From the Editor: Are The Walls Closing In On Wound Care?

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Issue Number: 
Volume 12 Issue 8 - August 2018
Caroline E. Fife, MD, FAAFP, CWS, FUHM

My house has withstood five hurricanes and a flood event of Biblical proportions, but has been nearly destroyed twice by that most unpredictable of forces — indoor plumbing. I really didn’t think the problem was all that bad this time, although I was putting buckets underneath light fixtures to catch the water and it was a sunny day outside. I couldn’t see that much water, which is what happens when it is running between the walls. So, the “abatement team” that I keep on speed dial began deconstructing the walls, removing cabinets and kitchen appliances, and pulling up flooring. Four days later, they thought they were done until the quality officer arrived, walked over to a wall that appeared to be undamaged, and easily peeled off a section of paint and drywall with her fingers. “I have allergies,” she said, “and I can just sense where the mold is starting to grow.” Sure enough, under that wall was black mold, which means I will be rebuilding part of my house (again) and I’ll need a new plumber (again) in hopes of fixing the source of the problem. In the process, I was forced to do some housecleaning that I had been putting off for two decades because this disaster affected the messy spaces that guests don’t usually see. It was an exhausting, unpleasant job. However, what’s ironic is that now the part of my house that everyone sees is a total wreck, but the unseen (usually disorganized) areas are all cleaned up. As I went along with this project, I made some changes that will help my house to be more functional than prior to the most recent incident. Currently, things are worse than ever, but I know, eventually, things will be better.


I don’t want to force an analogy here, but we’ve had some disasters recently in the field of wound care, and we need an abatement team with a good nose. For some practitioners, the disaster is just beginning, and it may finally be time to clean up the messy areas we were hoping nobody would notice. The proposed rules for outpatient hospital departments were recently published and, as we have been expecting, everything is about to change for cellular products. Episodes of care may finally be here, and the Centers for Medicare & Medicaid Services has included “hyperbaric oxygen therapy (HBOT) for diabetic wounds” on its list of proposed (but not finalized) topics for Recovery Audit Contractor audits. Hundreds of providers may be required to participate in corporate integrity agreements as part of a settlement with the United States Department of Justice under the False Claims Act. The Medicare Administrative Contractor WPS® Government Health Administrators is issuing letters to HBOT providers in Jurisdiction 5 to “self-audit” their HBOT charges and return payments from as far back as six years ago in response to an audit by the Office of Inspector General. I’ve only scratched the surface with the few I have listed here. 

This is going to be a big, messy closet cleaning. My daughter used to shove all the stuff she didn’t want to deal with under her bed, and I’m embarrassed to admit how long that scheme of hers fooled me. Eventually, however, you get caught and you have to clean up your mess. If you haven’t had to deal with issues like this before, allow me to casually explain. Strangers will come in and tear down what it took you years to build. It will cost you a lot of money and it will be a mess for a long time. If you are smart, you learn from it. You decide to work with better people and fix the problems that got you into the mess. Then, you find a way to rebuild differently. If you try to ignore it, the problem doesn’t go away. Instead, it grows where you can’t see it until it is too late to be fixed. What worries me is not that we have to tear down and rebuild in our field, but that there may be individuals who think they don’t have to.