What you do in the outpatient center is not easy, and not everyone is doing it. In many cases, they'd prefer to let us decipher this challenging demographic's path to healing. Patients we're entrusted to serve are complex in their needs, diagnoses, and compliance with our wound treatment plans. We see them frequently, often over extended periods of time, and due to the very nature of their mixed, long-standing wound etiologies, we don't always get to see complete and total wound healing for quite some time. These are etiologies we aren't managing, but must be factored in to be effective. Considerable time is spent equipping these patients for personal success by coordinating resources and providing education. And for the patient whose end goal is stability, we recognize that outcome as success each time we see them.

Our teams are specialty trained and come from diverse disciplines fueling a true collaborative setting where patients benefit from our expanded perspectives. We value the partnership with referring providers and with the patient as we foster therapeutic alliances and healing.

We have resources that are specific to address the needs of such complex patients. So with all that, why do we need some encouragement?

The Fluidity of Wound Care and Hyperbaric Oxygen Therapy

It can feel as if we are dissolving from a solid to a liquid state as the practice of medicine is morphing from a reactive posture to a proactive one. Here are a few of the catalysts for constant change and ways we can respond:

Regulatory Updates
These updates seem to be fast and furious, and the ability to be nimble and attentive is paramount. Updates to your chargemaster to reflect changes in Current Procedural Terminology (CPT) codes, changes in reimbursement based on the definition of your place of service, and changes to supervision and training requirements are just a few fairly recent examples. Notice of these changes can be found through Centers for Medicare & Medicaid Services (CMS) email alerts, social media postings, blogs, journals, and corporate notices from your hospital. Pay close attention and anticipate changes because the trickle is not likely to stop, especially as "Innovation" has become the mantra of CMS.

Payment Model Changes
The shift from volume to quality is real, and things like cost reduction, improved outcomes, and satisfaction are demanding the spotlight. Quality reporting that is publicly posted now has greater ramifications for contracting and marketing. Physicians and hospitals are compared online, and our pricing is supposed to be transparent, yet no one really understands how to discern the information. Know what is out there about your facility, and be prepared to address possible questions with your patients as best you can.

When Discouragement Comes

Hyperbaric Oxygen Therapy Utilization Trends
Having started my career as an inside attendant at a military multiplace facility, I often wish that others had the experience of not worrying about things like overutilization. There wasn't a sense that we would be questioned about how and when we treated patients with hyperbaric oxygen therapy (HBOT) because we knew the patient it should be used for and weren't motivated to do anything differently. It was before the days of lawsuits, Office of Inspector General scrutiny, and payment denials.

Most facilities now are monoplace based, treating chronic conditions, and we're exceedingly cautious when the order is written for HBOT. Because that's where most of us live, we have to follow the Local Coverage Determinations closely. Know where to find this information and review it regularly to keep up to speed with changes made to things like supervision requirements, treatment indications, and wound documentation requirements.

Medicare Targeted Probe and Educate Processes
Not everyone receives one of these love notes of impending probe and educate sessions for the same reason, and it may take you some time to pinpoint why you received one. When the additional document requests come in, you may immediately be concerned that the charting won't pass scrutiny. Hopefully you have stored items like referral notes and previous treatment records. Gather those along with your charting, and meticulously piece together the patient's story of arrival to your center, workup, and treatment. It is helpful to create a table of contents and number every page of the records for easy reference with your reviewer.

If your center is deemed noncompliant, you can expect an education session and another review after 45 days. Whatever feedback is given should be shared with the team and then audited internally on a regular basis for improvement. Things like inconsistent wound documentation between staff in the same chart or a lack of orders should be addressed. Having strong lines of communication with your facility's revenue cycle team is key to getting through the probe successfully.

Conclusion

Considering the environment of our practice, what does it take to thrive? What does your own job satisfaction look like in this climate? Most importantly, what happens when we fail?

It takes work with intention. Nurse and provider charting in unison, talking through how you will reflect the true patient situation and not contradict each other's narrative, is one example.

It takes resilience. Be encouraged because what you do matters. Read patients' comments on satisfaction surveys occasionally as a reminder of your good work.

It takes an agile spirit. In times of great change, it helps no one to be rigid. Be teachable and find ways to say yes when you can.

Failure happens. Learn from it, equip your team with the knowledge of your experience, and do better the next time. We can benefit from each other's perspective, and yet many centers don't really know what other centers are going through. There are ways to keep up through social media and journals that will be very helpful.

Your passion for wound care is worth the effort. Your patients need your expertise. Keep on keepin' on, friends. Our future is counting on it. You do good work. Let that resonate in your spirit.

About the Author
Kelly Byrd-Jenkins currently serves in the Texas Hill Country as Director of Wound Care, having a diverse background in both clinical and operational aspects. She was selected in 1993 for specialty training in wound care and hyperbaric medicine by the US Air Force. She earned her CHT and DMT during active duty years while supporting clinical, research and emergency treatment teams as well as chamber operations and maintenance. Over the many years in the specialty, she is proud to have earned her CWS. She has been privileged to work with some of the physician "giants" of the wound care and hyperbaric specialty and continues to advocate for physician led programs that preserve patient's quality of life and dignity.