Measuring Success: Your Wound Clinic’s Year in Review

To run a financially and clinically successful wound clinic, programmanagers must be willing to reassess their practice on a recurring basis. This article offers guidance on what to look for and consider.

“It’s not the plan that is important; it’s the planning.” — Dr. Graeme Edwards

This is the time of year when many of us proclaim our resolutions to change and better ourselves.  These aspirations can just as often be business related as they are personal. Regardless, the sad fact is most of our well-intended resolutions fail — meaning we’ll often find ourselves making the same “promises” year after year. According to statistics from the University of Scranton, research shows that as many as 45% of Americans say they usually make New Year’s resolutions, with only 8% being “successful” in achieving their goals.¹

History traces the act of making resolutions to some 4,000 years ago, when the Babylonians began their new year (which started in mid-March, when crops were planted) with a 12-day festival. They would make promises to the gods to pay their debts and return borrowed objects. The gods would bestow favors for the coming year on those who kept their promises. How can we as wound care providers be effective in meeting our clinic goals and be successful — and thereby not be “doomed” to repeat history? This article will offer some related tips. 

Managing Expectations & Resolutions

Experts recommend we limit our resolutions to a few realistic, specific, measurable goals that can be shared with others.² These goals should be challenging as well as achievable. For instance, instead of resolving to meet one complicated and comprehensive goal, we may find more success by breaking down one important goal into smaller components while working toward a specific end. In this manner, we can more easily reevaluate our goal(s) throughout the year. As mentioned in a previous column, we are all creatures of habit, and research shows that it takes 66 days to develop new habits.³ Therefore, unless we take time to routinely work on our goals, the outcomes will not become automatic and will continue to fail. The key word here is “consistency” while breaking down barriers and/or changing undesirable habits. 

When measuring success, start with what’s probably the most important question that every wound clinic program manager should be able to answer: What is your business plan or goal? Having a plan will help guide one’s business. But that plan can’t be so complicated that it’s too daunting to understand, let alone attain. Sometimes the process of having a written plan in place is more valuable than the plan itself. (Consider the S.M.A.R.T. goal method.⁴) For example, a program manager may want the wound center to add $200,000 in profits for 2017, as opposed to the goal being “I want more profit.” There should be a quantifiable measure or metric used to track and assess this goal weekly, monthly, and/or quarterly. However, if profiting is the sole focus of opening or running a clinic, the individual might want to change professions.

Seeking Consultation & Advice

In the event that one’s clinic needs assistance in establishing goals and operating efficiently, wound care consultants and management companies are available. Whether or not outside assistance is utilized, all program managers should define and collect accurate, timely data to assist business decisions. Data collection may be a challenge to keep up with, but the advantages are well worth it when comparing past and present clinic performance. Having up-to-date information can also help pinpoint problems that can be corrected before the future is too heavily impacted. At the same time, future goals can also be formulated with this information. 

According to Brendan Anderson, co-founder and managing partner of Evolution Capital Partners LLC, Beachwood, OH, a consulting firm that works with small, second-stage businesses, detailed, timely financial statements and the establishment of defined performance metrics are the most important keys to success. Of course, the most important elements to keeping metrics are tracking them and evaluating what they mean in relation to the success (or lack thereof) of one’s business. As William Thomson “Lord Kelvin,” the Scots-Irish mathematical physicist and engineer who was known for his mathematical and engineering prowess during the 1800s, said, “When you can measure what you are speaking about, and express it in numbers, you know something about it.” When it comes to the wound clinic, being mindful of metrics and the “story” that they tell means being willing to reassess one’s clinic on a regular basis to ensure that the business is operating effectively from a clinical and financial perspective. Now that we have entered a payment system that does not reward clinics existing in a homeostatic state, program managers should be more mindful than ever about this aspect of their practices. 

Reassessing Your Clinic To Measure Success

To measure the success of our clinics, let’s start by metaphorically removing the walls and looking at the foundation. To me, that foundation consists of three important components: the business, the clinical practice, and the employees. It’s inevitable that these components must co-exist and thrive simultaneously. An example of this was stated in an article written by Today’s Wound Clinic clinical editor Caroline E. Fife, MD, FAAFP, CWS, FUHM, in 2014: “Wound care professionals will be incentivized to achieve the highest quality outcomes at the lowest total cost of care (not necessarily using the lowest-cost products or procedures) with high levels of patient satisfaction.”⁵ 

This statement incudes those three components: business (ie, “cost”), clinical (ie, “outcomes”), and “employee” (ie, “wound care professionals”). On the business side, valuable data may include revenue, expenses, and cost per patient encounter to predict clinic viability. How much money are you spending on wound care dressings, equipment, and service contracts? “Business 101” shows us that expenses must not surpass revenue. Reviewing service contracts on a regular basis may be of benefit, with the possibility of establishing lower rates. Also needing frequent reassessment are a clinic’s operations and patient volume. Patient cancellation/no-show rates data may demonstrate a process or facility problem. 

A high no-show rate will not only cause delayed care for the patient, it will result in poor utilization of staff time, poor continuity of care, and decreased revenue. The average rate of no-shows nationally in 2000 was 5.5%, according to the Medical Group Management Association.⁶ Of the 63% of facilities that tracked these data, only 46% had policies to address this problem.⁶ Maintaining data on patient volume and existing versus new referrals will establish whether or not the clinic’s marketing plan is effective and if there are any issues with a referring entity. On the clinical side, ultimately we’re looking at outcomes. Desmond Bell, DPM, CWS, offers “5 Simple Rules for Growing A Successful Wound Care Center”⁷ as well as “8 Steps to Developing a Community-Based Wound Care Team: A Practical Guide for Reaching Beyond Wound Center Walls.”⁸ What are your healing rates, particularly for wounds with less expectation of healing? What’s your amputation rate? Does your clinic have treatment algorithms based on wound etiology? Do you incorporate clinical practice guidelines? Do you have appropriate, cost-effective dressings and advanced products? Is your qualified healthcare professional (QHP) documentation appropriate? How are you training your QHPs and your staff? Are QHPs communicating to referring entities? How is care being coordinated across the continuum? Are your patients being properly educated, or are they noncompliant to the program? Do you have a system to check as to “why” some patients may not be meeting benchmarks? Dissatisfied patients and families are sometimes a byproduct of inadequate communication/education.⁹

Employee development and retention is an ongoing process that starts at the hiring phase. Are you hiring for success or just to fill a position? Chris Morrison, MD, FAPWCA, FCCWS, FACHM, outlines several steps for determining proper staffing and the hiring process in the article “Effective Measurers for Recruiting Wound Clinic Staff.”¹⁰ How are you training your staff members, and how often? Are people learning about new techniques and products to keep up with evidence-based care? Educating employees on the financial and clinical aspects of the business will allow them to be part of the solution when making cost-effective decisions. Do you have an employee turnover problem? Statistics show 46% of the millennial generation, typically those born in the early 1980s through the mid-1990s and early 2000s, left their last place of employment due to “lack of career growth.”¹¹ This could be costly and could diminish patient outcomes as well as overall patient satisfaction. It takes an average of 52 days to fill an open position.¹² The average amount that companies in the United States spend to fill an open position is $4,000.¹² This does not take into consideration the amount of money it takes to train new employees: 52% of small businesses report there are few or no qualified applicants for the positions they are trying to fill.¹³

Reimbursement 

Finally, the reassessing of any wound clinic is not going to be complete without ensuring that all clinical and business staff members are current on procedures related to reimbursement, documentation, billing, and coding. Just as with general business and clinical consultation services, there are available resources for clinicians and program managers seeking education related to these areas of practice management. Do you know what the current local coverage determinations (LCDs) are for your clinic? LCDs are just one important consideration to understand in order to determine clinic finances, as payer payment frequently changes. Do you know what your payer mix is? To best determine financial success, the following should be considered:¹⁴

1. Knowing why any denials have occurred.
2. Ensuring everyone understands insurance verification and authorization processes.
3. Do you know what you are being paid for care services?
4. Does documentation reflect the services billed? 
5. Do claims reflect services performed?
6. Can anything be done differently to prevent further denials? 

Frank Aviles Jr. is wound care service line director at Natchitoches (LA) Regional Medical Center; wound care and lymphedema instructor at the Academy of Lymphatic Studies, Sebastian, FL; physical therapist/wound care consultant at Louisiana Extended Care Hospital, Lafayette, LA; and physical therapist/wound care consultant at Cane River Therapy Services LLC, Natchitoches.

References

1. Faculty Research Offers Health Tips for the Holidays. University of Scranton. Accessed online: https://www.scranton.edu/news/articles/2016/12/Faculty-Reseach-Holidays.shtml

2. Kruse K. 7 Secrets of People Who Keep Their New Year's resolutions. Forbes. Accessed online: www.forbes.com/sites/kevinkruse/2016/12/26/7-secrets-of-people-who-keep-their-new-years-resolutions

3. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: modelling habit formation in the real world. Euro J Soc Psychol. 2010;40:998–1009.

4. Doran GT. There's a S.M.A.R.T. Way to Write Management's Goals and Objectives. Management Review. 1981;70(11):35-6.

5. Fife CE. Reassessing your outpatient wound clinic: building tomorrow’s wound care facility today. TWC. 2014;8(7):12-6.

6. Izard, T. Managing the habitual no-show patient. Fam Pract Manag. 2005;12(2):65-6.

7. Bell D. 5 simple rules for growing a successful wound care center. TWC. 2008;2(3).

8. Bell D. 8 steps to developing a community-based wound care team: a practical guide for reaching beyond wound center walls. TWC. 2013;7(3):8-10.

9.  Cioroiu M, Levine J. Improving communication in the wound clinic. TWC. 2013;7(3):28-9.

10. Morrison C. Effective measurers for recruiting wound clinic staff. TWC. 2013;7(3):22-6.

11. 11 Interesting Hiring Statistics You Should Know. Inc. 2015. Accessed online: www.inc.com/peter-economy/19-interesting-hiring-statistics-you-should-know.html

12. Talent Acquisition Factbook 2015. Bersin by Deloitte. 2015. Accessed online: https://marketing.bersin.com/talent-acquisition-factbook-2015.html

13. Small Business Optimism Soars Post-Election. NFIB. 2016. Accessed online: www.nfib.com/surveys/small-business-economic-trends

14. Stevens R. 9 Tips for Improving Your Hospital's Wound Care Billing and Coding Performance. Becker's Hospital Review. 2014. Accessed online: www.beckershospitalreview.com/finance/9-tips-for-improving-your-hospital-s-wound-care-billing-and-coding-performance.html