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ESTABLISHING WOUND CARE SERVICES IN OAKWOOD AMBULATORY CENTER

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Presentation on theme: "ESTABLISHING WOUND CARE SERVICES IN OAKWOOD AMBULATORY CENTER"— Presentation transcript:

1 ESTABLISHING WOUND CARE SERVICES IN OAKWOOD AMBULATORY CENTER
Dr. Paolo Marciano,MD Dr. Christopher Williams, MD Dr. Marija Grahovac, MD Dr. Viji Nagappan,MD Dr. Frederick Junn, MD 1

2 POPULATION IMPACT By 2030, 1 in 5 US residents will be age 65 or older
Approximately 2% of the US population has chronic non-healing wounds = $50 billion/year 2

3 HISTORY OF WOUND CARE SURGICAL TREATMENT – Egypt 1400 BC
HEMOSTASIS –Egypt 1500 BC BIOLOGICAL DEBRIDEMENT –France 1557 WOUND DRESSING – Sumer 2100 BC HYPERBARIC OXYGEN –England 1662 WOUND PHYSIOLOGY – Ukraine 1908 3

4 4

5 PURPOSE OF WOUND CARE SERVICES
OHMC does not have an established outpatient wound care service center Comprehensive wound care, that will enhance healing and prevent infections 5

6 GOALS OF WOUND CARE SERVICES
Cost-effective, evidence-based wound care services Coordination across specialties: Primary Care Physicians, Infectious Disease Physicians, Surgeons, Podiatrists, Dermatology, Plastic Surgery, and Nutritionists. 6

7 WOUND CARE AND BEYOND Center of excellence by providing exemplary wound care services and achieving patient satisfaction Teaching opportunities to nurses, physicians, medical assistants, residents and medical students. Potential research center for wound care. 7

8 WOUND CARE CENTER - OPERATION
HUMAN RESOURCES - Infectious Disease physician, Geriatrician, General surgeon; one wound care nurse - Office Manager; Medical Assistant; front desk staff TECHNOLOGY - instruments needed for minor procedures; wound care products

9 WOUND CARE CENTER - OPERATION
PROVIDER CERTIFICATION: Certification obtained by completing online courses or attending live courses Certification website:

10 WOUND CARE CENTER - OPERATION
FACILITY: Oakwood Healthcare center, Schaeffer clinic (alternative option – Mercury Drive clinic Pre-existing facility = no added building costs Plan 2 half day clinics (utilize staff already working in the clinic)

11 PRODUCTS NEEDED Use products in compliance with Medicare Supplier Standards Wound cleansers Self-adherent bandage ABD Pad, Kerlix, 4 x 4 gauze Skin protectants Alginate dressings Skin moisturizers Hydrogel dressings Skin ointments Hydrocolloid dressings Foam dressing Absorptive dressings Gloves Tubigrip (light compression bandage) Antiseptic solution ACE Wrap (moderate compression bandage) Normal Saline Tape Surgical Instruments

12 TYPE OF WOUNDS ARTERIAL ULCERS VENOUS STASIS ULCERS DIABETIC ULCERS
PRESSURE ULCERS SURGICAL WOUNDS TRAUMATIC WOUNDS ORTHOPEDIC WOUNDS SOFT TISSUE INFECTIONS

13 Assess nutritional status
SAMPLE INITIAL ASSESSMENT Wound care H & P Directed wound exam Wound Photography Assess nutritional status Assess social support

14 TREATMENT OFFERED Wound debridement
STEP ONE Wound debridement Wound cultures & antibiotics as appropriate STEP TWO Education on using wound care products Education on impact co-morbid illness has on wound healing STEP THREE Provide education on nutrition Referral to vascular surgery, plastic surgery, podiatric surgery, hyperbaric oxygen therapy

15 PROJECT TIMELINE October 2012: Facility readiness
October 2012: Provider availability November 2012: Provider contracts November 2012: Staff availability December 2012: Supplies readiness December 2012: Advertising January 2013: Staff training February 2013:Begin exploration SNF March 2013: Start OHS wound care clinic

16 BUDGET Gross Revenue Procedures billed with CPT codes (commonly performed procedures: debridement, strapping, biopsy, chemical cautery, application of negative pressure dressing, and application of biological skin substitutes) Non-procedure care billed with E&M Billed at Medicare nonfacility rate (“free-standing” or “independent” clinic)

17 BUDGET CPT Codes Surgical Debridement Procedures

18 BUDGET CPT Codes Application of Skin Substitute Procedures

19 BUDGET CPT Codes Additional Procedures Range from $77.15 to $104.86
Application of compression bandages Application of negative pressure wound therapy Low-Frequency, noncontact, nonthermal ultrasound Range from $77.15 to $104.86

20 BUDGET E&M Codes

21 BUDGET Operating Expenses 2 days/week, 5 hrs/day, 50 weeks/year
Registered Nurse 0.25 FTE at $30/hr Business Office Assistant 0.25 FTE at $15/hr Physician Collections Occupancy costs 400 sqft ($400 per month) Medical Supplies are 5% of Gross Revenue

22 BUDGET Gross Revenue 1000 appointments/year, 20 appointments/week, 10 appointments/day Each patient will average 4 appointments so 250 new patients/year Average E&M = $95 Average CPT = $265 Assume only 25% of visits result in a procedure, so each patient will provide $550

23 BUDGET Statement of Operations Year 1 Year 2 Year 3 Year 4 Year 5
Patients 250 300 350 400 500 Gross Revenue $137,500 $165,000 $192,500 $220,000 $275,000 Contractual Adjustments 27,500 33,000 38,500 44,000 55,000 Net $110,000 $132,000 $154,000 $176,000 Operating Expenses Physician Compensation $68,750 $82,500 $96,250 Staff Wages RN 15,000 27,000 30,000 Staff Wages BOA 7,500 13,500 Occupancy Costs 4,800 Medical Supplies 6,875 8,250 9,625 11,000 13,750 Office Supplies 1,000 Total operating Expenses $103,925 $119,050 $152,175 $167,300 $202,050 Net Income $6,075 $12,950 $1,825 $8,700 $17,950 Statement of Operations

24 MARKETING INITIATIVES
Reach population that will increase projected volume Meet with Oakwood Marketing December 2012 Newspaper, radio, online ads, mail information to referring physicians OHMC website to explain services provided

25 SWOT ANALYSIS STRENGTHS: low start up expenses; using available facility; enthusiastic providers; profitable in year 2 WEAKNESSES: reimbursements; volume - OPPORTUNITIES: expand to SNF; Medical Education; Research THREATS: wound care clinics in HFH, Garden City Hospital

26 SKILLED NURSING WOUND CARE
FUTURE DIRECTIONS SKILLED NURSING WOUND CARE

27 BALANCED BUDGET RECONCILIATION ACT 1998
Caused bundling of payments to part A PPS Wound Care supplies billed to SNF part A Some debridement related supplies billed to part B Wound care physician visits are part B

28 SNF WOUND CARE TEAM Creation of wound care team
IDT rounds with certified wound care physician Facility supported wound care nurse and supplies Designated day for rounds

29 WOUND CARE Simple debridement done at bedside
Surgical debridement referred to hospital Future plan to operate wound care teams at multiple SNFs with partner groups and services.

30 ACKNOWLEDGEMENTS Dr. Mark Bustamante, MD – Group coach
Doug Pulver – Oakwood Corporate Services Our OPLA mentors Our OPLA team OHMC Wound Care nurses Heritage Hospital Wound Care Team

31 REFERENCES US Department of Commerce Economics and Statistics Administration, US Census Bureau, May 2010 George Broughton et al. A Brief History of Wound Care. Journal of Plastic and Reconstructive Surgery. 117 (7S) 6-10, 2006. Keith G. Harding et al. A 25-Year Wound Care Journey Within the Evolution of Wound Care. Advances in Skin and Wound Care. 25 (3) 66-70, 2012 Caroline E. Fife et al. Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry. WOUNDS. 24 (1) 10-17, 2012.


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