Advocate Aurora Puts Wound Care First with New PDGM Strategy

For home health providers trying to survive the fundamental shift that is the Patient-Driven Groupings Model (PDGM), leveraging resources as efficiently as possible will be especially important.

For Advocate Aurora Health’s post-acute care division, that means improving outcomes around wound care through enhanced training and education. It’s a clinical pathway several industry experts and consultants have long touted as a key to PDGM victory.

“The biggest steps that people are going through right now are understanding revenue cycle and operational processes — and how PDGM is going to impact them,” Don Spiers, post-acute and long-term care product manager for Relias, previously told Home Health Care News. “What we’re looking at is potentially more people providing care that is tied to wound care, which will be one of the highest areas of reimbursement under PDGM. Providers are looking for patients and opportunities to expand their scope of practice in that area.”

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Advocate Aurora Health is one of the largest nonprofit, integrated health care systems in the country. The organization has dual headquarters in Milwaukee and the Chicago suburbs while serving nearly 3 million patients annually throughout Illinois and Wisconsin, operating across 27 hospitals, 500 outpatient locations and 63 Walgreens clinic sites.

As part of its PDGM-related wound care push, Advocate Aurora is working with Medline, a Northfield, Illinois-based manufacturer and distributor of medical supplies with more than 20,000 employees.

With Medline’s help, Advocate Aurora Health began training more than 400 of its nurses in wound care self-management. To do so, it brought them in for scenario-based clinical training at the beginning of the year.

“We brought those teams in and offered them a training program where they were met with the different types of scenarios they would see frequently with patients at home,” Katie Riley, vice president and post-acute chief nursing officer for Advocate Aurora Health, told HHCN. “They were provided with different materials and products and were tasked with using those to benefit clinical outcomes.”

Making sure nurses are well-versed when it comes to different products not only impacts Advocate Aurora Health’s clinical outcomes — but its bottom line as well.

“Oftentimes, a lot of our misuse of these products, first and foremost, doesn’t help us with the outcomes of the patients,” Riley said. “But also using these products and resources correctly promotes cost-efficiency.”

Advocate’s new training initiative shifts the organization away from a more task-based checklist system to an interactive program that includes in-person education, webinars and simulation labs.

Another key aspect of the nurse training program is preparing nurses to teach patients and their families how to provide wound care when a nurse isn’t in the home.

“For home health, it’s our goal to work in collaboration with patients and their families,” Riley said. “When we aren’t with the patient, they have to know how to manage independently. We want to involve them in their care.”

Indeed, PDGM thrusts wound care into the spotlight. Wound care patients are typically referred to home health agencies from institutional settings such as in-patient hospitals, skilled nursing facilities (SNF) and in-patient-rehabilitation facilities (IRFs), with co-morbidities that are more reimbursable under PDGM.

In fact, reimbursement tied to the wound clinical grouping is estimated to be almost 25% higher than under the Prospective Payment System (PPS), according to BlackTree Healthcare Consulting.

For Advocate Aurora Health, the payment overhaul — which went live on Jan. 1 — reaffirmed their strategy to focus on wound care self-management.

“Wound care is such a piece of specialized knowledge,” Riley said. “Not every clinician is well-versed on it. When you are dealing with patients in their home, you are the eyes and the ears, you want to ensure that you are able to see subtle changes that happen and use critical thinking skills to escalate concerns and solve problems in a timely fashion.”

This was an opportunity to align reimbursement with patient needs and outcomes, according to Riley.

“PDGM is rocking the world because it’s a major change in the financial model,” Riley said. “What PDGM has encouraged us to do is ensure that, in the provision of our care, we are not providing services that are inefficient or wasteful. We want to make sure that we are providing the most beneficial resources to the patient.”

Moving forward, Advocate Aurora Health is working to make sure that incoming nurses and clinicians receive the same wound care training.

“We have new clinicians that come on every month and we want to make sure that they are onboarded with the same level of tools to assist them,” Riley said.

AccentCare is another home health provider that has recently doubled down on wound care. The Dallas-based company — one of the largest home health providers in the country — partnered with telehealth provider Synzi as part of a pilot launched earlier this year.

The three-month pilot focused on home health wound care in a handful of AccentCare offices in rural Mississippi, where access to appropriate specialists is often limited.

More than a third of all home health patients suffer from chronic wounds, according to virtual wound care management company Swift Medical.

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