An Introduction to Clinic Volume and Revenue: A Clinical Director’s Thoughts

  I began my journey in the outpatient setting quite by accident and good fortune in 2001. I was ready to leave a seven-year period of working in the wound care industry at the same time a long time friend and colleague had a position available managing a well-established wound center. The hospital was ending a long-term management contract and the center was to become a new hospital department.

The Clinic Life

  So there I arrived armed with pretty good knowledge of wound healing and wound care theory and practice, and basically zero knowledge of wound care as a business—no concept of charging, coding, regulatory, and all of the other critically important information one should have in that position. So I spent a humbling first year being coached and guided in the more ‘business’ side of this clinic care, and over time have had the good fortune to have friends and mentors like Kathy Schaum (see Kathy Schaum’s introduction article to the Consultant and Management services section on page 46) to learn from and who continue to provide the wound care industry with education on regulatory aspects of the wound care business.

The Swinging Spectrum

  Wound clinic directors and managers clearly may come from a variety of backgrounds and have different approaches to their focus on administration of the clinic. The spectrum may swing from a complete business and marketing background to a purely clinical one, and probably the ideal would be found somewhere in between. However, the obvious reality is that while employees in wound clinics are doing great things for the patients that we serve, we are part of the business of healthcare. This naturally means that to our hospitals we are a cost center and hopefully a revenue and profit center. This results in the need for a balance between the business and clinical segments within the clinic setting.

Deceiving Data

  When conversations arise, or survey results are shared about clinic volume and revenue, we still must consider them in the context of our own setting. At meetings we hear colleagues from other settings and clinics around the country discuss patient numbers. For example, if they are seeing twice the patients that our own clinic is seeing, this cannot be interpreted as more or less successful. So many factors come into play; the size of the hospital system, the population of the area that the clinic is located in, the services that the hospital provides, and more.

  Is the hospital the Level 1 Trauma Center for the region?
  Do they have a burn center? (The patient mix in a clinic in that hospital will be very different from those in a smaller community hospital.)
  How much competition/other wound clinics are in the area?
  Is the hospital located in a geographical climate area that has population swings depending on the time of year?

Critical Success Factors

  We must all determine our critical success factors based on what can be expected for our specific locale, as well as the expectations of our hospital administration. If large profits are the expectation for the clinic—it may be a goal that for some is getting tougher to meet. The concept of “build it and they will come” won’t always work. Large ads and billboards don’t work if the patient outcomes as well as patient and referring physician satisfaction are not there. My own personal benchmark for success is not just in volume. Volume can be impacted by how often we schedule our patients. I look at new patient referrals month after month as my marker for community confidence.

Driving the Confidence

  That confidence is driven by several factors, the most important of which is patient outcomes. Achieving healing, reduction of pain, improvement of the management of a particular di­­­sease process and helping patients achieve the highest possible quality of life is the information that can and will spread through the medical community. This of course is the basics for providing outpatient wound care. Attention to revenue and costs is certainly the other side of the business that must be considered. We must know what the costs of providing our care are in order to keep the clinic doors open. No matter how wonderful the care is, if a center is losing valuable dollars through their operations it cannot be sustained. By the same token, we must be careful not to become totally revenue driven; by solely making treatment decisions in terms of what will either generate the most revenue or save the most in treatment costs. Careful monitoring of patient progress and intervening with advanced or active modalities may cost more up front, but will often save dollars in the long run. Evidence based, patient centered care decisions created around the patient’s needs should prevail.

Benefits

  The wound care clinic brings both direct and indirect financial benefits to the hospital beyond just the wound care that takes place in the center, which can sometimes be difficult to measure.

  The obvious direct and more tangible benefits are the revenue producing labs, vascular and imaging studies, surgeries, and appropriate hospital admissions. The indirect—less tangible but no less important—benefits include avoidance of unnecessary emergency department visits and admissions, early intervention during hospital stays, and working closely with case managers and discharge planners to help to expedite safe discharges thus reducing the hospital length of stay. This is particularly important for the non-insured or underinsured patient, for whom outpatient care is a far less costly alternative, as well as provides skilled management of the wound likely avoiding further expensive complications and admissions.

  And lastly, all of this loudly speaks to the need for an electronic system for managing and monitoring all of those things that help us not only monitor care, healing rates, and outcomes, but at the same time track costs related to those outcomes, and enable reporting and analysis of patient and payer mix, referral sources, and to generate reports related to adjunctive modalities such as hyperbarics. The need for this analysis can help the wound center justify the costs associated with these systems—something that is simply too overwhelming to keep track of manually.

Dot Weir, RN, CWON, CWS, is co-editor of Today’s Wound Clinic and Founding Editorial Board Member. Weir is the Clinical Director of The Wound Healing Center at Osceola Regional Medical Center in Kissimmee, Florida. Weir can be reached for questions via email at Dorothy.weir@hcahealthcare.com.