One of the many changes brought on by the Patient-Driven Groupings Model (PDGM) is the growing importance of wound care. Several home health providers are now preparing to lean into the wound care opportunity.
Nationally, there is a growing need for wound care, as about 8 million Medicare beneficiaries have wound-related conditions. Last year, the national volume of home health wound care claims checked in at 6 million.
Due to changing patient demographics and needs, the industry is on track to hit 9.4 million wound care cases by 2025.
Despite the heightened focus of late, wound care hasn’t always been a big draw for home health providers. Historically, wound care was considered high risk, with providers fearing that these cases would negatively impact their bottom lines, according to Melissa Alvares, vice president of marketing at Swift Medical.
Swift Medical is a Toronto-based wound care management technology company.
“[Wound care] was actually dreaded by a lot of home health agencies,” Alvares said Wednesday during a webinar hosted by Home Health Care News. “This is because agencies have seen wound care patients eat into their margins. Wound care patients commonly deal with a lot of complex conditions, and they require very resource-intensive care, from both a staffing and supplies perspective.”
With the launch of PDGM, which began on Jan. 1, wound care has become a more favorable reimbursement opportunity. In fact, of the 12 clinical groupings under the new payment model, wounds present the highest potential for reimbursement, according to Swift Medical statistics.
This is especially important at a time when cash flow has become uncertain for some agencies due to a number of factors.
“As many agencies are looking for ways to defend their market share and margins, wound care will become increasingly important as part of this case mix,” Alvares said.
For example, at a home health agency where 25% of cases are wound care patients, those patients would bring in over 34% of total reimbursement. If 50% of the cases are wound care, overall reimbursement would rise by more than 12%.
One company that has been aggressive about aligning itself for the wound care opportunity under PDGM is LivinRite Home Health.
Manassas, Virginia-based LivinRite is a Medicare-certified home health agency that provides private duty, skilled nursing, physical therapy, occupational therapy, speech therapy, personal care, home infusion and wound care. The company serves 22 counties in northern and central Virginia.
While wound care has always been part of LivinRite’s service offerings, PDGM has inspired the company to elevate its wound care program even further. The agency has developed a comprehensive program that uses different technologies and a designated specialty team of wound care clinicians.
“We’ve gone off on a slightly different route from the traditional wound care programs that you’ll see,” Colin Elliot, senior vice president of business developments and acquisition at LivinRite, told HHCN. “We have a wound care team that is based here in our central office. All of our staff that is out in the field are able to take photographs of any wounds and through a HIPAA-compliant, secure application, they’re able to upload those photographs immediately.”
This tool allows LivinRite to store data in the company’s electronic health record (EMR) and improve overall outcomes, according to Elliot, who also serves as LivinRite’s chief administrative officer.
LivinRite has also assembled a deep bench in terms of its wound care team. The team consists of a wound, ostomy and continence nurse (WOCN), a certified wound care specialist, two clinicians authorized to perform selective sharp debridement, two nurse practitioners, an edema therapist and a consulting physician.
In addition to the HIPAA-compliant photograph tool, the company is also in the process of developing a telemedicine program utilizing virtual visits.
Though LivinRite is confident in its would care efforts, the company still needs to see how the reimbursement actually shakes out under the new payment model.
“We are still waiting to see exactly how this is going to fall out, as far as how the reimbursement actually comes through,” Elliot said. “But we do see this as an area of potential increased reimbursement for us.”
Of course, LivinRite isn’t alone when it comes to zeroing in on PDGM’s wound care opportunity.
Last year, Dallas-based AccentCare launched a telehealth pilot targeting wound care patients through a partnership with virtual care platform Synzi.
Plus, Advocate Aurora Health’s post-acute care division began training more than 400 of its nurses in wound care self-management.
“PDGM is rocking the world because it’s a major change in the financial model,” Katie Riley, vice president and post-acute chief nursing officer for Advocate Aurora Health, previously told HHCN. “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.”