Preparing Your Wound Center for the Tsunami of Wounds to Come-Size May Not Matter

Wound care facilities across the country are currently facing a number of critical factors that will alter the way they are able to deliver efficient effective care to their patients. The impact of the many challenges will be felt within the industry for years to come. The majority of what we are facing as an industry will be outside of our immediate control such as the current obesity and diabetes epidemic, the aging multi-morbid patient demographic, and the aging provider population. The centers that will be best positioned in the new era of healthcare will be those that are able to adapt to the full time wound clinic physician model. Part one of this new exclusive series titled “Preparing for the Tsunami -Size May Not Matter,” will illustrate how adaptation of this model can lead to better clinical outcomes, better reimbursement for hospitals, as well as increase patient and referral physician satisfaction regardless of the whether your center is small or large.

Destroying the Dabbler Model

Traditionally most wound care centers have been nurse driven. However, with changing reimbursement (CMS) guidelines many facilities were forced to incorporate more physicians into the wound center model. Many centers have adapted a model where multiple physicians from different specialties will provide clinic coverage. This “dabbler” model can lead to mixed outcomes as different physicians may have multiple different approaches to wound care. It can also lead to lack of adherence to evidence based protocols due to multiple providers. As a number of these physicians tend to specialize in different areas of medicine such as vascular surgery, general surgery or infectious disease understandably the major focus and commitment is to their primary area of specialty. This can often lead to scheduling conflicts with the wound clinic resulting in prolonged wait times for patients and decreased levels of patient satisfaction. This model can lead to frustration and decreased satisfaction among the Wound Center Team and support staff as well.

Case Study in Practice

I am currently the medical director of Advanced Wound Care and Hyperbaric Medicine at Passavant Area Hospital, located in Jacksonville, Ill. Our center operates as an outpatient clinic within the hospital. Our hospital is a licensed 100 bed facility with a catchment population of approximately 80,000 people. The hospital has approximately 3000 medical surgical discharges per year. We have approximately 5000 patient visits per year to our wound center and have maintained that level of visits over the past 10 years, From 2001-2007 our center worked under the nurse driven model combined with approximately 20 hours of various specialty physician coverage. In 2008 the facility hired a full time physician to act as both medical director and full time wound care physician. In 2009 we added a full time collaborative nurse practitioner which has allowed us to establish satellite clinics in neighboring communities. I will use our sites experience as a case study to illustrate in this article series the evidence for establishing full time physician model and demonstrate how this can lead to:

1.Significantly improved healing rates.
2.Increased reimbursement for the hospital with lower Staffing ratios.
3.Increase patient satisfaction.
4.Improved satisfaction among referring physicians.
5.Increase adherence to evidence based protocols.

Our center has demonstrated significant improvement in a variety of critical areas with the implementation of a full time wound care physician. The full time physician model will be the key to both financial and clinical success of Wound Center’s across the country as we enter an unprecedented era of healthcare with many challenges including:

1. Changes to payment model.
2. Falling reimbursement.
3. Aging patient population.
4. Diabetes epidemic.
5. Obesity epidemic.
6. Aging provider population resulting in significant physician shortage.

An Era for Change

Now, more than ever it will be important for small and large centers to implement a full time wound physician model. Our experience has demonstrated that both the facility and patients will benefit from this model and centers will be better prepared to capitalize on the new opportunities this will create. In the next installment of this column we will take a closer look at the subject of strategies to enhance healing rates at your facility and how the full time physician model is the cornerstone to achieving better outcomes.

Michael Molyneaux, MD graduated medical school at Dalhousie University in Halifax, Nova Scotia Canada in 1996. He then completed a family practise residency and went on to work as an emergency room physican for 10 years. Dr. Molyneaux is a board certified in family practise in both Canada and the United States and has practised in Canada, United States, and New Zealand. He established his own clinical trial research company in 2005 and have been a principal investigator in a number of clinical trials. He took the position of full medical director of the Wound Center at Passavant Hospital in 2008 and devoted himself to full-time wound care and hyperbaric medicine. Dr. Molyneaux continues to do Emergency Medicine on a part time basis.
His position as medical director has allowed him to have both a clinical and administrative role within the hospital. Dr. Molyneaux feels it is very important for physicians to become more involved in both advisory and operational positions within hospitals. This will be particularly important in the new healthcare era as reimbursement and payment models change for both the hospitals and physicians
Apart from his duties as full-time wound clinician and medical director of the wound center, he currently sits on the Board of Directors for both the hospital and the physician organization to which he belongs. Dr. Molyneaux is a member of the medical executive and the current Vice President of the Medical Staff. He is also very involved in physician recruitment and performance improvement committee at the hospital and has worked together with the Board and Administration to establish a clear vision of alignment with large physician groups and the hospital.