Cath Lab Digest

Setting the Scene
Providing clinically excellent and cost effective wound care remains both a goal and a challenge for many hospitals. The healthcare industry has struggled with cost and quality issues in many arenas for years but wound management has only recently become one of the metrics assessed. This is in part due to the increased interest in wound care services by third party payors, the Centers for Medicare and Medicaid Services (CMS), and the Joint Commission.

The market for wound management services is large, often underserved, and growing. It is estimated that more than 7 million people in the US (2% of the total population) experience a chronic, nonhealing wound and require care. Once a hospital realizes the need for a formalized wound care program, it must decide if it has the capacity and resources to start one on its own or if it should outsource to a wound care management company. Perhaps as many as half of the hospital-affiliated wound centers currently use a management company. What are the pros and cons of using such a company versus “doing it yourself?”

Pro: Management Company
Many essential elements are critical to the success of a hospital-based outpatient wound care program (see Table 1). Hospitals must realize the importance of each element and decide if they can provide them with a home-grown program.

Why Outsourcing?
While wound care has emerged as a specialty service, developing clinical systems and education to treat these patients is a challenge for many hospitals, consuming significant time and resources. The Association for Advancement of Wound Care Quality of Care Task Force documented that the framework of quality systems for wound care model facilitates high-quality wound care across the continuum of care.1 Factors influencing clinical effectiveness include the professional competency of wound care providers, medical information systems, wound and quality-of-care outcomes tracking and response, resources, cost effectiveness, consumer expectations, and research practice.
Certification and accreditation are important to establishing a wound management program. Few wound management companies have earned the Joint Commission’s “Disease-Specific Care Certification” for clinical and operational excellence in wound management. Undersea and Hyperbaric Medical Society (UHMS) facility accreditation also bolsters additional program credibility. Using a Joint Commission-certified and UHMS-accredited management company can save the hospital significant time and resource commitment and gives the program the superior credibility it needs to be recognized as a resource in their community.

Developing a comprehensive wound management program that provides the pillars of quality stated in the AAWC conceptual framework can prove arduous to hospitals and health systems.1 Many hospitals are finding they do not possess the core competencies to handle wounds on a volume basis. Developing a program can be time-intensive and burdensome to staff, education, marketing, and finance. While many of the necessary components of the program can be acquired separately and “assembled” by the hospital, this requires a significant investment in acquiring the knowledge base to assess these components; plus, the time and cost of acquiring and assembling these components (from education of professional staff to database design and validation) can be prohibitive or extend the time from concept to program implementation. Development costs, as well as the ongoing expense of keeping the program updated, need to be carefully planned. Hospital “home grown” programs can fail to heal wounds as quickly as possible and miss opportunities to utilize hospital services.

For these reasons, many hospitals utilize the outsourced services of a management company with expertise in all areas of wound care that can provide a comprehensive, proven approach to wound care management. Outsourcing wound management services does not reflect on the abilities of current clinicians — rather, it allows clinicians to focus on care while other duties are handled elsewhere.