From the Editor: Wound Quality Measures

  A 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 on initial visits and combined magnetic resonance imaging 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.

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