Best Practices: Limb Preservation

It is no longer sufficient to “salvage” limbs — we must be engaged in the new math of health economics and how we will demonstrate the value of the care we have provided and the limbs (and lives) we are saving. According to new data, only 51% of eligible healthcare providers (EHPs) have participated in the Physician Quality Reporting System (PQRS). The 2013 PQRS incentive payments to participating clinicians totaled more than $214 million. However, nearly half a million EHPs will experience a 1.5% negative payment adjustment this year because they failed to be successful with PQRS in 2013. Among those subject to the penalty, 98% did not even attempt to participate in PQRS. That’s true for almost all wound care clinicians I know. Starting this year, there are no PQRS incentive payments — there are only penalties for not participating. What’s more, our new healthcare system will link resource use (costs) to outcomes and quality.

Delving Into Data
We’ve had a model for wound care services that reimbursed for high-cost interventions regardless of whether they improved outcome, but failed to reward low-cost interventions that might make a substantial difference in outcomes (eg, total contact casting). We are entering a world in which the resource use of individual providers will be monitored. Although it will take some time to interpret data, it’s already available. Recently, officials with the Centers for Medicare & Medicaid Services (CMS) made Medicare claims data publicly available. CMS will allow entrepreneurs to conduct approved research in hopes of achieving “a greater understanding of what the data says works best in healthcare.” While the identity of individual patients will be protected, data does provide the identity of providers. CMS will begin accepting innovator research requests in September. That means it will be possible (theoretically) to know which wound care practitioners were the greatest users of healthcare resources and who provided the most efficient care. Innovators and entrepreneurs will access data via the CMS Virtual Research Data Center (at www.resdac.org). Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics, explained that CMS previously prohibited researchers from accessing detailed CMS data if they intended to use it to develop products or tools to sell. However, with the new healthcare system it is hoped these data will lead to innovations that will improve our understanding of value.

In 2007, the late Robert A. Warriner III, MD, and I published a mathematical model that predicted the likelihood that hyperbaric oxygen therapy would improve the outcome of a patient living with a diabetic foot ulcer. Not enough people were interested in predictive models at the time, but predictive models are one of the hoped-for results of access to the CMS dataset.  As you read the articles in this issue of TWC, consider the interventions that may cost the least to implement while achieving the best effect on outcomes.

Caroline E. Fife, MD, FAAFP, CWS, FUHM, is chief medical officer at Intellicure Inc.; executive director of US Wound Registry; medical director of St. Luke’s Wound Clinic, The Woodlands, TX; and co-chair of the Alliance of Wound Care Stakeholders.​