October 2012 by HMP Communications, LLC

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Today’s

Contemporary Approaches to Wound Clinic Management

The Changing Face of Wound Care:

Quality Measures Industry changes are on the horizon. Here’s your head start on adaptation.

Also in This Issue: Meaningful Use Standards Business Briefs

October 2012

SAWCSPRING

www.todayswoundclinic.com sawcspring.com

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Today’s

Volume 6, Number 8, October 2012 • www.todayswoundclinic.com

Table of Contents • Feature Articles 10

Making Wound Care More Meaningful: Understanding Incentive-Based Programs Many physicians may find it difficult to qualify for federal EHR Meaningful Use incentives. As of October 2014, those who still haven’t met Meaningful Use standards will face Medicare payment cuts.What does it take to qualify? What are some appropriate solutions? Zubin Emsley

The Changing Face of Wound Care: Measuring Quality The wound care industry as we know it is about to change, and quality measures need to be on every wound care clinician’s radar if the industry is to “survive” this change.Where do we stand right now? Find out here. Caroline Fife, MD, FAAFP, CWS

The ‘Rapid Track’ to Improved Wound Outcomes At University of Mississippi Medical Center, many wound care patients are seen on a newly created subacute care department (the Rapid Track) that works independently and offloads the hospital’s main ED. By facilitating earlier, more appropriate delivery of wound care, the department has benefitted overall patient care as well as eased logistical and financial concerns.

Kristi A. Henderson, DNP

TODAY’S WOUND CLINIC® (ISSN 1938-6311), is published by HMP Communications, 83 General Warren Boulevard, Suite 100, Malvern, PA 19355. TODAY’S WOUND CLINIC® website, www.todayswoundclinic.com, is registered with all major Internet search engines. Full content is available online to TODAY’S WOUND CLINIC print subscribers. Subscriptions: TODAY’S WOUND CLINIC annual rates for US subscriptions: $99.00 annual; single copies, $39.00. ®

Single or replacement copies of TODAY’S WOUND CLINIC® are subject to availability. To subscribe to TODAY’S WOUND CLINIC®, call (800) 237-7285, ext. 221, write to TODAY’S WOUND CLINIC®, Circulation Department, HMP Communications, 83 General Warren Boulevard, Suite 100, Malvern, PA 19355, or visit us online at www.todayswoundclinic.com. Reprints: Bulk professional-quality reprints (minimum quantity 100) of articles may be purchased. Contact the Managing Editor at (610) 560-0500 for information.

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Advertising queries should be addressed to Jeremy Bowden, Publisher, Today’s Wound Clinic®, HMP Communications, 83 General Warren Boulevard, Suite 100, Malvern, PA 19355. Telephone: (800) 237-7285 or (610) 560-4154 Fax: (610) 560-0501. Email: jbowden@hmpcommunications.com Display and classified advertisinG: HMP Communications, 83 General Warren Boulevard, Suite 100, Malvern, PA 19355, Phone: (800) 237-7285 or (610) 560-0500 x259 Corporate Offices HMP Communications, LLC 83 General Warren Boulevard Suite 100 Malvern, PA 19355 Phone: (610) 560-0500 or (800) 237-7285 Fax: (610) 560-0502

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Editorial Staff

Today’s

Volume 6, Number 8, October 2012 • www.todayswoundclinic.com

Founding Editorial Board Kathleen Schaum, MS Christopher Morrison, MD Val Sullivan, PT, MS, CWS Managing Editor Joe Darrah jdarrah@hmpcommunications.com

Table of Contents 4

Clinical Editors and Founding Board Caroline E. Fife, MD, FAAFP, CWS Dot Weir, RN, CWON, CWS

Web Editor Samantha Alleman salleman@hmpcommunications.com

From the Editor

Business Staff

Caroline Fife, MD, FAAFP, CWS

Executive Vice President Peter Norris pnorris@hmpcommunications.com

Departments 6 Business Briefs Is Your Wound Clinic Prepared to Provide Care Under Parallel Reimbursement? Kathleen D. Schaum, MS

15 SAWC News Brief

VP/Group publisher Jeremy Bowden jbowden@hmpcommunications.com Publisher Kristen J. Membrino kmembrino@hmpcommunications.com National Account Manager Kevin Melesky kmelesky@hmpcommunications.com

HMP Communications, LLC

“Gives Back” Program Awards Wound Care Scholarships

Industry Insider

Controller Meredith Cymbor-Jones

An inside look at Sechrist Industries Inc. & Progressive Wound Care

Vice President, Special Projects Jeff Hall

PRESIDENT BIll Norton

Marketing Manager Stephanie Manzo

Clinician’s Report

Educational Programs

Creative Director Vic Geanopulos vgeanopulos@hmpcommunications.com

TWC News Update

Art Director Bernadette Zeminski bzeminski@hmpcommunications.com

obile wound care app gets sponsorship; new diabetes M drug proves effective

Senior Production Manager Andrea Steiger asteiger@hmpcommunications.com Production/ Circulation Director Kathy Murphy kmurphy@hmpcommunications.com

32 Advertiser’s Index

Audience Development Manager Bill Malriat

TWC Online

MEETING PLANNER Tracy Blithe, CMP

www.todayswoundclinic.com Keep up with the latest updates, news, and articles posted by TWC on our home page and social media sites.

MEETING PLANNER Mary Beth Kurimay

HMP Communications Holdings, LLC Chief Executive Officer Jeff Hennessy

Find us on Facebook @ www.facebook.com/todayswoundclinic

Chief Financial Officer Dan Rice Senior Vice President Anthony Mancini

83 General Warren Boulevard, Suite 100, Malvern, PA 19355 Editorial Correspondence should be addressed to Managing Editor, Today’s Wound Clinic®, HMP Communications, 83 General Warren Boulevard, Suite 100, Malvern, PA 19355. Telephone: (800) 237-7285 or (610) 560-0500 /Fax: (610) 560-0502. Editorial policy: TODAY’S WOUND CLINIC® seeks to provide practical, timely insight into clinical and operational issues inherent to the success of an outpatient wound center. Program Directors, Medical Directors, and Clinical Managers (including Nurse Practitioners and other professional wound care providers across multiple disciplines) will benefit from the interactive nature of feature articles and regular departments that address medical and practice management options and perspectives affecting fiscal and, most importantly, patient outcomes of wound clinics. Articles from knowledgeable, experienced practitioners are invited and will be subject to Editorial Board review. , LLC

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Director of e-Media and Technology Tim Shaw Sr. Manager, IT Ken Roberts

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fromtheeditor

few years ago, I got a call from the medical director of a large HMO. After introducing himself, he said, “I want to know why it costs less to send a patient with a chronic wound to see you than somewhere else.” It was an awkward situation because I was being paid a fixed salary regardless of how many patients I saw each day, and the truth was that I had decided to see how efficient I could be at organizing the evaluation and workup of patients in order to make my life as “easy” as possible. I did vascular screening Caroline Fife on initial visits and combined magnetic resonance imagCo-Editor of TWC ing for osteomyelitis with magnetic resonance angiograms. I was not happy with the use of bone scans anymore, and money was actually being saved. Within 72 hours I could get patients into the catheterization lab for revascularization if needed, or into a treatment plan that was best for them — all as outpatients. I also minimized follow-up visits, which allowed me to see more new patients. The downside was that I might not generate as much revenue from each individual patient, but more patients got treated, and more appropriately, I felt.

Changes Coming In this issue of Today’s Wound Clinic, we explore the “brave new world” of healthcare and how it is linked to such concepts as quality measures and the “Meaningful Use” of electronic health records (EHRs).The HITECH Act, which launched the new advent of US healthcare, focuses on the creation of a nationwide exchange of information and the standards needed to make that possible. More than $20 billion was set aside to incentivize providers to adopt EHRs and use them in a “meaningful” way, which includes the submission of quality data to the Centers for Medicare & Medicaid Services (CMS). However, many physicians are finding it difficult to qualify for federal EHR Meaningful Use incentives. Eligible providers who do not meet these standards by October 2014 will face Medicare payment cuts. An article by Zubin Emsley, CEO of a national EHR vendor, discusses how specialist practices can adapt in the feature article “Making Wound Care More Meaningful: Understanding Incentive-Based Programs” on page 18.

Today’s

Editorial Board Founding Editorial Board Members Co-Editor of Today’s Wound Clinic Caroline Fife, MD, FAAFP, CWS Co-Editor of Today’s Wound Clinic Dot Weir, RN, CWON, CWS Christopher A. Morrison, MD, FACHM, FCCWS Valerie Sullivan, PT, MS, CWS Kathleen D. Schaum, MS

Editorial Board Members Andrew J. Applewhite, MD, CWS, UHM Leah Amir, MS, MHA Desmond Bell, DPM, CWS Trisha Carlson, MSN, MBA-HCM, RN, CWCN Donna J. Cartwright, MPA, RHA, CCS, RAC, FAHIMA Moira Hayes, MHA, RRT, CHT Cathy Thomas Hess, BSN, RN, CWOCN Harriet Jones, MD, BSN, FAPWCA Robert S. Kirsner, MD, PhD Trisha Markowitz, MSN, MBA-HCM, RN, CWCN, DAPWCA Pamela Scarborough, PT, DPT, MS, CDE, CWS Susie Seaman, NP, MSN, CWOCN

Impact on Wound Care Meaningful Use of an EHR means submitting quality data to CMS, and the Affordable Care Act will create “value based” payment that will tie reimbursement to quality metrics. How will that affect wound care, and what will providers report? The industry will not “survive” this transition if we can’t work together to answer these questions. I review where we currently stand in the feature article “The Changing Face of Wound Care: Measuring Quality” on page 10. Meanwhile, the very principles we have been discussing, “the right care, for the right patient at the right time,” is exemplified by Kristi A. Henderson, DNP, beginning on page 22 in “Wound Care on the Rapid Track,” a feature article that describes a program at the University of Mississippi Medical Center (headed with the assistance of fellow TWC board member Harriet Jones, MD, BSN, FAPWCA) that features a subacute department that offloads the hospital’s main emergency department in an effort to improve wound care. By facilitating earlier, more appropriate delivery of care, the department has benefitted overall patient care as well as eased logistical and financial concerns.We need more innovative programs like this.With all the pending changes coming, I’m reminded of a quote by Albert Einstein: “Not everything that can be counted counts, and not everything that counts can be counted.” We must figure out how to measure what counts, and how to report it to CMS. n

Tere Sigler, PT, CWS, CLT-LANA Pamela G. Unger, PT, CWS, FCCWS Randall Wolcott, MD, CWS

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83 General Warren Boulevard, Suite 100, Malvern, PA 19355 © 2012, HMP Communications, LLC. All rights reserved. Reproduction in whole or in part prohibited. Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of HMP Communications, LLC, the editorial staff, or any member of the editorial advisory board. HMP Communications, LLC is not responsible for accuracy of dosages given in articles printed herein. The appearance of advertisements in this journal is not a warranty, endorsement or approval of the products or services advertised or of their effectiveness, quality or safety. HMP Communications, LLC disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Content may not be reproduced in any form without written permission. Reprints of articles are available. Contact HMP Communications, LLC for information.HMP Communications, LLC (HMP) is the authoritative source for comprehensive information and education serving healthcare professionals. HMP’s products include peer-reviewed and non-peer-reviewed medical journals, national trade shows and conferences, online programs and customized clinical programs. HMP is wholly owned subsidiary of HMP Communications Holdings LLC. Discover more about HMP’s products and services at www.hmpcommunications.com.

Caroline Fife, co-editor of TWC, chief medical officer at Intellicure Inc. cfife@intellicure.com. 4

October 2012 Today’s Wound Clinic®

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The pressure is off. Off of you, off the wound, off the patient.

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Bloomgarden, ZT; American Diabetes Association 60th Scientific Sessions, 2000. Diabetes Care 24:946-951, 2001.

Bohne, G; Cost Effectiveness and Implementation of an Easy to Apply Total Contact System for Diabetic Grade 2 Neuropathic Foot Ulcers in Multi Physician Clinic. CSASWC Conference, 2009.

Shah, S; The Economics of Total Contact Casting. SAWC Spring Conference, April 2011.

Armstrong, et al; Diabetes Care, June 2001.

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businessbriefs

Is Your Wound Clinic Prepared to Provide Care Under Parallel Reimbursement? Kathleen D. Schaum, MS Information regarding coding, coverage, and payment is provided as a service to our readers. HMP Communications and the authors do not represent, guarantee, or warranty that the coding, coverage, and payment information is error-free and/or that payment will be received.The ultimate responsibility for verifying information accuracy lies with the reader.

ost wound care professionals know the terms “Medicare Shared Savings Program” and “qualityof-care initiatives,” and have heard about demonstration projects that are being implemented (eg, bundled payments for care improvement, global payment initiatives, accountable care organizations, independence at home, patient-centered medical home, etc.). Some wound care professionals may work in health systems that already participate in one or more of these programs while others may work in systems that are preparing to participate, but may not be aware of impending changes. Other wound care professionals may think their practice will never participate in these programs and may be caught off guard if their administration decides to participate. Therefore, all wound care professionals should take the time to ask their administration if/when/what types of programs are on the horizon. No matter what stage of participation providers find themselves in, now is a good time to begin to understand the fact that you and/or your workplace could potentially be eligible to receive Medicare payments in addition to your normal feefor-service (FFS) payment (because you and/or your workplace are participating in one of more of these programs). Otherwise, providers will experience reductions in Medicare payments because of non-participation/non-compliance. In this article, the author describes payment

by the Medicare FFS program and the Medicare Shared Savings Program and/ or quality-of-care initiatives as “Parallel Medicare Reimbursement Programs.” The wound care professional’s challenge is to learn how to achieve quality outcomes at the lowest total cost of care under these parallel payment programs.

Medicare FFS Payment Systems Before we discuss how wound care providers can take the lead in Medicare Shared Savings Programs and/or qualityof-care initiatives, let’s briefly review the current volume-driven Medicare FFS payment systems. • Medicare Physicians’ Fee Schedule: the physicians’Medicare payment system that’s based on the resource-based relative value units assigned to each CPT® code. Under this system, physicians are paid for each medically necessary service and procedure they perform. Physicians do not have incentives to reduce visits or procedures, unless their Medicare contractor’s Local Coverage Determinations (LCDs) limit utilization. • Medicare Severity-Diagnosis Related Groups: the acute care hospitals’ Medicare payment system. Under this system, acute care hospitals are paid a lump sum based on patient diagnosis for each medically necessary admission. Hospitals do not have incentives to reduce admissions, but do have incentives to reduce lengths of stay. • Ambulatory Payment Classification (APC) system: the name of most hospital-based outpatient wound care departments’ (HOPDs) Medicare payment system. (There are exceptions, such as Maryland, critical-access hospitals, and Indian Health System). Under this system,HOPDs are paid based on the

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resource-driven APC group to which each service and procedure they perform is assigned by Medicare. HOPDs are not incentivized to reduce the number of visits or procedures unless their Medicare contractor’s LCDs limit utilization. • Home Health Resource Group: the acuity-based Medicare payment system for home health agencies. Under this system, agencies receive lump sum payments based on resources (identified in the Outcome and Assessment Information Set that determine the patient’s functional, clinical, and service needs) that will be required by the patient for each medically necessary 60-day episode of care. Home health agencies are not incentivized to reduce episodes of care. • Resource Utilization Group: the acuity-based Medicare payment system for skilled nursing facilities. Under this system, these facilities are paid daily per diems based on resources identified for each patient in the Minimum Data Set that is completed on days 5, 14, 30, 60, and 90. Skilled nursing facilities do not have incentives to reduce Medicare covered stays. • Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies Fee Schedule: the Medicare payment system for DME suppliers. Under this system, DME suppliers are paid based on the payment rate assigned to the Healthcare Common Procedure Coding System (HCPCS) code that represents the equipment or supply provided to the Medicare beneficiary. DME suppliers have very few incentives to reduce the amount of equipment or supplies they provide. By now you probably realize that patients who live with chronic wounds do not always have a consistent wound

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businessbriefs Will Your Wound Clinic Take the Lead? Wound care physicians, podiatrists, non-physician practitioners, nurses, and therapists have been trained on chronic wound management from diagnosis to the best level of closure (depending on the patient’s underlying conditions). Unfortunately, the various silos of care prevent most wound care professionals from managing patients throughout the continuum. New Medicare programs and initiatives are now offering wound care professionals the opportunity to manage wound care patients from start to finish. These new payment programs will require wound care professionals to “think outside the box” and to develop wound care case management teams that will follow patients as they move throughout the continuum of care. Wound care professionals and clinics should not expect administration to approach them when they first begin work on Medicare Shared Savings Programs: at first, administration will be busy establishing similar programs for heart disease, renal failure, end-stage renal disease, etc. Therefore, wound care professionals should brainstorm on how their wound clinics can coordinate case management teams throughout the continuum. The wound clinic could change its focus from a volume-driven department to a center for excellence that case manages patients throughout the continuum of care and that cares for patients in the wound clinic when it is clinically necessary to do so. The opportunities are endless. Is your wound clinic ready to accept this challenge of providing care in a fee-for-service environment and case managing the patients’ care for the best outcomes at the lowest total cost of care throughout the sites of service in your health system?

care physician and nurse case manager to coordinate care as they move through the continuum of care. Very few physician-lead case management teams own the responsibility for providing the best outcomes at the lowest cost of care from the time the wound is identified until the wound has reached its expected outcome. During the 2012Wound Clinic Business (WCB) seminars, attendees have shared numerous instances in which wound care cases lacked coordination of care. Some of the most common examples reported are: • The patient’s diagnosis was non-specific or inconsistent as various wound care physicians, podiatrists, and non-physician practitioners provided wound care for the patient in different care settings. • Wound care plans changed significantly (sometimes with positive results and sometimes with negative results) as the patient moved to different care settings. • Duplicate diagnostic tests were often ordered because test results were not transferred to the next site of care. • Surgical dressings purchased by the patient were wasted because a new physician changed the dressing order unnecessarily. • Medication errors occurred due to illegible orders. WCB seminar attendees also report

waste/duplication is often encountered as patients move to the next site of care because transferring facilities and/or providers failed to transmit complete documentation. Because each site of care/provider has different reimbursement incentives, inconsistent wound management outcome goals are often influenced by the Medicare payment system of the site of care/provider/supplier, rather than by the specific needs of each Medicare beneficiary.

Medicare Shared Savings Recognizing that current Medicare FFS payment programs do not emphasize patient-centered outcomes and reduction of total cost of care, Medicare has released numerous incentive programs to begin achieving these goals.These new programs offer payment incentives for providers to work together and become accountable for coordinating patient care. For example: • In the “bundled payments for care improvement”initiative,Medicare makes a single payment to provide all services related to a treatment or condition during an episode of care.To succeed in this initiative, wound care professionals should focus on coordinating wound care for an entire episode of care (from 3 days prior

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to hospitalization, through hospitalization, and 30 days following discharge). • In the “global payment” initiative, Medicare makes 1 payment to primary care physicians to manage each patient across the healthcare delivery system.To succeed in this initiative, wound care professionals should work with primary care physicians to coordinate care of patients living with chronic wounds in that delivery system. • In “accountable care organizations,” Medicare offers payment incentives for healthcare providers to work together to treat an individual patient across care settings. To succeed in this program, wound care professionals should use their skills, clinical practice guidelines, and published data about wound care procedures and products to lower the growth in wound care costs while meeting performance standards on quality of care and by putting patients first (patient satisfaction). • In the“independence at home”initiative, Medicare provides payment incentives to physicians and nurse practitioners to direct home-based primary care teams. To succeed in this initiative, wound care professionals should work with primary care physicians to reduce preventable hospitalizations, prevent hospital and skilled nursing facility readmissions, decrease unnecessary emergency department visits, improve the quality of wound care, and decrease the total cost of wound care. Note that these incentives are expected to boost physician house calls. • In the “patient-centered medical home” initiative, Medicare provides payment incentives to healthcare settings that facilitate partnerships between individual patients and their physicians and, when appropriate, the patient’s family. To succeed in this initiative, wound care professionals must understand how to work with registries, information technology, and health information exchanges.

Who Should Lead New Initiatives? It is well known that physicians control approximately 85 percent of the decisions that drive quality and cost of medical care.

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businessbriefs SECRET TO SUCCESS: Establish case management teams that focus on quality, not quantity. Just like physicians are leading programs and initiatives for the management of heart disease, diabetes, end-stage renal disease, etc., those physicians with wound care expertise should lead and be rewarded for coordinated patient-centered wound care initiatives. Their goals should be to reach wound care-related quality benchmarks and to decrease the total cost of wound care across the continuum of care. Also similar to other major disease states,wound care physicians must use electronic health records (EHRs) to capture data that measure their patient-centered wound care outcomes. To assist in managing the care of the patients throughout the continuum of care, wound care physicians should surround themselves with excellent nurses, therapists, and non-physician practitioners. Together, they should learn and speak the performance-based language, participate in the early development of case management-based wound care programs, set clear goals and strategies for quality wound care, accept accountability for reaching quality benchmarks, use EHRs to capture useful patient-centered outcomes data, and share risk through various Medicare and commercial incentive programs based on improved quality outcomes at the lowest total cost of care. These wound care case management teams should provide evidence-based, patient-centered care, coordinate care with all stakeholders, improve efficiency, eliminate unnecessary diagnostic tests, reduce duplication of effort, reduce medical mistakes, reduce unnecessary readmissions, reduce waste, emphasize prevention, and use data to show quality of wound care provided. Most importantly, these wound care case management teams should not wait for someone from administration to come to them. Instead, they should blaze new frontiers for coordinated wound care services by proactively approaching administration with their ideas of how to case manage wound care across the continuum of care. These teams will require courage to transform the way wound care is delivered. However, the rewards of

changing the paradigm for patients living with chronic wounds will be gratifying and may lead to additional Medicare payments. Together, wound care case management teams can improve quality, reduce cost, and create a sustainable system to manage wounds for a population that will increasingly require their expertise and care. Imagine that your outpatient wound care department deploys case management teams to the hospital, to the long-term care hospital, to the skilled nursing facility, to patients at home, and to patients who must be seen in outpatient wound care departments (for deep surgical debridements, for application of cellular and/or tissue-derived products, for hyperbaric oxygen, etc). Also imagine that your outpatient wound care department has a telemedicine system that will allow case management teams to communicate and collaborate on difficult cases. Finally, imagine your outpatient wound care department housing the master EHR for all patients living with chronic wounds throughout your health system. This type of wound care case management system would allow you to provide the right patient-centered care, for the right reason, at the right time, and for the right payment. Most importantly, your wound care case management system would prove to be fiscally responsible and sustainable under the parallel FFS programs and the Medicare Shared Savings Programs.

Coding, Payment, Coverage Many wound care professionals have the mistaken idea that they will not need to pay attention to using the correct ICD9-CM/ICD-10-CM diagnosis codes, the correct CPT service and procedure codes, and the correct HCPCS codes for medical equipment and supplies when they participate in the Medicare Shared Savings Programs and/or quality-of-care initiatives. Many wound care professionals also mistakenly believe they will no longer have to stay abreast of the latest Medicare payment system updates, of Medicare’s National Coverage Determinations (NCDs), or of their Medicare contractor’s LCDs. How-

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ever,nothing is farther from the truth when providers and health systems are working under parallel Medicare reimbursement programs. In some way, each of these parallel Medicare reimbursement programs is based on codes,the current year’s Medicare payment system, and coverage guidelines established by the Centers for Medicare & Medicaid Services (CMS) and/or by the Medicare contractor that processes the Medicare claims of each provider. Therefore, all wound care professionals must learn and properly use all codes that are pertinent to their Medicare payment system. In addition, all wound care professionals must read and implement payment system regulations that are published as “final rules” and are effective on Oct. 1 (hospitals, home health agencies, and skilled nursing facilities) and Jan. 1 (physicians, HOPDs, and DME suppliers). Most importantly, all wound care professionals must read and comply with all NCDs and/or LCDs pertaining to the services, procedures, and products they provide to patients who live with chronic wounds. Because CMS will still process claims based on ICD-9-CM/ ICD-10-CM codes justifying medical necessity; CPT codes identifying services and procedures performed; and HCPCS codes identifying separately payable drugs, biologics, medical devices, and supplies, coding correctly and following Medicare coverage guidelines are more important tasks than ever. These behaviors lead to payment under the traditional Medicare FFS programs, and are used to track quality of care and total cost of care under Medicare Shared Savings Programs and/or quality-of-care initiatives (which can lead to an additional Medicare payment if quality of care is acceptable and total cost of care has dropped below Medicare established thresholds). n Kathleen D. Schaum is president and founder of Kathleen D. Schaum & Associates Inc. She can be reached at 561-964-2470 or kathleendschaum@bellsouth.net.

Today’s Wound Clinic® October 2012

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The Changing Face of Wound Care:

Measuring Quality Value-based payments are the future for wound care providers. What does that mean right now? Caroline Fife, MD, FAAFP, CWS

he validity of the Mayan calendar, which predicts the end of the world this coming December, is certainly a questionable debate. However, had the Mayans originally set forth to try their hands at predicting the end of the wound care industry as we know it today, they might have been spot on. The future of wound care is coming quickly in the form of quality measures, but many providers haven’t prepared for their respective apocalypse with the same fervor their colleagues have shown across other healthcare specialties. Depending on how you calculate the effects of the Affordable Care Act (ACA), Medicare will go bankrupt in 2024 or 2016, according to the 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, which also acknowledges that the current “volume based” business model for delivering healthcare is unsustainable. The “fee for service” (FFS) system, which pays physicians for each individual service provided, has resulted in what many could consider an expensive yet mediocre delivery of healthcare. Reimbursement based on number of services can actually reward substandard quality, and it could be argued that the least-skilled practitioners are compensated the most, since the more tests or interventions they perform and the longer their patients remain in their care results in more revenue earned. This is set to change, however, as health reform legislation will dramatically change the way providers are paid, giving payment

bonuses and/or penalties based on the achievement of patient outcomes. Section 3007 of the ACA includes a Senate provision that would pay for individual physician services based on a “value index,” creating a new value-based payment modifier that will be used to provide differential payments to physicians based on quality and cost of care beginning in 2015. Since the payment adjustments are to be budget neutral, some physicians will receive bonuses while others will face penalties under this provision. Current pay-for-performance programs, known as “value-based purchasing,” will be expanded. It is likely that payment based on quality measures will soon represent a substantial portion of a wound care physician’s income. However, the movement away from FFS began in earnest in 2006, when then President George W. Bush signed the Tax Relief and Health Care Act (TRHCA), which authorized the Centers for Medicare & Medicaid Services (CMS) to establish and implement a physician quality reporting system — the Physician Quality Reporting Initiative (PQRI). Participating in PQRI (now called PQRS [Physician Quality Reporting System]) has been challenging for wound care clinicians. Also known as Pay for Performance (P4P), the initiative has not been living up to that name so much as it is “paying for reporting” without requiring physicians to “pass” or “fail” on any quality measures reported. The Medicare Improvements for Patients and Providers Act (MIPPA)

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of 2008 authorized a 2 percent bonus for physicians who successfully reported quality measures. Bonuses increased to a total of 4 percent in 2011 (2 percent for PQRS reporting plus 2 percent for electronic prescribing). In 2011, there were 173 measures applicable to primary and specialty physicians. Most of the measures were designed to evaluate whether a clinician provided the “right” care, not whether the patient’s outcome was favorable. Today, both the focus of the measures and the voluntary nature of PQRS are changing.

Guidelines vs. Quality Measures

Crucial to adjusting to the changes ahead for the wound care industry is having an understanding of the difference between clinical practice guidelines (CPGs) and quality measures. CPGs are a way of describing what ought to be done, while quality measures are a test to determine what kind of care was actually performed. Imagine that, as a member of the American Heart Association, a series of CPGs existed to reduce the likelihood of cardiac disease among adults. These CPGs might include controlling blood pressure, optimizing the patient’s weight, and helping patients to stop smoking. How would these CPGs compare to quality measures? A good way to illustrate this is to visualize patients as a numeric value (just this once). In the case of tobacco use, all patients who used tobacco become the denominator (number of eligible patients). The numerator would then be all smokers whom the

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changingfaceofwoundcare Meaningful Use and the $44,000 Provision Among the many provisions included in the American Recovery and Reinvestment Act signed by President Obama is a piece of legislation known as the HITECH (Health Information Technology for Economic and Clinical Health) Act, a mandate funded by more than $20 billion to incentivize clinicians and hospitals to adopt health information technology. The Medicare Electronic Health Record (EHR) Incentive Programs (part of this mandate) pay up to $44,000 in bonuses to each eligible provider (EP) who adopts and “meaningfully uses” an EHR. “Meaningful use” is determined, in part, by the reporting of certain quality measures, including 3 core measures and 3 “clinical quality” measures from a set of 38 each year for a total of 6 core. Physicians who report their data are to be compensated by taking away money from those who don’t report. Beginning in 2015, non-reporting physicians will lose 1 percent of their Medicare revenue; in 2016 they will see a 2 percent deduction, and in 2017, a 3 percent deduction can be expected. Separately, as part of the Physician Quality Reporting System (PQRS), there are 265 quality measures defined for 2013, of which physicians must submit at least 3 in order to qualify for a 0.5 percent bonus or avoid a 1.5 percent “adjustment.” The Centers for Medicare & Medicaid Services (CMS) worked with the National Quality Forum, whose membership includes a variety of healthcare stakeholders such as consumer groups, hospitals, accrediting and certifying bodies, and healthcare research and quality improvement organizations, to retool 113 of the 265 PQRS measures into “electronic measures.” Of those, CMS selected 51 to be part of the US Department of Health and Human Services’ EHR Direct program, which has established a secure, scalable, standards-based method for participants to send authenticated, encrypted health information directly to trusted recipients over the Internet (http://wiki.directproject.org/file/view/DirectProjectOverview.pdf). Given that those 51 EHR measures contain all 44 HITECH measures (6 core + the 38 aforementioned), physicians can use EHR Direct to meet both the HITECH Meaningful Use requirements and those of the PQRS. When a physician submits measures through EHR Direct, a 0.5 percent PQRS bonus is awarded, a 1.5 adjustment (the reduction in total Medicare billing for not reporting) is avoided, and part of the requirement for HITECH adoption money is met. Unfortunately none of the wound care measures are electronic, so these physicians cannot take advantage of the EHR Direct program in this way. For more information on Meaningful Use, see the Feature Article “Making Wound Care More Meaningful” on page 18.

clinician counseled to stop smoking (a quality measure). Naturally, the goal would be to counsel all smokers to quit and have a measurable to report, as in 200 of 200 (200/200). Remember, the measure to assess counseling for smoking cessation did not specify how many patients actually quit; the measure was designed only to determine how many were counseled. Also, remember that the incentive money was awarded merely for reporting on said measure, regardless of whether or not it was met. Could a physician simply have counseled only 1/200 smokers and have gotten a bonus just for reporting data? Conceivably. (In reality, calculating measures is much more complicated because there

are exclusion criteria for numerators and denominators of particular measures.) For more details on quality measures, visit www.qualitymeasures.ahrq.gov/content. aspx?id=32560.

Wound Care’s Quality Measures

There were no measures relevant to wound care when PQRS launched, but there is now a measure directly applicable to our industry: the percentage of patients with venous ulcers who were prescribed any type of compression 1 time during the year in which they were treated. Since all physicians had to report at least 3 measures successfully to qualify for a bonus, wound care physicians have been forced to report on measures that aren’t directly applicable to the industry

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(eg, screening for fall risk, tobacco cessation counseling, diabetic blood pressure control, etc.). In 2000, officials with the American Medical Association (AMA) decided to focus on wound care as part of their Physician Consortium for Performance Improvement® (PCPI) project, an effort intended to enhance quality and patient safety while fostering accountability in healthcare by developing, testing, and implementing evidence-based performance measures for use at the point of care. For guidance, they went to the American Academy of Plastic Surgery (ASPS). (Since “wound care” is not a recognized medical specialty and is hindered by not having representation within these types of organizations, the ASPS stood as a viable ally with its voting members by having seats on the AMA House of Delegates.) A multidisciplinary working group came up with 7 measures, and CMS has announced its intention to add 2 of these measures to PQRS. These measures include the “overuse” measures that require physicians to “pass” a measure by not performing swab cultures or using wet-to-dry dressings.There are also some measures that are indirectly relevant to wound care such as hemoglobin A1c measurement and smoking cessation. (See Table 1 on page 14 for a brief summary of the 5 current PQRS measures relevant to wound care.) Initially (in 2007), physicians were to report measures using their “claims” (a paper-based charge document to track these “quality measure” interventions). This method was not successful because it was complex and required a lot of work. In April 2008, CMS expanded the data collection process from the laborious claims-based reporting method to include reporting data via qualified patient registries. However, registry reporting was always meant to be temporary, with a goal to eventually have all physicians report their measures directly from their electronic health records (EHRs). Theoretically, there are four different ways that an eligible provider can submit data to CMS. These approaches are: claims-based, registry-based, directly from

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changingfaceofwoundcare Table 1: Physician Quality Reporting System Measure Specifications Measure Number

Measure Title

Description

Instructions

126

Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy Neurological Evaluation.

Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months.

This measure is to be reported a minimum of 1 time per reporting period for patients with diabetes mellitus seen during reporting period.

127

Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention Evaluation of Footwear.

Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing.

This measure is to be reported a minimum of 1 time per reporting period for patients with diabetes mellitus seen during the reporting period.

186

Chronic Wound Care: Use of Compression System in Patients with Venous Ulcers.

Percentage of patients aged 18 years and older with a diagnosis of venous ulcer who were prescribed compression therapy within the 12-month reporting period.

This measure is to be reported a minimum of 1 time per reporting period for patients with venous ulcer(s) seen during the reporting period.

245

Chronic Wound Care: Use of Wound Surface Culture Technique in Patients with Chronic Skin Ulcers.

Percentage of patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer without the use of a wound surface culture technique.

This measure is to be reported at each visit occurring during the reporting period for patients with a diagnosis of a chronic skin ulcer seen during the reporting period.

246

Chronic Wound Care: The Use of Wet-to-Dry Dressings in Patients with Chronic Skin Ulcers.

Percentage of patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer without a prescription or recommendation to use wet-to-dry dressings.

This measure is to be reported at each visit occurring during the reporting period for patients with a diagnosis of a chronic skin ulcer seen during the reporting period.

an EHR, and group practice reporting. However, since neither the group practice nor the EHR direct options include any of the 5 wound care measures, wound care clinicians can, by default, use only claims-based or registry-based reporting. To become eligible for an incentive, an eligible professional must submit each measure on 80 percent of eligible beneficiaries, and no measure or measures group can have a 0 percent performance rate. It seems unlikely that these measures will significantly improve the outcome of patients living with chronic wounds or decrease the cost of caring for these patients. Clearly, practitioners of advanced wound care need to develop better measures that reflect the care they provide to patients. However, if quality measures are a large component of physician payment, it could be argued that substandard measures would be better than none at all.

Measured Quality in Wound Care

Aside from improving the quality of care for patients in the US, this initiative is also about developing a nationwide program of data transmission to CMS regarding clinician adherence to practice standards. That means wound care practitioners need to consider the types of quality 14

measures by which they would like to be measured. The industry needs to determine measures that would improve patient outcomes, decrease costs, and reflect the quality of care provided. Most would probably agree that the current measures do not suffice. Improving upon them would require large-scale participation, namely in the form of industry members supporting development of better electronic measures. However, development and testing of improved measures for the industry overall will be key. For instance, consider measures like offloading diabetic foot ulcers during each patient visit, or conducting vascular screening with nonhealing leg ulcers. Imagine a measure for adequate compression of venous ulcers at each visit, or placing all pressure ulcer patients on an appropriate support surface. These are among the measures proposed by stakeholders with the National Alliance of Wound Care (www.nawccb.org), a nonprofit organization governed by a voluntary board of directors. As wound care providers, we must begin to act like the specialists we know we are if we want to continue to care for patients in the face of healthcare reform. The measure development and testing process to meet CMS standards is not a

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simple process. Wound care organizations and manufacturers need to combine their resources to create and test electronic measures for wound care. This will require substantial funding, potentially from a coalition of industry and specialty societies. If we begin working together as an industry now, we might have wound care quality measures ready by 2015, when value-based purchasing becomes a reality. If we do not create and test wound care quality measures within the next 12 months, the wound care industry may not exist in order to even be considered a specialty within the next decade. Consider that a Mayan-like prediction. n Caroline Fife is chief medical officer of Intellicure Inc., The Woodlands, TX, and coeditor of TWC. RESOURCES 1. American Medical Association. Physician Consortium for Performance Improvement. www.ama-assn.org/ama/pub/ physician-resources/physician-consortiumperformance-improvement/about-pcpi.page 2. 2 012 Physician Quality Reporting System Medicare Electronic Health Record Incentive Pilot: Quick Reference Guide. www.cms.gov/medicare/quality-initiativespatient-assessment-instruments/pqrs/ downloads//2012pqrs_medicareehrincentpilot_final508_1-13-2012.pdf www.todayswoundclinic.com

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SAWCnewsbrief SAWC ‘Gives Back’ Program Awards New Wound Care Scholarships

From left to right are 2012 scholarship winners and presenters: Terry Treadwell, MD, FACS; Mary Haddow, RN-BC, CWCN; William Ennis, DO, MBA, FACOS; Igor Altman, DO, MBA; Matthew Garoufalis, DPM; Sahani Howie, DPM; Harriett Loehne, PT, DPT, CWS, FACCWS; and Pam Scarborough, PT.

group of clinicians was recently recognized for excellence in wound care at SAWC Fall 2012 in Baltimore, MD. Officials with the North American Center for Continuing Medical Education LLC (NACCME), the continuing education sponsor for the Symposium on Advanced Wound Care (SAWC), and HMP Communications LLC, SAWC co-host, announced the newest scholarship recipients for their SAWC “Gives Back” program. Four wound care providers were honored during a private ceremony at the convention Sept. 13. Each winner earned free registration to SAWC and was selected by several prominent wound care societies and associations, including the American College of Wound Healing and Tissue Repair (ACWHTR), the Association for the Advancement of Wound Care (AAWC), the American

Podiatric Medical Association (APMA), and the American Physical Therapy Association’s (APTA) Clinical Electrophysiology and Wound Management (CEWM) section.The 2012 SAWC Fall scholarship winners are: Wound Healing Fellow Scholarship - Igor Altman, DO, MBA, presented by William Ennis, DO, MBA, FACOS, president of ACWHTR; Wound Care Nurse Scholarship – Mary Haddow, RN-BC, CWCN, presented by Terry Treadwell, MD, FACS, past-president of AAWC (on behalf of Robert J. Snyder, DPM, CWS, AAWC president); Wound Care Podiatrist Scholarship – Sahani Howie, DPM, presented by Matthew Garoufalis, DPM, president-elect of APMA; and Wound Care Therapist Scholarship – Harriett Loehne, PT, DPT, CWS, FACCWS, presented by Pam Scarborough,PT,editorial board member

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of Today’s Wound Clinic, PT, DPT, CWS (on behalf of Rose Hamm, president of APTA’s CEWM section). “Wound care is predominately a multidisciplinary focused practice,” said Howie.“This multidisciplinary approach to wound care is a theme further supported through the SAWC scholarship awards program. I feel that it acknowledges the importance of a team approach to addressing the complicated wounds that we all deal with on a regular basis.” With optimal outcomes best provided by an interdisciplinary care team that often includes physicians, podiatrists, therapists, and nurses, the SAWC Spring & Fall scholarships not only honor these clinical specialties but also wound care fellows and researchers. “The SAWC scholarship program was launched in April of 2012 as a way to thank the many clinical specialists and their societies/associations who advocate for optimal care and treatments for patients with wounds,” said Jeremy Bowden, vice president/group publisher of the wound care division at HMP Communications, which produces numerous publications, including Today’s Wound Clinic. “The SAWC Spring and Fall conferences are the largest combined wound care meetings in the United States, and we wanted to begin a biannual tradition to honor special recipients selected by prominent wound care groups with the various SAWC scholarships.” The next group of scholarship winners will be celebrated May 1–5 in Denver, CO, at SAWC Spring 2013. n Today’s Wound Clinic October 2012 15

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SAWCSPRING 速

The official meeting site of the Association for the Advancement of Wound Care

AAWC

May 1-5, 2013 Colorado Convention Center Denver, Colorado www.sawcspring.com

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Where Wound Clinic Professionals Go For Answers The Symposium on Advanced Wound Care Spring and Wound Healing Society (SAWC Offering up to 30.5 credit ho Spring/WHS) meeting is the urs for wound ca re premier multidisciplinary wound clinicians! care program and is the largest annual gathering of wound care clinicians in the United States. More than 2,000 physicians, podiatrists, nurses, therapists, and researchers are expected to attend the 2013 SAWC Spring/WHS meeting. No other wound care conference offers the level of education, the number of quality sessions, and world-renowned educators each year that clinicians at wound care centers have come to expect at SAWC Spring/WHS. Key Sessions For Clinicians At Wound Care Clinics • Demystifying the Use of Compression • How to Address Complications of Diabetic Foot Ulcers • Assessing the Latest Evidence on HBOT • Wound Care in Special Populations: From Our Smallest to the Largest • Healthcare Reform: What it Means for You • MicroRNA in Wound Repair and Regeneration: A New Paradigm • Telemedicine: What is its Role in Wound Care? • Managing Complex Wounds in the Acute Setting • Strategies For Healing In Palliative Wound Care • Making Wound Centers Run Smoother – A Panel Discussion Learning Objectives • Identify common wound-related skin conditions and their management. • Discuss advances in wound-related physiology, pathology, epidemiology, prevention, assessment, and management. • Evaluate the effects of research on the future of patient care. • Translate scientific data and emerging research knowledge to clinical practice. • Implement the latest best-practice strategies to prevent and manage pressure ulcers. • Explore the wide range of treatment modalities for wound care, including new and emerging therapies. • List the medical and surgical treatment of wounds • Provide optimal healthcare delivery through improved understanding of sites of service and payment schema. • Review current evidence- and consensus-based guidelines and describe how guidelines can be developed into practical algorithms that are used in everyday wound care.

To register for SAWC Spring/WHS in Denver, visit www.sawcspring.com

Intended Learners This conference is designed for physicians, nurses, physical therapists, researchers, podiatrists, and dietitians involved in wound healing or wound care issues. Accreditation Information This activity has been planned and implemented by North American Center for Continuing Medical Education, LLC (NACCME) and the Wound Healing Society (WHS) for the advancement of patient care. North American Center for Continuing Medical Education, LLC (NACCME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. Physicians: NACCME designates this live activity for a maximum of 30.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 6.25 AMA PRA Category 1 Credits™ for WHS Day 1 4 AMA PRA Category 1 Credits™ for the pre-conference 17.25 AMA PRA Category 1 Credits™ for the main conference 3 AMA PRA Category 1 Credits™ for the post-conference Nurses: This continuing nursing education activity awards 6.25 contact hours for WHS Day 1, 4.0 contact hours for the pre-conference, 17.25 contact hours for the main conference, and 3.0 contact hours for the post-conference. Provider approved by the California Board of Registered Nursing, Provider Number 13255 for 6.25 contact hours for WHS Day 1, 4.0 contact hours for the pre-conference, 17.25 contact hours for the main conference, and 3.0 contact hours for the post-conference. Podiatrists: North American Center for Continuing Medical Education, LLC (NACCME) is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine. This program is approved for 6.25 contact hours for WHS Day 1, 4 contact hours for the pre-conference, 17.25 contact hours for the main conference, and 3 contact hours for the post-conference. Dietitians: North American Center for Continuing Medical Education, LLC (NACCME) is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 6.25 continuing professional units for WHS Day 1, 4 continuing professional education units for the pre-conference, 17.25 continuing professional education units for the main conference, and 3 continuing professional education units for the post-conference for completion of this program. CDR Accredited Provider #HM001 Level 3 Synthesis Level Physical Therapists: North American Center for Continuing Medical Education, LLC (NACCME) will apply for pre-approval accreditation in California, Florida, Louisiana, Ohio, and Texas, which require pre-approval. If you practice in another state, please consult its PT board. Note: The following sessions are non-accredited: WHS Session F: Concurrent Mini-Symposia WHS Session G: Organogenesis talks WHS Session H: Animal Model Roundtable Requirements for Credit: To be eligible for documentation of credit for each session attended, participants must participate in the full activity and complete the online general survey and the online evaluation form for each session by June 5, 2013. Complete the forms at http://www.myexpocredits.com/naccme . After completing the forms, participants may immediately print documentation of credit. Copyright ® 2012 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education. ADA Statement: North American Center for Continuing Medical Education complies with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please call 609-371-1137.

Robert Kirsner, MD, PhD

Dot Weir, RN, CWON, CWS

Cancellation Policy: Please note the cutoff date for cancellation is March 19, 2013. All cancellations must be received in writing and postmarked by that date. Full registration (less a $75 processing fee) will be refunded only to cancellations received in writing before the above date. No refunds will be issued after March 19, 2013 — without exception. Registrations are transferable at any time.

Vice Chairman and Stiefel Laboratories Professor Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami, FL

Osceola Regional Medical Center Kissimmee, FL

For registration or general information, call 800-854-8869.

SAWC Chairpersons

SAWCSpring2013_2pageAd_TWC.indd 3

*Information contained herein is subject to change without notice.

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Making Wound Care More Meaningful:

Understanding Incentive-Based Programs Zubin Emsley

n today’s fiscal healthcare climate, remaining financially secure can be as imperative to clinicians as it is to provide optimal care — a standard that continues to be redefined by federal programs and professionals seeking to improve care delivery across the healthcare spectrum. The federal government’s program to promote “Meaningful Use” of electronic health records (EHRs) in an effort to establish secure, confidential exchange of health information across the care continuum, is paramount and has become a household name among providers and hospitals. But many clinicians have yet to qualify for the financial rewards associated with EHR implementation set forth by guidelines initiated by the Centers for Medicare & Medicaid Services’ (CMS) EHR Incentive Programs, which provide payments to eligible professionals (EPs) and hospitals as they demonstrate meaningful use of certified EHR technology. (Ambulatory practice-based physicians, designated as “eligible professionals” by CMS, can receive up to $44,000 through Medicare incentives and up to $63,750 through Medicaid if they attest [qualify] by Oct. 4, 2012. Those who first qualify next year and in 2014 will be eligible to receive lesser amounts.) Why haven’t more specialist physicians qualified at this point? Cost and financing are issues. Some physicians have

said the incentives are not large enough to compensate them for costs associated with installation of an EHR system. Another factor is basic uncertainty about the future of their businesses. A recent survey by the Physicians Foundation found that 92 percent of practicing physicians said they were “unsure” where the US health system would be or how they would fit into it 3-5 years from now. Other providers may be waiting to see if new legislation ends the program (an unlikely event, since the program has bipartisan support). What’s more, for clinicians running wound care centers, concerns regarding EHR Meaningful Use are closely tied to Medicare’s Physician Quality Reporting Initiative, now known as the Physician Quality Reporting System (PQRS). Both EHR Meaningful Use and PQRS take the “carrot and stick” approach, with incentives given to early adopters and penalties on the horizon for non-adopters. The time to adapt is now.

Conforming to Meaningful Use

Under current rules, all physicians who do not meet EHR Meaningful Use standards by October 2014 will face Medicare payment cuts of 1 percent in 2015 and 2 percent in 2016. There is quite a bit of overlap between the PQRS and Meaningful Use pro-

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grams, since both require using an EHR to record and report clinical measures to CMS. It is currently possible to receive both Meaningful Use incentives and meet PQRS requirements; however, separate filing is required. CMS officials have said they will align the two programs in 2014 so that physicians can file once and get credit for both programs. There are several important facts physicians working in wound care clinics need to know about EHR Meaningful Use: • Ambulatory surgery centers and most other types of freestanding clinics do not qualify as eligible hospitals, and thus can’t collect stimulus payments as organizations. The individual physicians may qualify, but they must file on their own as “EPs.” • The requirements state that 50 percent of an EP’s patient encounters during the reporting period must be at one or more practices that are equipped with a certified EHR system. This allows EPs to participate in the program even if they work at multiple locations with varying levels of Meaningful Use adoption. For example, if a physician treated the majority of his/her patients at a clinic with an EHR, but also treated some patients in a private office without an EHR, he/she could still qualify.

www.todayswoundclinic.com

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For a demo of the ConnectEd Learning Management System, please contact your Hollister Wound Care representative, or visit us online at www.hollisterwoundcare.com/connect-ed.

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changingfaceofwoundcare Definition of EP

Under Medicare’s EHR Meaningful Use, EPs include: doctor of medicine (MD), osteopathy (DO), podiatric medicine (DPM), optometry (OD), or chiropractic (DC), and dentist or dental surgeon (DDS or DMD). Medicaid has a slightly broader definition of eligible professionals, including nurse practitioner (NP), certified nurse midwife (CNM), and physician assistant (PA; if employed at a federally qualified health center or rural health clinic). Note that one cannot collect incentives from both programs. Stage I of Meaningful Use took effect in January 2011. As of Aug. 1, 2012, 66,883 physicians overall had qualified for the Medicare Meaningful Use while another 50,887 had qualified through Medicaid. This represents 18 percent of all physicians who participate in that program and are eligible for Meaningful Use, according to CMS officials. To date, some 25,000 family practice and internal medicine physicians have attested, comprising almost 50 percent of all those who have qualified. The attestation rates for specialist physicians are significantly lower. For example, only 2,137 general surgeons and 2,500 orthopedic surgeons have qualified so far — low rates for technologically advanced physicians. What are the specific barriers that wound care physicians and other specialists report facing in qualifying for these incentives? ChartLogic Inc., a national EHR vendor based in Salt Lake City, UT, recently conducted a survey of about 100 specialist physicians who had successfully qualified for Stage I. This survey found the most difficult challenge reported was “distributing clinical summaries to patients,” cited by 38 percent of those reporting. The Stage I attestation guidelines require the medical office to make available clinical summaries, either paper or electronic, to patients within 3 business days after a physician’s examination. The survey also found the second major difficulty was in “collecting patients’ vital

signs” (height, weight, blood pressure, body mass index). This requirement was cited by 14 percent of specialist practices as their most difficult challenge. A third specific challenge of “collecting patient demographics” was reported by 8 percent of practices to be most difficult. Stage I requirements state that practices must collect demographics as structured data, including preferred language, gender, race, ethnicity, and date of birth. Note that all the practices responding to the survey had successfully qualified for Stage I incentives, so they were able to meet these challenges successfully.

Qualifying For Payments

The days of simple reimbursement through fee-for-service medicine are coming to an end. Both the federal government and private payers are requiring new measures of accountability — measures that require the use of EHRs. The selection and implementation of an EHR should be viewed in terms of a sound business investment that will generate a positive return of investment and improve patient care. While the clock is ticking, there is time to plan for EHR implementation in a careful manner. Medical group leaders who wait too long may find themselves rushed into hasty decisions and without time for effective training. Below are some tips that may prove helpful: 1. Select an EHR designed for specialist care. Data collection can be more burdensome to wound care clinicians in a busy clinic than for primary care physicians, who generally see 20-25 patients per day, many of whom are returning patients, according to the American Academy of Family Practitioners. In contrast, most wound care physicians see many first-time patients each day. While vital signs can be collected by nurses or medical assistants, physicians will need to document each patient evaluation. Busy clinicians should look for an EHR system that has customized templates and multiple ways

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of entering information. Advanced EHR systems enable physicians to input data via keyboard, point and click, and touch screen. 2. Ask patients to self-report demographics. Patients are accustomed to self-reporting personal information in many situations, so it’s feasible to have them do this in the waiting room when possible. Many medical offices provide check-in kiosks or tablets to patients to facilitate data entry. If a clinic serves many elderly patients, consider staying with a paper solution. One option is to collect the needed demographic with “bubblein” forms that can be fed into optical mark readers, which will then load the data to the EHR system. Before purchasing the forms or optical scanners, check EHR compatibility. 3. Use a patient portal for clinical summaries. Printing and mailing a patient summary (within 3 days per Meaningful Use standards) is an option, but can be costly and time consuming. One cost-effective alternative is to install a patient portal, a web-based application that allows patients to interact with providers. Many, but not all, certified EHRs come with patient portals. When a clinic or medical practice has installed a portal, staff can quickly upload the clinical summary to a web site to be viewed by the patient. Note that current Stage I Meaningful Use standards do not require patients to read or to download a clinical summary; it just needs to be “available.”Vendors can demonstrate the process of ensuring a portal is compatible with an EHR. If it takes numerous clicks of the mouse to send or upload a patient summary and 50 patients are seen per day, extra work each day for all involved can be expected. n Zubin Emsley is chief executive officer of ChartLogic Inc. For more information, visit www.chartlogic.com.

www.todayswoundclinic.com

10/3/12 2:35 PM

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The ‘Rapid Track’ to Improved Wound Outcomes Aware of the constraints faced by an overcrowded ED, staff at UMMC is taking a new approach to wound management. Kristi A. Henderson, DNP

here may not be anything more indicative of the frailties that exist in today’s healthcare system than the continued overcrowding of emergency departments across the US. As Americans live older with chronic health conditions, the wound care industry specifically is becoming more affected. According to Nawar et al, more than 11 million visits for wound-related issues occurred in EDs throughout the US in 2005.1 The result of a variety of circumstances (ie, a large uninsured/underinsured population, a lack of access to healthcare specialists such as wound care providers, a lagging economy coupled with high costs for medical care), the burden placed on EDs in this country is exemplified by the number of patients who seek care in the ED for services that should be conducted

in a dedicated specialty clinic — including wound care. Aside from a backlog that gets created when large crowds present in a facility’s ED, patients also face the risk of receiving inappropriate treatments when well-intentioned providers become too pressed for time and often turn to prescribing systemic antibiotics to treat common maladies. In 2009, ED visits in the US exceeded 136 million people,2 and as much as 20 percent of all medical malpractice claims (and more than 10 percent of all malpractice settlements) have stemmed from clinical issues that are associated with wound care.3 While wounds that are associated with acute injuries often require an initial ED visit, non-acute wounds and skin infections are better served by early access to a wound care spe-

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cialist (WCS). ED visits are typically managed by different providers, which results in fragmented care when patients return to the hospital for recurrent conditions. An awareness of this problem has led to a unique program for wound care patients at the University of Mississippi Medical Center (UMMC), Jackson, MS, which serves as the only academic medical center in a state that’s dealing with great health disparities, high disease and mortality rates, and a large portion of its population being considered low socioeconomic status. Through the utilization of the new initiative, UMMC has reduced its traffic within the ED while improving outcomes and streamlining woundspecific care more efficiently in its outpatient center, eliminating the need for patients to make multiple visits.

www.todayswoundclinic.com

10/3/12 2:22 PM

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changingfaceofwoundcare UMMC’s ED patient volume exceeded 100,000 visits in 2001, with approximately 75 percent being adults. The “Rapid Track for Minor Care” was launched in May 2011 as a means to provide non-urgent treatment in a dedicated area of the ED for conditions such as wound care.

Need For A Quick Fix

UMMC’s ED patient volume exceeded 110,000 visits in 2011, with approximately 75 percent being adults. With this demand for care came an increase in the number of patients experiencing wound care/skin infection complaints (7,095 patients). Many of these same patients were found to be returning to the ED for multiple visits related to the same needs, resulting in care that proved expensive for them as well as the facility. Also home to Mississippi’s only Level I trauma center, children’s hospital, and transplant center, UMMC is the largest diagnostic, treatment and referral care system located in the state (722 beds). Inpatient stays total approximately 29,000 annually, with more than 209,000 outpatient and emergency visits each year. The adult ED includes a 35-bed unit with areas devoted to trauma, general medicine, orthopedics, and non-urgent care area. The Rapid Track is staffed 16 hours per day by family nurse practitioners who are experienced in urgent care management and operates with the following goals at the forefront: • providing timely access to a WCS; • providing education on wound care management and procedures; • providing continuity of care; and • decreasing ED visits for wound care management. Patients arriving to the ED with a skin infection or wound care issue are

triaged by a nurse practitioner (NP) for appropriateness of care and a consult with a WCS is performed if the NP is unable to treat the patient with a single ED visit. Consults allow for a baseline assessment and early intervention by a WCS if needed. In these instances the NP accompanies the wound physician during the patient’s evaluation and treatment. This collaboration has benefited the NP with training in procedures such as incision and drainage, debridement, nail removal, and application of various wound dressings. At the time of discharge from the ED all patients are given follow-up appointments with the specialist to foster continuity of care.

Results Seen

Between May 2011 and August 2012, 76 wound care consults for unique patient encounters were provided in the Rapid Track. Many patients required additional clinic follow up by the WCS on an outpatient basis during this timeframe, which has fulfilled the goal of reducing census in the ED as well as improving continuity of care. Harriet L. Jones, MD, BSN, FAPWCA, associate professor of medicine and physician wound specialist at UMMC, has been very impressed with the success of the program thus far: “One of the first nurse practitioners who embraced the concept of what we were trying to do had previously been a wound care provider at a facility nearby. She was such an important contact and helped remind other Rapid Track providers that there was now somewhere to refer their patients for follow up. Patients also appreciated

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the fact that they had a more appropriate and user-friendly venue for subsequent care. This program continues to help offset the long wait times associated with wound patients. Additionally, we have found some patients have earlier, more appropriate intervention and fewer inappropriate treatments, such as prescriptions for systemic antibiotics, that may not really be indicated. Almost a year after this program started, I was seeing a patient new to me who had been referred from the ED for a follow up, and I’m very proud to say the continuity of care we provided may have prevented an unnecessary limb amputation.”

Future Focus

With the success UMMC officials have seen with the Rapid Track program, the next step to improving wound care management at the facility is already underway. With a focus on expanding the reach of the Rapid Track beyond the hospital walls, a telemedicine program is on the horizon that is expected to deliver care by wound specialists across the state. Set to launch this October, the telewound service will allow local community hospitals, nursing homes, and clinics to request a WCS consult with UMMC physicians. n Kristi A. Henderson is associate professor in the school of nursing and chief advanced practice officer at the UMMC. She can be reached at khenderson@umc.edu. Harriet L. Jones, MD, BSN, FAPWCA, associate professor of medicine and physician wound specialist at UMMC, contributed to this article. References 1. Nawar EW, Niska RW, Xu J. National hospital ambulatory medical care survey: 2005. Adv Data. 2007;386:1-32. 2. CDC. Fast Stats ER Visits. 2012. Retrieved online at www.cdc.gov/nchs/ fastats/ervisits.htm. 3. Pfaff J, Moore G. ED wound management:identifying and reducing risk. ED Legal Letter. 2005;16:97-108.

www.todayswoundclinic.com

10/3/12 2:22 PM

INVESTIGATE

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The nation’s premier event devoted to managing the wound care and hyperbaric oxygen therapy (HBOT) revenue cycles for hospital-based outpatient departments and physicians who work there. 2012 brings many new reimbursement and payment policy changes for wound care, HBOT departments and physicians. Even if you have attended a Wound Clinic Business meeting in previous years, you won’t want to miss this entirely new 2012 program, which highlights all the changes you must implement. • Investigate your REVENUE CYCLE TEAM’S knowledge of the ideal operational processes by following a patient through initial access/registration, assessment with management documentation requirements, charge capture and diagnosis and, finally, claim submission and payment. Then further your team’s knowledge of why and how to conduct internal audits pertaining to wound care and HBOT.

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industryinsider An Inside Look at Sechrist Industries Inc.

n interview with Ed Pulwer, chief executive officer, president. Today’s Wound Clinic (TWC): How long have you been in wound care, and how did you enter this area of healthcare? Ed Pulwer (EP): I have been with Sechrist Industries, my initial Ed Pulwer, entry into wound chief executive officer, president, care, for 3 years; Sechrist Industries Inc. however, I have more than 30 years’ experience in other medical arenas such as critical care and diagnostics. TWC: What’s your day-to-day role? EP: My responsibilities include all functional areas of the company, such as sales, research and development, marketing, regulatory/quality, manufacturing, etc. Since all Sechrist hyperbaric chambers are made in the US at our Anaheim, CA, facility, we are diligent in making sure that each and every product meets all regulatory and quality standards. TWC: What do you find most rewarding about providing for your industry? EP: Being a part of an organization that is providing a significant therapy and a beneficial medical product to thousands of patients everyday globally. As I watch the reach of hyperbarics and wound care grow each year, it is reassuring to know that our products are there to help people in need. TWC: How would you describe the overall mission of your company? EP: Sechrist is a team of dedicated

professionals whose purpose is to identify, develop, and sustain a global offering of high-quality technology and innovative solutions to the healthcare community.We identify and fulfill healthcare opportunities that will improve the quality of patient care, add convenience and efficiency for the practitioner, and provide cost-effective technology applications. TWC: What’s new with Sechrist? EP: We have several new products that will enhance hyperbaric technology for both patients and the clinical environment available in 2013. TWC: How is your company unique? EP: Our People. All employees have a sense of responsibility and passion for the products we manufacture.They know and have seen the benefits to patient care as an example in healing patients with severe wound care issues. TWC: Why are you passionate about the work of your company? EP: As the incidents of nonhealing wounds continue to grow, our passion for providing hyperbaric therapy to thousands worldwide grows. Knowing that the products we make will help patients in the treatment of wounds and improve their quality of life gives meaning to the jobs we do every day. Knowing that we are providing technology that will help patients improve their quality of life is what makes all of us passionate about our company. TWC:How is your company approaching challenges in wound care? EP: From our perspective, one of the main challenges to wound care is the access patients have and the understanding of the benefits and results that can be provided

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through the use of hyperbaric technology. There are many patients who need access to this type of treatment.To help overcome this, we are working within the medical communities to help people understand the benefit of hyperbaric therapy. Also, many companies providing medical products face the same challenges we do — such as reimbursement. The fact that we can show excellent results helps tremendously in continuing to educate practitioners and the public. TWC: What are your most popular products and/or services? EP: Sechrist’s H-Model Hyperbaric Chambers and our data acquisition software system, H.E.R.O.™ Based on our original pneumatic chamber, the H-Model series of hyperbaric chambers includes key safety features as well as features that improve patient comfort. The H.E.R.O. system is a new product, but one that’s exceedingly popular since it provides the ability to electronically document all aspects of hyperbaric treatment and allows data to be collected for use in other reporting systems. TWC:How do you ensure proper training on products and services? EP: All new customers are trained onsite by our technical service department, and these teams are available 24/7. TWC: What are the future goals for you and your company? EP: We want to increase the awareness of the benefits that hyperbaric therapy provides not only in the medical community but to the public, and take this awareness beyond our borders globally.There are several clinical trials ongoing for new indication,and this is an area that will need industry support and educational programs. n

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industryinsider

An Inside Look at Progressive Wound Care

n interview with John P. Kennedy, RPh, PhD, clinical advisor Today’s Wound Clinic (TWC): How long have you been in wound care, and how did you enter this area of healthcare? John P. Kennedy (JPK): A little more than 10 years. My career started as a researcher in the pharmaceutical industry. Wound care was John P. Kennedy, RPh, PhD not on my radar when clinical advisor, Progressive Wound Care I graduated. Ultimately, patients led me here. I began to focus on chronic infection in 2000, which led me to biofilm-based investigations that included chronic wounds. In 2006, I began an academic post that included a clinical component, giving me the opportunity to work with patients again.At this academic post, I continue to focus my clinical and research efforts on bioburden and biofilm-based wound care strategies. TWC: What’s your day-to-day role? JPK: Serving as a clinical advisor and educator to wound care providers who wish to leverage the unique advantages of biofilm-based wound care. TWC: What do you find most rewarding about providing for your industry? JPK: Now that I am “back in the clinic” and talking about patients with other clinicians daily, I get direct feedback on the impact of my work (and the work of others). It’s real, tangible, and unfiltered. Such a perspective drives an expediency that, like it or not, you personally “feel.” The expediency is impossible to avoid, as the patient is right there, right now.The problems just come, day-by-day, ready or not. While the phone calls and cards from patients with dramatically positive outcomes are rewarding and significant,

the failures are what keep me up at night. TWC: How would you describe the overall mission of Progressive? JPK: To educate wound care providers on the impact of chronic wound bioburden and affect outcomes through biofilmbased wound care solutions. TWC:What’s new with your company? JPK: From a product line perspective, the expansion of our DNA-guided wound care solutions tops the list. These include topical wound gels used alone or in combination with our negative pressure wound therapy dressings.Within the year, we will be launching the first foam-based, complex iodine dressing in wound care (IodoFoam(R)).We are excited about IodoFoam and other products that will follow. TWC: How is your company unique? JPK: Progressive is the only wound care company that from inception has focused on bioburden-control-based biofilm paradigms. Our mission was always to bring these biofilm-based solutions to the market, but in the beginning biofilm was largely unknown or underappreciated in wound care. Few corporate partners were interested in pursuing such products. Thankfully, interest in biofilm management has increased dramatically since we began development. TWC: Why are you passionate about the work of your company? JPK: Because I know firsthand from the clinic the difference it makes in outcomes, and the quality of life for our patients.As a clinical advisor, I am creating relationships one clinician at a time, often regarding a single patient. It is the only approach I really know. Collectively, I have learned far more from working with clinical cases than I have shared on any one case, and learning is a lifelong passion for me.

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TWC: How is your company approaching challenges in wound care? JPK: If by challenges you mean healthcare reform, then in short, improved patient outcomes will be our approach. We have always focused on outcomes and unmet needs as the driver for product development. TWC: What are your most popular products and/or services? JPK: Within our dressing line, the DNA-guided personalized options are clearly the most popular for advanced therapy. Our standard negative pressure wound care sets and topical anti-biofilm gels are also quite popular. TWC: How do you ensure proper training on products and services? JPK: We provide webinars, live continuing education, video, and print materials. The most common subject areas are biofilms, treatment options, molecular (DNA) diagnostics, and strategies for advanced practice. Outside of formal training,clinical advisors are available to address any specific case directly. TWC: What are the future goals for you and your company? JPK: There is no reason why the topical anti-biofilm agents can’t be just as targeted and personalized (microbial DNA guided) as the topical antibiotics we currently provide. As we grow in volume, it will justify making the anti-biofilm components just as targeted as the antibiotics. There are certainly more standard anti-biofilm solutions that we can bring to market, two of which we hope to launch in the next year. Wound biofilms are extremely diverse, thereby dictating the demand for multiple management solutions. Behind the scenes, we are constantly expanding our research and knowledge base. n

www.todayswoundclinic.com

10/4/12 11:57 AM

clinician’sreport Hollister Wound Care Inc. WEBSITE: www.hollisterwoundcare.com CONTACT: 888-740-8999; leslie.rader@hollister.com LOCATION: Libertyville, IL FOUNDED: 2006 PROGRAM PROVIDED: ConnectEd® Learning Management System (LMS).

PROGRAM DESCRIPTION: ConnectEd® Learning Management System is a comprehensive, interactive program that allows clinicians to customize their own educational catalog with evidence-based content. Deliver, track, and manage wound care education within your facility through your existing LMS or directly through the Internet. The ConnectEd Learning Management System gives you the technology that can: Deliver – critical educational requirements; Track – individual progress and compliance; Manage – wound care education through customizable learning libraries; and Improve — Bottom line savings by helping to meet education requirements without disrupting required nurse-topatient ratios.

TARGET AUDIENCE: Bedside nurses and wound care providers.

Educational Programs

care professionals to stay knowledgeable of the latest clinical advances in treatment options.

TARGET AUDIENCE: SAWC conferences are designed for physicians, nurses, physical therapists, researchers, podiatrists, and dietitians who are involved in wound healing or wound care issues. SAWC provides attendees who study and treat wounds with state-of-the-art reviews of clinical problems and research information.

FOR MORE INFORMATION: SAWC meetings are multi-day meetings held in the spring and fall. To register or to learn more information, visit www.sawcspring.com or www.sawcfall.com or call 800-237-7285, ext. 233. n

Wound Care Education Institute (WCEI)® WEBSITE: www.wcei.net CONTACT: Mike Grivas, CWCMS, vice president of business development; 877-4629234; mike@wcei.net

LOCATION: Plainfield, IL FOUNDED: 2003 PROGRAM PROVIDED: Skin and Wound Management Course

PROGRAM DESCRIPTION: WCEI’s Skin and Wound ManageFOR MORE INFORMATION: Contact a Hollister Wound Care ment Course is a 5-day wound care training seminar designed to representative by emailing leslie.rader@hollister.com, or visit www.hollisterwoundcare.com n

Symposium on Advanced Wound Care WEBSITE: www.sawcspring.com; www.sawcfall.com CONTACT: HMP Communications LLC LOCATION: Malvern, PA FOUNDED: 1987

provide participants with current evidence-based education in the areas of skin and wound management for licensed healthcare providers who plan to take both the skin and wound management course and the wound care certified (WCC)® exam from the National Alliance of Wound Care.®

TARGET AUDIENCE: Licensed healthcare providers holding any of the following credentials — MD, DO, DPM, PA, PT, PTA, OT, NP/APN, RN, LPN/LVN.

FOR MORE INFORMATION: Call 877-462-9234; email Info@ Program Provided: SAWC Spring and SAWC Fall meetings. wcei.net; or visit www.wcei.net. n PROGRAM DESCRIPTION: As the nation’s top two interdisciplinary wound care conferences, SAWC Spring and SAWC Fall meetings provide a venue at which wound care clinicians can advance their knowledge and skills to work toward one common goal: decreasing the number and severity of wounds. With more than 130 clinical session offerings combined, SAWC provides the highest level of clinical education. SAWC hosts a major exhibition of products and services for wound

Wound Clinic Business (WCB) WEBSITE: www.woundclinicbusiness.com CONTACT: HMP Communications LLC LOCATION: Malvern, PA FOUNDED: 1987

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TWCnewsupdate Mobile Wound Care App Garners Sponsorship WellDyne Health, a health solutions provider and distributor based in Lakeland, FL, has announced an exclusive sponsorship for WoundSmart,™ a wound care documentation application for the iPhone and iPad. A fully functional documentation suite that can be used to document a wound’s progress on a daily, weekly, or monthly basis while maintaining a secure wound care history,WoundSmart also allows providers to maintain patients’ demographic information, lab results, cultures, and radiographic history in one place, officials said.The app also maintains a record of wound progress, including size and depth,as well as all wound and peri-wound characteristics, grade, drainage, wound procedures, interventions, and signs of infection, in addition to pictorial documentation.

Halifax Health Expands Wound Care Services Healthcare providers at Halifax Health Medical Center, Daytona Beach, FL, recently began offering hyperbaric oxygen therapy, further expanding on wound care within the facility and region. According to the Daytona Beach News Journal, the hospital invested $500,000 to install two hyperbaric chambers to treat patients with chronic, nonhealing wounds. The two chambers can treat up to eight patients per day. Hospital officials will hold a community event to showcase the chambers Nov. 1. n

Celleration Launches Mist Applicator for Wounds A new product by Celleration Inc., Eden Prairie, MN, provides wound care clinicians increased flexibility to access the most difficult-to-reach wounds while allowing larger wounds to be treated more easily, according to officials. The MIST® 360 Applicator offers low-frequency ultrasound delivered without contact through a saline mist. Unlike conventional wound treatments that are limited to treating the surface, MIST Therapy delivers sound waves, which stimulate cells to shorten the healing process, into and below the wound bed to reduce barriers to healing, like bacteria and sustained inflammation, officials said. The mist also makes it easier for healthcare providers to treat wounds that are larger and/or in difficult to access areas of the body. “We are very pleased to be able to provide another treatment solution for these difficult-totreat wounds and to demonstrate Celleration’s commitment to meeting our customers’ needs through bringing innovation to the wound care market,” said Mark Wagner, CEO. For more information, visit to www.celleration.com.

“We are excited to sponsor such an innovative product,” said Doug Taylor, executive vice president of sales and marketing with WellDyne. “It will dramatically help wound care professionals easily and effectively document the life of a wound, providing patients with the highest quality of care while delivering real-life wound solutions.” WellDyne Health also distributes CellerateRX,® a patented advanced wound care collagen product that is exclusively licensed by Wound Care Innovations LLC, Fort Lauderdale, FL, a wholly owned subsidiary of Wound Management Technologies Inc., Fort Worth, TX, an emerging commercial stage company with primary products in the advanced wound care market. n

AAWC Announces 2012 Sponsors Officials with the Association for the Advancement of Wound Care (AAWC) have announced their corporate sponsors for 2012.This year’s group includes 3M Skin and Wound Care, St. Paul, MN; Advanced Tissue, Little Rock, AR; KCI Medical, San Antonio, TX; Convatec, Skillman, NJ; Healthpoint Biotherapeutics, Fort Worth,TX; Hill-Rom, Batesville, IN; Molnlycke Health Care US LLC, Norcross, GA; Shire Regenerative Medicine, Chesterbrook, PA; and Smith & Nephew, Andover, MA. Representatives from these supportive corporations, along with AAWC board members, constitute the AAWC’s corporate advisory panel (CAP), which works to support the wound care industry on issues with payers and government. Participation in the CAP provides a forum for common issues and concerns to be addressed, validated, and submitted to payers and government agencies, according to AAWC. Participating AAWC board members on the CAP include: Robert J. Snyder, DPM, CWS, president; Terry Treadwell, MD, FACS, past-president; Vickie Driver, MS, DPM, FACFAS, president-elect; Peggy Dotson, RN, BS, secretary and chair of the regulatory affairs committee; Barbara Bates-Jensen, PhD, RN, CWOCN, research board member; and Janice Young, RN, BSN, MPH,WOCN, industry board member. The panel meets regularly, including at such meetings as the Symposium on Advanced Wound Care in the spring and fall, to discuss mutual concerns and areas of interest. The AAWC’s 2013 sponsorship campaign is underway. Contact AAWC by calling 800-237-7285, ext. 113 or by visiting http://aawconline.org. n

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AAWC

www.todayswoundclinic.com

10/3/12 2:51 PM

TWCnewsupdate Spiracur Awarded NHS Agreement, SNaP Nets Drug Tariff Approval Spiracur Inc., Sunnyvale, CA, has announced its inclusion on the NHS Supply Chain’s framework agreement for the provision of advanced wound care, including for its suite of negative pressure wound therapy (NPWT) solutions. Spiracur officials have also announced the company has been granted reimbursement status for its SNaP Wound Care System and is listed on the United Kingdom’s drug tariff effective Oct. 1. The framework agreement provides NHS trusts, government departments, and private sector entities that are active in the UK healthcare sector with access to a pre-selected list of approved suppliers in order to expedite the procurement

process and potentially reduce costs. The SNaP system is a mechanically powered, portable NPWT system encompassing proprietary spring technology that reduces air density within an enclosure. The springs stabilize in the presence of exudate so that a constant controlled amount of negative pressure is delivered to the wound bed. Recently, a prospective study to evaluate outcomes for the treatment of lower extremity diabetic, venous, and mixed etiology leg wounds using SNaP commenced at Cardiff University School of Medicine in Wales. For more information, visit http://spiracur.com. n

Once-Per-Week Diabetes Drug Shows Promise in Clinical Study A new drug for treatment of type 2 diabetes that would be administered once per week has shown effectiveness in lowering blood sugar levels during a mid-stage clinical trial, according to a report by Reuters. The pill, known as MK-3102, which is being developed by Merck & Co., Whitehouse Station, NJ, is from the same class of medicines as Merck’s successful daily diabetes drug Januvia, known as DPP-4 inhibitors. The 685-patient study reportedly tested MK-3102 at five doses ranging from 0.25 mg-25 mg against a placebo, with the primary goal being reduction in A1c. After 12 weeks of treatment with the Merck drug, A1c was reduced 0.71 percent at 25 mg, 0.67 percent at 10 mg, 0.49 percent at 3 mg, 0.5 percent at 1 mg, and 0.28 percent for the lowest dose of 0.25 mg. The reductions compared with placebo for all doses were said to be statistically significant, according to Merck officials, who recently presented data at the European Association for the Study of Diabetes (EASD) meeting in Berlin. The 0.71 reduction seen with the 25 mg dose is similar to the glucose reduction attained by Januvia (sitagliptin). Based on the Phase II results, Merck is reportedly launching larger Phase III trials and has chosen to advance only the 25 mg dose to test MK-3102 against, and in combination with, a variety of diabetes treatments. “We do anticipate the efficacy, safety, and tolerability of this will be comparable to sitagliptin,” Nancy Thornberry, Merck’s head of diabetes and endocrinology, told Reuters. As with all new diabetes treatments since Avandia was linked to serious heart risks, MK-3102 will have to demonstrate heart safety in its Phase III trials, according to the report. n

clinician’sreport PROGRAM PROVIDED: WCB meetings PROGRAM DESCRIPTION: The nation’s premier event devoted to managing the wound care and hyperbaric oxygen therapy (HBOT) revenue cycles for hospitalbased outpatient departments (HOPDs) and physicians who work there. Each year, Andrea Clark, a nationally prominent health information management (HIM) expert, and Kathleen Schaum, MS, a nationally recognized wound care reimbursement expert, bring new information on reimbursement and payment policy changes for wound care, HBOT

departments, and physicians. Investigate your revenue cycle team’s knowledge of the ideal operational processes by following a patient through initial access/ registration, assessment with management documentation requirements, charge capture and diagnosis, and claim submission and payment. Then, further your team’s knowledge on how to conduct internal audits pertaining to wound care and HBOT, and why they’re needed.

TARGET AUDIENCE: Medical directors, physicians and podiatrists, non-physician

www.todayswoundclinic.com

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practitioners, program directors, clinical managers, therapists, billing directors, charge description master directors, HIM directors, coders, office managers, corporate compliance officers, revenue integrity auditors, and hospital executives.

FOR MORE INFORMATION: WCB meetings are 1-day regional meetings held in 8 cities around the US.You can learn more by visiting www.woundclinicbusiness.com or by calling 800-2377285, ext. 233. n Today’s Wound Clinic October 2011 31

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Apligraf® Essential Prescribing Information Numbers in parentheses ( ) refer to sections in the main part of the product labeling. Device Description: Apligraf is supplied as a living, bi-layered skin substitute manufactured from cells processed under aseptic conditions using neonatal foreskin-derived keratinocytes and fibroblasts with bovine Type I collagen. (1) Intended Use/Indications: Apligraf is indicated for use with standard therapeutic compression in the treatment of uninfected partial and/or full-thickness skin loss ulcers due to venous insufficiency of greater than 1 month duration and which have not adequately responded to conventional ulcer therapy. (2) Apligraf is indicated for use with standard diabetic foot ulcer care for the treatment of full-thickness foot ulcers of neuropathic etiology of at least three weeks duration, which have not adequately responded to conventional ulcer therapy and extend through the dermis but without tendon, muscle, capsule or bone exposure. (2) Contraindications: Apligraf is contraindicated for use on clinically infected wounds and in patients with known allergies to bovine collagen or hypersensitivity to the components of the shipping medium. (3, 4, 5, 8) Warnings and Precautions: If the expiration date or product pH (6.8-7.7) is not within the acceptable range DO NOT OPEN AND DO NOT USE the product. A clinical determination of wound infection should be made based on all of the signs and symptoms of infection. (4, 5) Adverse Events: All reported adverse events, which occurred at an incidence of greater than 1% in the clinical studies are listed in Table 1, Table 2 and Table 3. These tables list adverse events both attributed and not attributed to treatment. (6) Maintaining Device Effectiveness: Apligraf has been processed under aseptic conditions and should be handled observing sterile technique. It should be kept in its tray on the medium in the sealed bag under controlled temperature 68°F-73°F (20°C-23°C) until ready for use. Apligraf should be placed on the wound bed within 15 minutes of opening the package. Handling before application to the wound site should be minimal. If there is any question that Apligraf may be contaminated or compromised, it should not be used. Apligraf should not be used beyond the listed expiration date. (9) Use in Specific Populations: The safety and effectiveness of Apligraf have not been established in pregnant women, acute wounds, burns and ulcers caused by pressure. Patient Counseling Information: VLU patients should be counseled regarding the importance of complying with compression therapy or other treatment, which may be prescribed in conjunction with Apligraf. DFU patients should be counseled that Apligraf is used in combination with good ulcer care including a non-weight bearing regimen and optimal metabolic control and nutrition. Once an ulcer has healed, ulcer prevention practices should be implemented including regular visits to appropriate medical providers. Treatment of Diabetes: Apligraf does not address the underlying pathophysiology of neuropathic diabetic foot ulcers. Management of the patient’s diabetes should be according to standard medical practice. How Supplied: Apligraf is supplied sealed in a heavy gauge polyethylene bag with a 10% CO2/air atmosphere and agarose nutrient medium. Each Apligraf is supplied ready for use and intended for application on a single patient. To maintain cell viability, Apligraf should be kept in the sealed bag at 68°F-73°F (20°C-23°C) until use. Apligraf is supplied as a circular disk approximately 75 mm in diameter and 0.75 mm thick. (8) Patent Number: 5,536,656 Manufactured and distributed by: Organogenesis Inc. Canton, MA 02021 REV: December 2010 300-111-8 References: 1. Veves A, Falanga V, Armstrong DG, Sabolinski ML; Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24(2):290-295. 2. Data on file, Organogenesis Inc. 3. Apligraf® [package insert]. Canton, MA: Organogenesis Inc; 2010.

Advertiser’s Index Derma Sciences.............................................................5 Healthpoint Biotherapeutics............................... Cover 2 Hollister Wound Care..................................................1 9 Intellicure Inc. ...............................................................7 Medela..........................................................................3 MiMedx Group ............................................................1 3

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Net Health Systems............................................ Cover 3

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Organogenesis Inc. ...................................... 32, Cover 4 Sechrist Industries Inc. ...............................................2 7 Total Wound Care Solutions........................................2 3 Wound Care Education Institute..................................1 1

32 October 2012 Today’s Wound Clinic®

www.todayswoundclinic.com

Potential Payment May Now Be Available for Every Application As of January 1, 2012, the Centers for Medicare and Medicaid Services (CMS) is eliminating the physician 90-day global surgical period for skin and dermal substitute procedures. For more information, please visit the News page on the Healthpoint Biotherapeutics website at www.healthpointbio.com/news.

Call our Reimbursement Navigation Hotline at 1-877-805-5005 for more information.

ÂŠ2012 Healthpoint Biotherapeutics Healthpoint is a registered trademark of Healthpoint, Ltd. TM1302-0112

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New Ideas For Your Paper. The freedom to create your own personalized documentation workflow is possible with WoundExpert. Reduced page loads, clicks, and scrolling gives users enhanced access to patient information relevant to each encounter. WoundExpert is the most comprehensive Certified wound care speicific software available.

Spend less time with paper and more time caring for the needs of your patients

ÂŠ 2012 Net Health Systems, Inc. WoundExpert is a Registered Trademark of Net Health Systems, Inc.

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WoundExpert.com 800-411-6281 9/27/12 9/28/12 5:18 3:57PM PM

After 4 weeks of failed conventional therapy— Rethink the Wound. Think Apligraf®.

Healing Wounds. Healing Lives. Act now for fast and complete healing of diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs).1-3 • Choose the ONLY bioengineered, bilayered, living cell–based product3 • Apligraf is the ONLY treatment indicated for both DFUs and VLUs3 • FDA approval for DFUs as early as 3 weeks3 • FDA approval for VLUs as early as 4 weeks3 • Frequent reassessment and reapplication of Apligraf as needed can signiﬁcantly improve the speed of healing and incidence of complete wound closure in DFUs and VLUs1-3

For information on support programs and tools available from Organogenesis Inc., call 1.888.HEAL.2.DAY (1.888.432.5232—Option 3) Please see accompanying essential prescribing information, or visit www.Apligraf.com for complete prescribing information

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