As the year 2018 comes to a close, so too does the 12th volume of Today’s Wound Clinic (TWC). With this year in review, we help our readers revisit some of the topics covered in the journal over the last 12 months and reveal some of the most popular content as determined by you, our readers. Thank you all for your loyal readership. (This edition of TWC that you hold in your hands also marks our 5th annual Reader’s Choice edition. Your responses to a recent survey helped us decide on the content for this issue (and future editions, of course). So, thanks again!
With each new year, technology seems to make more significant changes (we will let you decide if these changes are positive or negative) in all aspects of life. Whether it be from the patient’s or the provider’s perspective, healthcare is certainly one of the arenas most impacted by new technology. Digital apps can be useful tools for developing patient education and adherence, as well as for offering easier, quicker, and more accurate documentation. In her article “Will Mobile Apps Bring Wound Care Technology to the ‘Cutting Edge’?” Chrissy Stanojev, a digital and social media marketing strategist based in the greater Philadelphia region, discusses the proliferation of healthcare-related digital apps, from the patient and clinician perspective, and how this evolving “social” foundation of technology in healthcare could specifically impact wound care clinicians moving forward. Have you become more technologically savvy nearly one year later?
Despite the continued adjustments that technology forces us to make, the overall complexity that exists in the practice of wound healing isn’t likely to change. A few universal truths will always exist, one of which is the fact that the perfusion of oxygenated blood to the wound is required for healing. Here’s another truth: even for the most experienced wound care clinicians, achieving closure of a chronic wound is never easy. In his article “Near Infrared Spectroscopy & Predicting the Likelihood of Future Wound Healing,” Adam Landsman, DPM, PhD, educates readers on the use of near infrared spectroscopy and its place within the evolution of how perfusion is gauged for better management of chronic wounds.
Of course, the continued rise of technology in healthcare also has brought with it continued risk for cyber crime – with serious consequences pertaining to HIPAA and patients’ privacy and security. As part of our ongoing column HIPAA Privacy & Security Compliance, Roger Shindell, MS, CHPS, CISA, and Lorna L. Hecker, PhD, CHPS, addresses the “Rise of the Cyber Criminal” by briefing wound care clinicians on some high-profile cases in which criminals have placed healthcare organizations (and their patients) in compromising situations. They also explore the landscape of cyber threats in an attempt to help wound clinics address the threat of HIPAA compliance intrusions. Would your compliance measures hold water nearly one year later?
Our January edition also saw the launch of one of our newer news departments, Technology Pulse. You can also find a similar collection of technology news in this edition of the journal online. We also released five episodes of the Today’s Wound Clinic Podcast hosted by Stephen G. Bergquist, MD, CWSP, which offers readers different perspectives on emerging technology from various key opinion leaders (KOLs). We were also accepted into the iTunes podcast library Jan. 15.
As healthcare in the United States becomes more engrained in a quality-based structure, outpatient wound clinics will need to align with other services throughout the continuum if they want to remain clinically and financially relevant. In our February edition, we focused on how wound care and vascular care can productively align. The need for outpatient providers to make patient referrals from the wound clinic to a vascular specialist will likely occur, and the decision on where to refer patients could be challenging. In their article “Choosing the Best Vein Center for Your Wound Care Patients,” Zoe Deol, MD; Sanjiv Lakhanpal, MD, FACS; Jessica Freeze; and Maxwell Tran give guidance for those who are seeking these referral options. Who is the ideal patient to refer to a vein center? Are there patients who should not be referred? How does one assess the credentials of a venous specialist? Which types of procedures (and why) should be expected for patients who undergo treatment at a vein center? What should wound care providers consider when seeking collaboration? All of these questions (and more) are addressed.
Even with collaboration and optimal treatment, however, wound healing may be prolonged and/or ineffective, and recurrence rates could remain quite high. Still, wound care clinicians and vascular specialists must approach collaboration from the standpoint of expected success. In his article “Venous Ulcers: The Evidence for Intervention,” Mark H. Meissner, MD, discusses how such collaborative efforts can improve patient outcomes while ultimately reducing costs. Similarly, Frank Aviles Jr., PT, CWS, FACCWS, CLT, dedicated his Let’s Be Frank column to encourage providers and program directors alike to let their guard down (in a sense) and make a commitment to the notion that “Seeking Advice Can Be The Foundation of Optimal Wound Care.” TWC also distributed a Patient Handout on chronic venous insufficiency and received valuable insight from Joseph T. Jenkins, MD, FACS, RPVI, RPhS, RVT, ABVLM (Diplomate), CWSP, and K. L. Todd III, MD, RPVI, on the “Relationship-Building Between the Wound Clinic & Vein Center” and the “unique opportunity” that wound care and vascular specialists have to improve venous disease, respectively.
Almost without question, the most highly sought-after content in print and online by TWC readers revolves around the administration and regulation of hyperbaric oxygen therapy (HBOT). Our March edition was committed to HBOT – practically cover to cover. Clinical editor Caroline E. Fife, MD, FAAFP, CWS, FUHM, took the lead by authoring articles on two very sensitive topics: the ethical considerations involved in the approved and off-label use of hyperbaric medicine and the “survival tactics” needed in wound care to navigate the waters of hyperbaric medicine quality reporting. Additionally, in her monthly Business Briefs column Kathleen D. Schaum, MS, reveals the most frequently asked questions about HBOT reimbursement, and TWC Podcast host Dr. Bergquist invited James (Jim) Wilcox, RN, BSN, ACHRN, CWCN, CFCN, CWS, WCC, DWC, FCCWS, DAPWCA, president of The Wound Care Experts LLC, to evaluate a hard-hitting industry report by the Office of Inspector General that found claims for HBOT services were denied due to a lack of medical documentation. As we embarked on the “new future” of HBOT, Helen B. Gelly, MD, FACCWS, UHM/ABPM, FUHM, outlined the Targeted Probe and Educate (TPE) program designed by the Centers for Medicare & Medicaid Services to help providers and suppliers reduce claim denials and appeals through one-on-one assistance. Jayesh B. Shah, MD, UHM (ABPM), CWSP, FAPWCA, FCCWS, FUHM, FACP, also offered an interesting commentary on the topic of “Research Associated With HBOT Utilization.”
At TWC, we always strive to produce and share content that underscores clinical and financial relevancy to the successful operation of outpatient wound care businesses. Sometimes, the focus must take somewhat of a negative slant in order to have the desired educational agenda. Our April edition proved to be a glaring (and popular) example of that approach as we took the liberty to help readers assess and address their “failing” wound care clinics. In his article “Diagnosis & Treatment of the Failing Wound Care Center,” Rafael Mazuz, MBA, dissects two underappreciated considerations that all program directors and clinicians should consider: organizational reporting structure and the alignment of one’s management approaches. And according to Dr. Fife, the success of any outpatient center is going to hinge on the objectivity in which that success is measured. In her article “How Should Outpatient Wound Clinics Honestly Measure Success?” she proposes the theory that wound care centers must objectively evaluate themselves today in order to positively impact their likelihood of seeing patients “tomorrow.” Likewise, Schaum stresses that, from a billing standpoint, “Determining What’s Broken With Your Wound Clinic Reimbursement & Implementing Required Fixes” is imperative for any clinic that may not be meeting the expected financial bottom line. From another proactive perspective, Aviles suggests “How to Save Your Wound Clinic From Failure” by acknowledging and (to a point) embracing mistakes as teaching moments.
According to Dr. Fife, “we have big, unanswered questions about wound bioburden, antimicrobial dressings, and infection, and we don’t seem to be getting closer to finding the answers.” In “I Do Not Like Green Eggs and Ham,” her From The Editor message that kicks off this year’s edition on infection control and prevention in the outpatient clinic, she reveals that today’s chronic wounds are not as easily kept free of infection and drainage as they were 10 years ago – and there are data to prove it. Today’s providers also have to remain more vigilant against skin and skin-structure infections (SSSIs) beyond the inpatient hospital walls as a result of significant morbidity in the community setting, as Daniel B. Chastain, PharmD, AAHIVP, and Gregory M. Steele, RN, MSN, FNP-BC, OCN, write in their article “Management of Skin & SSSIs in the Outpatient Clinic.” Antibiotic selection has become more challenging due to increasing rates of resistance in combination with patient-specific factors, including comorbidities and allergies. This article offers reference materials that the outpatient clinician will not want to miss.
Despite these challenges posed by infections, as technology continues to advance in healthcare, so too do the tools and strategies for treating chronic wound infections. However, we are seeing some homage paid to the past in some novel approaches. Recent efforts marry old and new modalities to delicately deliver agents that are effective against bacteria but do not interfere with normal wound healing. Using this perspective as a backdrop, Sarah Waterman Manning, MD; Michael Schurr, MD; and David Humphrey, MD, CWSP, FACCWS, discuss the current science and future considerations in this area of care in their article “Emerging Innovations in the Prevention & Treatment of Chronic Wound Infections.” Our May edition also assists providers and program directors in meeting their due diligence on the TPE program with our Business Briefs column that outlines frequently asked questions surrounding the program.
Pain management in the outpatient setting continues to be a problematic area of care, if for no other reason than its relationship with opioid abuse that’s currently gripping this country. This epidemic is just one of the “5 Trends in Pain Management for Today’s Wound Care Clinicians” that Jay Joshi, MD, DABA, DABAPM, FABAPM, tackles within this edition. We also feature a review of outpatient case studies that focus on pain management by Roger B. Schechter, MD, FACEP, FCCWS, and a guide to “Recognizing & Correcting Biomechanical Problems of the Foot” by Henry C. Hilario, DPM, AACFAS, and Aviles.
One of our most highly trafficked articles of the year has been “Amniotic Membrane Allografts in the Outpatient Wound Clinic: Current Practice Guidelines & Modalities” by Mallory Przybylski, DPM, MSc, as part of our edition on regenerative medicine. To that extent, Matthew Regulski, DPM, ABMSP, FASPM, FAPWH(c), provides both an article and a video series on the utilization of and an historical perspective on stem cells in the outpatient clinic. In this edition we also launched a new C-suite initiative – our Executive Spotlight series – featuring Organogenesis Inc. officials Brian Grow and Patrick Bilbo, and released the engaging series “Why This Doctor Chose Wound Care” by Jill Eysaman-Walker, DO.
When it comes to wound care, a reminder of the “basics” can often be the route to best practice. Our August edition took that perspective from a podiatric standpoint, and our “Wound Care Clinician’s Podiatric Glossary” stands as one of our most detailed resources to date. Similarly, the article “Endovascular Health 101 for the Outpatient Wound Clinic” by Desmond Bell, DPM, CWS, discusses current guidance, examines emerging trends, and offers a primer on helpful jargon commonly used when communicating with interventionists. TWC also introduced our new Wound Clinic Case Study series.
As a journal centered on the “business-side” of outpatient wound care centers, TWC also wanted to take the time to address the business of you, our readers — the wound care clinicians and program directors. And when we sought potential contributors to compile our inaugural Careers edition, we were met with a lot of enthusiasm that we think resulted in great content. From how to properly negotiate salary and helpful job interviewing strategies to developing leadership skills and planning for retirement, we have your career landscape covered. Anchoring the edition is a unique perspective on how to go about “Advancing Your Wound Care Career” by Jonathan Scott, CHT, and Mazuz, and a piece that offers insight from KOLs of various disciplines.
We at TWC know that you rely on us for continuous education on billing, coding, documentation, and reimbursement. This year, our annual reimbursement edition was paired with the fall meeting of the Symposium on Advanced Wound Care. Schaum, our reimbursement (et cetera) specialist once again took a shared hold of the reigns to bring readers a near cover-to-cover reimbursement syllabus. This year’s theme, “Revenue Management Cycle Insights,” could not have been more appropriate. This edition offers these insights from a comprehensive perspective: management companies, HBOT administrators, coders, and billers all have a stake in this special edition.
Each year, TWC also gives specific space to a diabetes edition, even though, yes, we realize that diabetes care is essentially reflected in every edition published. In November, we took things a step further with a “deep dive” into the “other side” of oxygen as it relates to diabetes and wound care: caring for a population living with comorbid sleep apnea and/or COPD. Debbi Whitten- Byles, RRT, RRT-SDS, and Aviles offer a comprehensive look at care planning in their article “Oxygen & Wound Healing: Going Beyond Hyperbaric Therapy.” We also shine a light on “Determining if Nutrition is the Missing Ingredient to Your Wound Healing” in an article by Liz Friedrich, MPH, RDN, CSG, LDN, FAND, NWCC.
You’re holding the December edition of TWC (or viewing online). For some of the topics our readers voted on this year, and our focus on safety in the wound clinic, peruse these pages (or links).