TIP OF THE WEEK
Managing wounds
In 2008, consumers will have the ability to evaluate home health providers on their ability to manage and heal wounds when Improvement of Status of Surgical Wounds and Emergent Care for Deteriorating Wounds are added to Home Health Compare. Wound care can be very labor intensive, depending on the type of dressing ordered, co-morbidities, nutritional status, social issues including adherence to the care plan, living conditions and support system. The average reimbursement is about $2,000.
Now is the time to start looking at the processes and protocols in place at your agency for improving the status of surgical wounds. Below are some ideas of where to start:
INITIAL ASSESSMENT
- Identify wound and its severity and plan subsequent visits accordingly
- Patient self-management is key to improvement for dressing changes daily or as needed on days when the agency staff are not scheduled to visit.
- Quality indicators depend on consistent and accurate assessment and answering of OASIS items, according to a recent OASIS Answers training session. OASIS items related to skin and wound assessment use the terms “partially granulating,” “fully granulating,” and “non- healing.” Many home health agencies use guidelines to assist them in clarifying these vague terms. OASIS User’s Manual, Chapter 8 includes important and helpful guidance for this issue.
STAFF EDUCATION
Staff members should be familiar with the following:
- Identifying the healing stage. See the Wound, Ostomy and Continence Nurses (WOCN) Society OASIS Guidance document (updated July 2006) for more information on how to accurately identify the healing stage for wounds.
- Assessing nutrition. Elements of the nutritional assessment can determine which patients will need more intensive monitoring for wound healing. Assessing Nutrition in Older Adults from the Hartford Institute of Geriatric Nursing provides more information on how to assess a patient’s nutritional status to establish the risk of skin breakdown.
- Most of the wound care suppliers provide clinical education for home health staff, some free of charge.
INTERVENTIONS
- Interventions should focus on discharging the patient with a healed wound or with the education they need to keep them from experiencing complications or rehospitalization.
- Use the resources on www.medqic.org. There are guidelines for evidence-based treatment based on wound assessment available under the Home Health tab and within the Acute Care Hospitalization toolkit.
- According to a recent training by OASIS Answers, there should be parameters for when the wound can be expected to show improvement, depending on the type of wound care product chosen to treat it. Ongoing assessment should look at previous measurements and description of drainage, odor, and surrounding skin as well as considering nutrition, comorbidities, and modalities, which might take pressure off surrounding tissue to promote wound healing.
NOTES ON BILLING AND REIMBURSEMENT
Use the Palmetto GBA, Regional Home Health and Hospice Intermediary, Medicare Part A Home Health Training Manual to find answers to your billing and reimbursement questions. Section 7.5.1 contains the Wound Summary Sheet, which contains definitions and descriptions of various types of wounds, associated ICD-9 coding, and pertinent OASIS items. Note that the Palmetto manual is updated as of September 2007 but still contains reference to a “healing ridge,” already removed from WOCN guidelines for describing healing.
RESOURCE SPOTLIGHT
MedQIC Tools for Improving the Status of Surgical Wounds
Improvement in the status of surgical wounds outcome is demonstrated by an increase in the percentage of patients who demonstrate an improvement in the condition of surgical wounds. These tools support the actions to be taken to achieve success with a particular strategy.
IN THE NEWS
PRESCRIPTION DRUG COVERAGE AND ELDERLY MEDICARE SPENDING
September 2007 -- National Bureau of Economic Research -- The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly. Of paramount importance -- often unaccounted for in budget estimates -- are the salutary effects that increased prescription drug use might have on other Medicare spending. This paper uses longitudinal data from the Medicare Current Beneficiary Survey (MCBS) to estimate how prescription drug benefits affect Medicare spending. It compares spending and service use for Medigap enrollees with and without drug coverage. Read more >>
September 11, 2007 -- Washington Post -- In the past 10 years, despite resistance from primary care physicians and fears that the role of hospitalists could erode continuity of care, the ranks of hospitalists have exploded from a few hundred physicians in 1997 to 20,000 today -- about as many as there are gastroenterologists or neurologists. That's the fastest growth for any medical specialty in the country, according to the nonprofit Society of Hospital Medicine (SHM), the professional society for hospitalists.
Initially, hospitals and managed-care groups, seeking to cut costs and improve care quality, drove the trend. But with hospital reimbursement rates failing to keep up with costs, many primary care physicians are being won over and now find the hospitalist arrangement saves them time and money. And although many patients may resent not having their doctor at their bedside, just when they need him or her the most, the hospitalist movement, by most accounts, is here to stay.
Read more >>
September 16, 2007 -- Ohio.com -- Whether Muslim or Amish, Eastern European or African-American, patients want doctors who can communicate clearly, without rushing and without medical jargon. Yet more than 90 percent of doctors and nurses believe they already have the necessary skills and training to interact with patients from different cultures, as well as those who have little understanding of medical information. Whether both groups can be right will be an ongoing discussion of Summa Health System's Diversity Advisory Council. Read more >>
COMING ATTRACTIONS
Preventing Pressure Ulcers
IHI Teleconference -- October 4, 2007, 1:00 to 2:00 p.m.
Dial: 800-860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.
Together We Make a Difference: Solutions for Senior Care 2007
October 5-7, 2007, Columbus Ohio.
The conference features plenary sessions and didactic sessions on medical direction, physician- nurse practitioner collaboration, urinary incontinence, atrial fibrillation, appropriate medication prescribing, and the latest diabetic medications (Registration ends Sept 28, 2007). Contact Catherine Austin at (216) 778-8087, Executive Assistant of OMDA, for more details.
Preventing Adverse Drug Events (Medication Reconciliation)
IHI Teleconference -- October 9, 2007, 1:00 to 2:00 p.m.
Dial: 800-860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.
Improving AMI Care
IHI Teleconference -- October 18, 2007, 1:00 to 2:00 p.m.
Dial: 800-860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.
OCHC Home Health Reform PPS Workshop
A full day in-depth program is scheduled for October 24, 2007 to provide detailed instruction on how to implement the changes at your agency. Download flyer >>
OHCO: Connecting OASIS and Clinical Decisions in the post-PPS Reform Environment
October 30, 2007
Contact Karen Lowe at (614)763-0036, Ext. 206 for more information.
The Many Facets of Pain Management: An Integrated Approach
November 7, 2007, 8:00 a.m. to 4:30 p.m.
MetroHealth Medical Center, Cleveland.
Call (216) 778-7707 for more information.
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