Envisioning the Future of Wound Clinics: 5 Pillars for Successful Care

“The best way to predict the future is to create it.” — Abraham Lincoln

  President Lincoln would have made a fine wound care provider. With an opportunity to work alongside our 16th Commander in Chief, we would revel in “Honest Abe’s” integrity, work ethic, and commitment to a cause greater than himself — not to mention that his extra-large hands that would virtually guarantee success at compression wrapping. But Lincoln’s true worth to the field would likely have been as a visionary. He saw value not only in determined singular effort, but, perhaps of greater importance, in creating a vision through an organized team approach that forged a path to the best shared outcome. Those who work in or are affiliated with a wound care clinic know this to be true as well — the impact of these concepts on the collective success we produce for our patients and our businesses. But what can we glean from the past that will impact our clinics of “tomorrow”? What does the future of wound medicine and wound care clinics look like? How must wound care providers and their clinical teams appropriately prepare themselves for the changes occurring and bound to occur within the US healthcare system? This article will examine five key factors that could dictate how wound clinics of the future successfully operate.

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Factor No. 1: Advancing Wound Care Science

  In today’s model of evidence-based standard of care, the best care demands the best proof of both outcome and value. In our ongoing quest for what “right” looks like in the wound clinic, we must have a solid foundation for our care decisions, not only to seek optimal outcomes but also to substantiate the ever-expanding cost of our products and services. Traditionally, as a specialty group, wound care has been challenged here. To date, clinical decision-making has largely been experiential and segmented (eg, “This is how I was trained” or “We’ve always done it this way”). Additionally, wound care education has been dismally lacking in medical and nursing schools (the average medical student receives fewer than nine hours of wound care training over four years). Combined with the fact that disease-specific research efforts are far from robust, it’s little wonder that this industry faces difficulties in gaining specialty recognition, expansion, and reimbursement. Obviously, these trends must cease and reverse if wound care is going to enjoy a future of clinical relevance. How would this be best accomplished? In one word: Data. This industry simply needs better evidence as to which therapies will work best for our patients, how to use these therapies, and when to use these therapies at the least expense to the healthcare system. Tomorrow’s wound clinic will thrive (or starve) on the richness of our data quality at the patient level first and foremost. Enter “big data,” a buzzword that simply refers to the use of predictive analytics or other advanced methods to extract value from extremely large data sets.

  Almost 7 million Americans, the majority of whom are under the care of a provider who is documenting a wealth of information (data points) with each treatment encounter, currently live with chronic wounds.¹ Wound care providers must collectively harness the power of this data as the “raw materials” for effective decision-making and product assessment. Practically speaking, this mandates large and appropriately structured data registries that are expertly mined and appropriately transparent (without repercussion) to the Centers for Medicare & Medicaid Services, industry, and others influencing the industry. Fortunately, this effort is already underway with several large provider entities from both the public and private sectors. This will spawn more meaningful research into the basic science as well as real-world delivery of wound care. Tomorrow’s care in the clinic without the development of today’s scientific evidence base is likely to be excessively costly, ineffective, and, in the end, irresponsible.

Factor No. 2: Commitment to Value-Based, Cost-Sensitive Care

  More isn’t always better, and the days of driving clinic revenue through volume-based activity are rapidly coming to an end. In the swirling seas of our cash-strapped healthcare economy, wound care providers are struggling to keep their heads above the financial waters. We have been taught that the “gold standard” is the best possible patient care offering. While this is often true, how much of the gold can we afford? Yes, early and appropriately aggressive care translates into better outcomes, but as leaders in wound care we must help to redefine the “best care” as that which produces the optimal outcome when considering the financial challenges we all shoulder. Make no mistake, episodic-care payments and cost bundling are square in the headlights of our future pathways to care. Thus, the wound clinic of tomorrow will deliver the least-expensive care that offers the greatest return on investment for the patient. Practically speaking, this translates into a careful re-examination of our product supply closet. (For instance, does any one of us really need four different brands of hydrogel?) Additionally, this means unifying and harmonizing our clinical pathway and decision-making across the provider group: It’s no longer cost appropriate for “Dr. X” and “Dr. Y” to use completely different clinical approaches to the management of venous leg ulcers. Finally, a commitment to this type of care means understanding what value really means to patients. Moving forward, this knowledge must be more comprehensive than a simple Press Ganey score. For many of us, the bold assumption is that patients want to be healed our way in a timeframe that suits our needs (and our financial bottom line). This may not always be the case. For example, a patient who may be considered to be noncompliant may continue to come into the clinic regularly because he or she derives a great deal of social contentment from the visits and the care that they behave in a certain way that ensures the “relationship” (ie, social support) continues. In this case, providing valuable and cost-effective care may mean being aware of, understanding, and rectifying any social/family issues that are present as the most important step to producing good outcomes.

Factor No. 3: Evolution of the Wound Care Provider

  Thankfully, the method of on-the-job wound care training by the next-most-senior member of the clinical team as a process of one’s scholastic evolution is now in the rearview mirror. The industry is finally witnessing the evolution of the full-time wound care provider as a mainstay in clinical care. Not only is this concept mandatory based on the complexity of products and services that current providers must master, it is simply the right thing to do for patients. Ask yourself: Would you allow a surgeon to perform your coronary bypass if he only operated on hearts every other Friday afternoon? Fortunately, an ever-increasing number of physicians and nurses have embraced wound care as a full-time vocation. While the precise number of these individuals is nationally unknown, wound service management companies are observing record numbers of providers interested in committing to a practice model of this nature. Additionally, wound care training fellowships are on the rise at such noted institutions as the University of Illinois and Stanford University. Thus, the wound clinic of tomorrow will enjoy the engagement of nurse and physician providers who are impassioned by the science and clinical process of advanced care. They will attend to their patients each day as if their livelihood and the patient’s best interest hang in the balance. As we support (and celebrate) their commitment, and tolerate nothing less in our wound clinics, today’s “dabbling” (eg, every other Friday afternoon) wound care provider will likewise, and hopefully in rapid fashion, be in the collective rearview mirror as well.

Factor No. 4: Leveraging the Care Continuum

  Like it or not, wound care providers know firsthand that our patients can’t always make it into clinic and that there will be “no shows” each week. There’s a multitude of potential reasons for missed appointments, but irrespective of the cause, the reality is that patients are consistently challenged to meet us at our care venue on our time. Thus, the successful wound clinics of the future will be less focused on site of service (the “bricks and mortar” of the actual center) and more concerned with nimble, patient-centric wound care solutions. In other words, if our focus becomes our effort to see the patient rather than their efforts to get to the clinic, success for all will be much more likely. This could mean going to the wounded patients — a traveling wound clinic, if you will (which, yes, will bring with it up-front financial and reimbursement challenges) across a multitude of care venues that would place more emphasis in visiting inpatient facilities, skilled nursing centers, long-term acute care hospitals and homes, as well as utilizing telemedicine through a continuum-based care approach of applying optimal evidence-based modalities regardless of venue. This “right patient, right treatment, right now” mindset is ideally suited for wound clinics to serve as leaders in the community if patients are successfully transitioned from our comfort zone within the clinics. This type of scenario may require forging closer relationships with inpatient caregivers and streamlining referral pathways for patients upon discharge. This may also require inpatient consult services or a commitment to a rounding program at several extended-care facilities on a weekly basis in one’s community. Wound care staff could thereby need to leave the clinic periodically to accomplish such tasks and support services, and overcoming staffing difficulties may pose critical to truly providing value to mobility-challenged patients in particular.

Factor No. 5: Constantly Improving to Impact the Future

  Finally, those who operate and provide care within the wound clinic space must remain committed to focusing on differential outcomes. We simply have to be better tomorrow than we are today, and along every time point in between we must be better than those who don’t share our interest and dedication to our fledgling specialty and these patients. If our commitment and measured outcomes are no better than the baseline of care provided in our community by those who couldn’t care less, then we simply don’t need to exist as wound clinics. Our future would be no longer, and we’d only have ourselves to blame.

D. Scott Covington is chief medical officer at Healogics, Jacksonville, FL.

Reference

1. Sen CK, Gordillo GM, Roy S, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17(6):763-71.