Cath Lab Digest

The Memorial Hermann Wound and Lymphedema Center
Houston, Texas

The Memorial Hermann Wound and Lymphedema Center Houston, Tex, will soon mark its 20th anniversary. Opened as the Hermann Center for Hyperbaric Medicine in 1989 with one nurse and a technical staff, it evolved in response to the needs of patients and the changing field of wound care. Wound healing (which includes a venous stasis clinic) and lymphedema divisions were added to the center’s operations in response to the lack of facilities available for patient referrals requiring chronic wound care.

The center has met many challenges from educating the staff to integrating computer technology, operating with a small advertising budget, and adjusting to changes in Medicare.
TWC asked Vonda Wall, Administrative Director Outpatient Diagnostic and Procedural Services for Memorial Hermann Hospital, to fill in some of the details of the center’s operations.

TWC: Is your center independently managed or overseen by a management company?
VW: The center has remained a hospital-managed facility, choosing not to participate in a management contract entered into by five other hospitals in the system in the year 2000. Our center continued to generate revenue when the system management contract was terminated early for financial reasons, resulting in the closure of the other locations.

TWC: What were the center’s initial challenges?
VW: Because there were no formal wound care courses, the center’s physicians and nursing staff had to be facility trained. At the time, only Unna’s boots were available for compression. The center constantly reviewed new products entering the market for inclusion in the formulary. Affiliation with the University of Texas Health Science Center allowed the center’s participation in clinical trials for becaplermin topical and bilayered skin substitute and use of negative pressure wound therapy only 2 years after its FDA approval. The center addressed the need for proper cost accounting associated with clinical trials by creating a separate cost center to capture labor and other expenses.

TWC: What efforts have been made in advertising and marketing?
VW: If the center were under a management contract, there would be extensive print advertising. However, the center has operated with a small advertising budget and owes the stable referral base in part to the venerability of the program and a well developed website (www.uth.tmc.edu/anes/wound1.htm).The center also credits its promotion to the correspondence regularly sent to referring physicians and copied to all of the patient’s treating physicians. The speed and ease of referrals have been made possible through utilization of an electronic medical record specific to wound care and hyperbaric medicine that generates follow-up letters and automatically appends photographs.

TWC: How have you incorporated computer technology into the center’s workflow?
VW: Our center became one of the first wound centers to completely computerize, going “live” in 1998 to allow complete control over every aspect of the patient data.

TWC: What is your patient base?
VW: Current patient distribution by diagnosis is: 26% diabetic foot ulcers, 25% venous stasis ulcers, 18% surgical complications, 17% pressure ulcers, and 14% arterial ulcers.

TWC: How did the addition of lymphedema treatment affect the center?
VW: In 1998, the need for post mastectomy lymphedema patient care was identified, necessitating the hiring of specialized staff trained to provide manual lymphatic drainage (MLD). The center’s only marketing strategy was a listing on the National Lymphedema website; within a year, seven MLD therapists were needed to meet patient demand. Today, the volume of lymphedema patients through this clinic, which uses the same space as the wound center, is equal to the volume in the wound center.

TWC: You cross train staff. Please describe this technique.
VW: With employees of diverse backgrounds and a need to maximize staffing productivity, the center began “cross training.” MLD therapists and hyperbaric technicians were trained in wound care and nurses were trained in advanced bandaging techniques with interesting dividends. Because employees have an in-depth understanding of the challenges faced by their colleagues, team spirit is excellent. An unexpected plus has been improvement in both patient outcome and satisfaction. Many patients require a team of caregivers to meet their needs for both wound care and edema control. From an operational prospective, the three centers (hyperbarics, wound care, and lymphedema) operate in the same location with separate revenue centers, allowing for more accurate cost accounting, improved cost containment, and productivity.

TWC: What have been some of your biggest operational challenges?
VW: The biggest operational challenge has been coping with dramatic changes in the Medicare reimbursement policy. Changes in coverage policy and reimbursement amounts have affected the type of patients treated with hyperbaric oxygen therapy. Coverage policy also dictates who can perform certain services. Although the hospital recognizes massage therapists as licensed professionals, Medicare does not. Since 2005, Medicare beneficiaries cannot be provided with MLD from the staff. Another operational challenge is the on-going balancing act between the demands of the University that provides physicians and the hospital system, which provides all other staff, space, and supplies.