Guest Editorial: Healthcare Reform/Wound Care Conform: It Is Time to Specialize

     Traditionally, the November issue of Ostomy Wound Management includes peer-reviewed articles from several AAWC members and extended news of our organization. This year is no exception. Article topics — reducing pressure ulcer prevalence and incidence, diagnosing a rare skin condition masquerading as a venous ulcer, and justifying and timing advanced therapies — reflect the depth and breadth of our members’ expertise and interests.  

  The past year has seen growth in AAWC participation in regulatory issues at the local and national level. The Wound Care Specialty Executive Council (WocSpec) allows the Association to search for, respond to, and proactively participate in creating the policies that impact our specialty at various levels. The regulatory branch of WocSpec has made numerous official comments to the Center for Medicare and Medicaid Services (CMS) this year on various topics, including comparative effectiveness studies on negative pressure wound therapy and local coverage decisions that affect our members. The AAWC has responded both in writing and through direct testimony at the CMS. As a result of these activities, the AAWC has been invited to participate in a clinical project with the Food and Drug Administration (FDA) and was the only wound care organization representing the field on the American Medical Association’s CPT Workgroup on debridement over the past 2 years.

     WocSpec is composed of numerous, focused departments that work collaboratively. Because the AAWC is concerned with policy development, the Guideline Department has collaboratively created and disseminated clinically useful guidelines that give AAWC clinician members access to evidence-based decision tools. The Wound Clinics Department is surveying the field to determine needs, gaps in knowledge, and opportunities for the AAWC to provide support to wound care clinics in the US. Membership surveys, another important component of an active specialty organization, have been conducted and survey results mined, interpreted, and ultimately distributed to empower the membership.

     Other important initiatives involve the formation of a patient member group that will facilitate patient access to clinical information and networking abilities. Also, the AAWC Board of Directors, Executive Director, and the AAWC staff, with the help of a professional facilitator, just completed a strategic planning session to prioritize and streamline our actions with the specific needs of the organization and its members over time. This will allow us to function as a more consistent voice and to deliver enhanced quality services.

     In addition to our internal endeavors to serve wound care, the AAWC has an eye on healthcare reform and its impact on our niche. In late October, the first iteration of the healthcare reform bill was released. Debate has been intense and a great deal is at stake for our patients and colleagues. Regardless of which side of the political aisle you sit, it is obvious some form of healthcare reform will be advanced.

     For wound care, I propose we need to conform, not reform. Despite the continuing efforts of the AAWC, the government still can’t point to a single group as the ultimate voice of wound care. Our multidisciplinary roots make us strong. However, territorial battles, multiple overlapping organizations, and the absence of credible academic bodies for each specialty to ensure content, examination, and certification negate much of these strengths in the eyes of payors, regulatory bodies and often times our patients. . At the Fall Symposium on Advanced Wound Care Fall in Washington, DC this past September, Dr. Kel Cohen (Professor Emeritus at Virginia Commonwealth University and a founding board member of the Wound Healing Society) again called for the creation of a specialty in wound care. I previously published an article on the creation of a clinical fellowship wound care program for medical school that could be tailored to each and every clinical area of medicine, such as nursing and physical therapy.1 Together, MDs, DOs, and DPMs need to create a program that ensures all physicians are singing from the same sheet of music when they say they are wound care doctors. Obviously, all specialties will continue to be bound to their own scopes of practice, but they would be linked by common standards of care and shared guidelines for training our next generation of wound care providers.

     We can’t reform until we catch up to other medical specialties such as cardiology, family medicine, and orthopedics, all of which benefit from the collaboration of MDs, DOs, DPMs, RNs, APNs, and PTs. Each clinical group would be responsible to its governing, degree-granting organizations for academic training, certification, and continuing education, but should a regulatory problem affect the foot and ankle world, for example, all relevant clinicians (eg, physicians, nurses, OR personnel) would respond collectively to preserve the standard of care they believe their patients need and their field deserves. To that end, all wound care clinicians must ensure the existence of a credible academic organization that represents their specific areas of clinical care and brings our specialties together under one umbrella of wound care — conforming, through the AAWC, for example, to ensure our field is strong, ethical, patient-focused, and evidence-based.

     So, let’s conform first then quickly get on the reform bus (it’s leaving soon!). As a founding Board member and now President of the AAWC, I believe we have the basis to serve as a larger umbrella organization. We need to be inclusive, open, and focused on the end goal — ie, to add credibility to the field of medicine to which we are dedicated. The AAWC board will continue to tackle the big questions and future goals through our strategic planning process, in full swing as we speak.

     I look forward to the upcoming months and years in wound care. One thing is certain: no one will look back and say it was a boring time in medicine or wound management. This article was not subject to the Ostomy Wound Management peer-review process.

Erratum: In the article Schank JE. Kennedy Terminal Ulcer: the “Ah-ha!” moment and diagnosis. Ostomy Wound Manage. 2009;55(9):40–44, the ulcer stage in the sentence "Eschar-covered areas would be noted as a Stage I" is incorrect. It should be Stage IV. The editors sincerely regret the error.

1. Ennis WJ, Valdes W, Meneses P. Wound care specialization: a proposal for a comprehensive fellowship program. Wound Repair Regen. 2004;12:120–128.