Wound program can boost revenue, patient care
Wound program can boost revenue, patient care
More rehab programs embracing the concept
The old saying, "When one door closes, another opens," might apply to the use of wound management programs by rehabilitation departments. The same rehab departments that are stretched thin in terms of commercial and Medicare reimbursement are building revenue and improving patient outcomes through wound care and wound management.
Adding wound management services can generate between $200,000 to $457,000 in revenue per year for a hospital, depending on the size of the institution, says Pam Unger, PT, partner and clinical director of The Center for Advanced Wound Care in Wyomissing, PA.
"After our first eight months [of operation], we’ve been a moneymaker," she says. "This is an area that’s booming across the entire country. There’s still reimbursement for it. It [wound care] has been identified as something that exists and needs to be treated. [Rehab departments should] try to intervene with a service that’s revenue-generating but also produces a positive outcome."
Although not a new concept, the area is rapidly being embraced by therapists. More than 20% of physical therapists responding to a survey sponsored by Alexandria-VA-based American Physical Therapy Association (APTA), the wound management special interest group, say wound care management should become a recognized specialty in the physical therapy field, says Carrie Sussman, PT, president of Sussman Physical Therapy Inc. and Wound Care Management Services in Torrance, CA.
"More than 1,100 respondents felt it should be a part of the practice of physical therapy. Eight hundred specifically said that it is part of their practice," says Sussman, a frequent consultant on wound management in physical therapy.
"Historically, therapists got into wound care via hydrotherapy, such as Hubbard tanks. But today, it has evolved to where therapists are doing open wound care. We’ve taken it to a more defined role," says Cordell Atkins, PT, a certified wound specialist who is a senior therapist and crew leader at Intermountain Health Care in Salt Lake City. Atkins also serves as chairman of APTA’s wound management special interest section. "But in our physical therapy role, we have to demonstrate a functional outcome purpose. If we’re working with pressure ulcers, we also have mobility activities or positioning activities, for example. If I look at diabetic wounds, I may look at gait activities, pressure reduction, total contact casting, or [shoe] insoles or inserts."
The common denominator among hospital rehab programs that have implemented wound management techniques seems to be the presence of a therapist interested in this area. Take Unger, for example. She entered the wound management area in 1981 when working in a nursing home. "Every time I had a patient with a wound, the wound got in the way of rehab. A patient wouldn’t be able to do his exercises or ambulate because he had a wound in his heel, for example," she says.
So Unger started researching what was out there. After doing some digging, she determined that rehab professionals could contribute to the area of wound management. She initiated a wound care program in the physical therapy department of a skilled nursing facility. She later established a wound care program for an 800-bed facility, then worked as a regional director for a Pennsylvania rehab agency, and, in 1991, decided to establish a wound care center at Community General Hospital in Reading, PA.
After doing some research and attending continuing education courses on wound management, Unger decided to develop a PT-directed wound care center, operating first out of the hospital’s inpatient therapy department and eventually as a wound clinic within the hospital. Initially, she worked as a consultant three days a week, helping the department beef up its wound management program and dealing with patients who had specific wound management needs.
Growth occurred gradually
It didn’t take long to establish a patient base. Because the hospital rotated therapists among inpatient care, acute care, and other rehab settings, Unger developed a good referral base between staff therapists and hospital physicians. "I took orders that came down from the physician, assessed the patient, and called the physician to discuss a care plan. The only outlay [to the hospital] was the cost of using me as a consultant." Unger billed a consultant’s fee by the hour to the hospital.
Eventually, Unger’s patient load grew enough for her to establish an on-site wound management department with ancillary clinical services at the hospital. "Initially, it was just me and a receptionist, and later we added a physical therapy assistant," she says. As patient volume increased over the years, The Center for Advanced Wound Care gradually grew to its current staff of nine. The center also added a satellite office with a staff of four.
"Don’t think you need to do it all on day one," advises Unger, who consults with hospital rehab units hoping to start a wound management program. "We have our best success with clinics when we start small and progress and grow."
Atkins’ involvement in wound management has led to the development of a physical therapy team specializing in wound management at Intermountain. Atkins and a partner, another physical therapist, work a seven days on/seven days off 10-hours-per-day schedule. The physical therapy team receives referrals from hospital and outpatient physicians — including plastic surgeons, general surgeons, orthopedists, endocrinologists, internists, family practitioners and podiatrists — as well as hospital-based nurse practitioners and physician assistants. The physical therapy team is able to treat the patients in their rooms or in the hospital physical therapy department, depending on the patients’ needs.
Hospitals shouldn’t expect to see this kind of patient volume immediately, however. Atkins has been providing wound management services for more than 17 years.
At the Veterans Administration Medical Center in west Los Angeles, the rehab department has seen subtle rather than dramatic changes since it began offering wound management treatment two years ago, says Randi Woodrow, PT, manager of physical therapy at the hospital.
"We’re using staff time in a better way, and the costs have been minimal," she says, adding that the hospital has not totalled the costs of adding the program because funds were drawn from the department’s continuing education budget.
Sussman instituted a wound management program for a skilled nursing facility to treat patients with severe mobility impairments who had developed pressure ulcers, and she found that the treatment improved patient recovery time and became an additional source of revenue for the facility. She since has branched out into a specialty in wound-management consulting for physical therapists and has co-written a book, Wound Care: A Collaborative Manual for Physical Therapists and Nurses.
Staff therapists educated physicians
VAMC’s decision to enhance its wound care program was driven by the physical therapy department, Woodrow says. "We had a physical therapist who came to us with wound care experience," she recalls. "We didn’t know what we were missing. She shared current information and education with us. It was really through her pushing that we identified that our knowledge wasn’t as current as it could be."
The hospital used Sussman to train some of the staff therapists as well as educate its attending physicians and residents, who primarily are physiatrists, Woodrow explains. After the presentation, the hospital’s staff therapists invested time in edu cating physicians one- on-one.
"It was really very time-consuming. Tradi tion ally, physicians would order a whirlpool treatment [for a patient with a wound infection] followed by betadine. Our message was that there are methods that are less invasive and more cost-effective" such as collagenase or hydrophilic dressings, she explains. "It was a process. It wasn’t like we decided to do it one day and had approval the next. The entire process [of educating physicians] probably took a year."
Sussman agrees that physician buy-in is essential to starting a wound-management program. "Pitch it as another revenue-generating center," she suggests. "It’s almost like taking your car in to be repaired. Your first two questions to the mechanic are, When can I get my car back?’ and How much [will it cost]?’ Similarly, physicians want to know when [you plan to implement the program] and what are the expected results. And what research do you have to back it up?" (See story at right for resources that may provide that information and additional suggestions from Sussman.)
Saving time and money
Woodrow says that although her department has not documented the cost and outcomes of wound management treatments vs. the whirlpool treatments typically recommended by the physicians, she has no doubt that the wound care techniques are saving time and money.
"Traditionally, when a physician would order the patient to be put in a whirlpool for 20 minutes, we needed staff time to clean the whirl pool, to sit with the patients for the 20 minutes [during treatment], and to then clean and drain the pool," she points out. "That was very time-intensive. Now, with things like electrical stimulation and dressing changes, we deal only with the involved part of the body with the wound."
Physician support is just part of the multidisciplinary team effort needed for a successful wound management program, say Sussman and Unger. "I pretty much did it all on my own initially when I started this in 1981, but you just can’t do that [today]," Unger asserts. "You’re not with a patient 24 hours a day. You need nurses, dietitians, and specialists like podiatrists or plastic surgeons."
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