to use one compatible system instead of having to use several photography systems in one facility. This author believes that wound care professionals must lead the push towards advancement of photograph technologies that will bridge the gap between the two worlds: documentation for patient care and for legal protection.
A Picture Is Worth A Thousand Words … or Maybe More in the Courts
There is tremendous debate among inpatient practitioners about wound photography. Should photographs be taken at all? Who should photograph and what mode of photography should be used? To assist with documentation, hospitals and other inpatient facilities have been using photography to augment narrative wound descriptions, validate treatment plans, and track wound progress, all in the hope of preventing litigation or at least protecting themselves in the litigation process. This effort has often been mired in frustration, particularly at the deposition and/or testimonial phase, when photos put in front of a jury are out of focus, not done according to facility policy and procedure or worse … show a visual decline in the wound status, supporting the plaintiff’s claim that appropriate care was not rendered. “One colorful wound picture will increase the amount of the settlement in a pressure ulcer case,” says Mary Bruno, Bruno Medical-Legal Consultants, Inc., Hernando, Fla. However, the question remains, which is the most effective method of taking pictures for the court room?
For a free look at this article in the TWC digital edition visit:
In Photography
The Power of Paperless: Understanding EMRs
May 12, 2008 | Leave a Comment
A s the wound care industry adapts to the paperless society and electronic medical records (EMRs), there is hesitation by some professionals to embrace the digital push. A large majority of healthcare transactions in the US still take place on paper.
However, our editors Caroline Fife, MD, FAAFP, CWS and Dot Weir, RN, CWON, CWS; and other industry professionals such as N. Blair Hughes, MHS, PT, CWS, director of specialty programs and wound care services for Frederick Memorial Healthcare System (FMHS), Frederick, Md, explain that there are many reasons for wound care facilities to start embracing the technological advantages that are available in EMRs. Fife, chief medical officer at Intellicure, Inc. (The Woodlands, Tex) reviews the company’s option for EMR. Weir, discusses an EMR option that her facility has been using for years, provided by Net Health Systems (Pittsburgh, Pa). Finally, Hughes discusses the EMR option used at her center (FMHS’s Advanced Skin & Wound Care Center) since 2000, provided by Wound Care Strategies (Harrisburg, Pa).
Regardless of their affiliations and personal experiences with the three different companies, Fife, Weir, and Hughes raise some very valuable points and are all advocates of adopting an EMR system in a wound care clinic setting.
For a free look at this complete article in the TWC digital edition visit:
InTech Article
Documentation: Clearing up the Role of Compliance
May 12, 2008 | Leave a Comment
Ensuring the Charts Match the Care Received
Moira Hayes, MHA, RRT, CHT
Auditing Options
Although physician and facility billing are controlled by separate governmental requirements, there are two overarching principles which apply to documentation compliance:
1) Billed level of service must correlate with the level of service documented in the chart. This is applicable for both the physician and the facility.
2) In some circumstances (ie, surgical excisional debridement), the level of service billed by the physician and the facility must correlate with each other.
Many healthcare organizations have been scrutinizing the documentation and revenue cycle of their outpatient wound care programs. Some organizations have no audit process at all, while others may audit 100% of charts, involving many hours of resources. However, most audit programs fall somewhere in between. Not only must a facility determine the method of audit, but the sample size. Some facilities may choose to perform a random audit of a specific percentage of charts (ie, one chart in 10). Alternatively, all charts might be audited over a specific time frame (eg, 1 month).
Typically, one of the following three methods is used to determine the billed level of service for either the physician or the facility:
1) Abstraction of the paper chart by a trained expert.
2) Allowing the provider to estimate their level of service and select it on the charge master.
3) Using an electronic medical record (EMR) to directly calculate the billed level of service based on documentation.
For a look at this complete article in the TWC digital edition visit:
Cover Story
Documentation:The 30,000-Foot View
May 12, 2008 | Leave a Comment
Caroline Fife, MD, FAAFP, CWS
Documentation is an intrinsic component of every patient encounter. The financial success of a facility depends upon the completeness of the process. The major factor affecting the quality of an organization’s data (and therefore its revenue stream) is the accuracy of documentation. If you are not already convinced of the importance of accuracy in documentation, a study by the Centers for Medicare & Medicaid Services (CMS) found that of all of the improper Medicare benefit payments made during 2001, 43% were due to documentation errors. It is well known that patient quality of care is also related to quality of documentation. Furthermore, documentation is essential to meet the changing demands of regulatory bodies such as the The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Office of the Inspector General (OIG), and CMS.
The What and Why of the Medical Record
In the 19th century, the medical record was a sort of personalized lab notebook in which clinicians recorded their observations. In the 21st century, the medical record has many functions, including, serving as a basis for planning and documenting patient care, communicating among numerous health professionals, and protecting the legal interests of the patient and healthcare providers. The medical record may supply information for internal hospital auditing and quality assurance, documenting compliance with governmental regulations, and provide data for medical research. It is also a means of determining the billed revenue for physicians and hospitals. Thus, documentation must validate the medical necessity and appropriateness of the diagnostic and/or therapeutic services provided. What is more interesting about today’s medical records is that they serve as a way of tracking the process of care not just for an individual patient, but for groups of patients in the form of benchmarking and clinical research.
For a free look at this complete article in the TWC digital edition visit:
InWhole
Lack of Documentation May Cause Loss of Dollars
May 12, 2008 | Leave a Comment
Kathleen D. Schaum, MS
E arly in their medical/clinical training, wound care physicians and clinicians learn the caution, if it’s not documented, it’s not done. Few physicians and clinicians, however, realize the enormous financial consequences that the lack of documentation can have on their practices if:
• they perform self-audits and find that their documentation did not support the codes that were billed and the payments they received and/or
•they receive a Medicare audit and find that their lack of documentation resulted in false claim submissions.
In wound care settings a variety of physicians and clinicians practice as a team to achieve excellence. Each member of that team should take personal responsibility for clearly documenting the work they perform. These professionals should not only use the documentation guidelines learned during their medical training, but should also follow the guidelines of the payers who review their claims for medical necessity. Most Medicare contractors provide educational seminars, webinars, online training, educational documents related to documentation, medical policies, and articles that include documentation requirements.
In the middle of 2007, the Office of Inspector General (OIG) released several reports regarding the wound care industry:
• May 2007: Medicare Payments for Surgical Debridement Services in 2004.
•June 2007: Medicare Payments for Negative Pressure Wound Therapy Pumps in 2004.
Unfortunately, both reports found that documentation in the medical records of wound care patients did not adequately support medical necessity of the procedure(s) performed and/or the product(s) ordered. The OIG found Medicare overpaid $64 million for false claims involving surgical excisional debridement and $27 million for false claims involving negative pressure wound therapy pumps and supplies.
For a free look at this complete article, visit TWC’s new digital edition, at InBusiness
