June 28, 2023
Tobi Yerokun MD, MPH, CWSP
“As a wound care provider, I want to eventually put myself out of business”. That’s the first thing I told my future employer when taking my first job as a medical director of wound care and hyperbaric medicine center. I got the job so it didn’t scare him as much as I thought it would. But it was the honest truth. I obviously wanted to help heal my patient’s wounds but my ultimate goal was to give them the knowledge to be able to prevent some of the wounds from happening in the first place, and educate their friends and family on ways to do the same. I saw it as my responsibility as a physician, and evidence that I am doing my job well. If enough people were educated on prevention, I wouldn’t have too many patients to see in my wound care center.
ENTERING THE NEW PREVENTION FRONTIER
The idea of focusing on prevention is still surprisingly novel in healthcare despite the evidence. Many health insurance companies provide financial incentives for preventive healthcare measures such as annual physicals, vaccinations, or participation in measured physical activity. It seems like the primary care world knows the importance. I’m not sure how much the wound care world has caught up yet. New outpatient wound care centers are opening on a regular basis. More healthcare institutions are recognizing that it is imperative to have dedicated wound care experts to treat their patients. However, this model remains expensive and only moves the needle on treatment, not necessarily improving quality.
CMS FOCUSING ON PREVENTION AND QUALITY
CMS considers prevention of pressure injuries a quality measure. The Hospital Acquired Condition (HAC) Reduction Program was launched as a way to improve CMS payment system to hospitals and encourage better quality. In the world of wound care, pressure ulcer rate and post-op wound dehiscence rate are both included as key measures of patient safety. One of the most important reasons this is the case is because of the serious cost associated with both. Hospital acquired pressure injuries (HAPIs) cost hospitals ~10 billion, yes with a B, annually. Focusing on prevention could result in significant savings for hospitals and improvement in quality, which could significantly move the needle on quality and efficiency in our healthcare system.
WHY IS THERE HESITATION?
I can only opine on why we don’t see more focus on prevention in healthcare, especially in wound care. I have a few ideas though.
- Cost savings is more difficult to quantify than increased revenue
- There are not enough well-trained wound specialists to meet the demand
- Some payors do not have payment models that encourage prevention
- It is difficult to adopt a new prevention model when the traditional model, which focuses on treatment, is more familiar.
There is probably some combination of all of these issues in most healthcare facilities. There is also a common viewpoint that the institutions with higher rates of preventable injuries have lazy staff. I tend to challenge that perspective. I do believe that motivation and morale can be variable from person to person, but I also believe that an environment is the largest determinant of that morale. Inefficiency and poor allocation of resources will inevitably decrease morale in any institution.
HOW CAN WE FIX THIS?
The O’Jays said it best…“money, money, money, money…moooooney”. There has to be incentive to focus on prevention. From a healthcare institution’s standpoint, the CFO and other stakeholders need to look more at cost savings and less at increased revenue. From a payor standpoint, reimbursement should focus on reduction of preventable conditions or injuries and quality of care. This is best done through a value-based care model.
QUALITY > QUANTITY
Value-based care models reimburse providers for quality care, by either preventing certain conditions or injuries, or ensuring efficiency and a positive patient experience during the treatment period. The following table describes the three main types of value-based care models.
| Accountable Care Organizations (ACOs) | Bundled Payments | Patient-Centered Medical Homes (PCMHs) |
| Siloed network of providers and healthcare organizations ensuring quality and continuity of care
E.g. Kaiser Permanente |
A calculated lump sum of money is given to a provider network with a goal of staying under that number
|
Organized system of primary care facilities that focus on prevention, quality and continuity of care
|
Now imagine that your grandmother has been admitted to the hospital for pneumonia for the last two weeks, and after she has recovered, there are no pressure injuries or wounds that have to be managed in a rehab facility and she is discharged directly home. She has a follow up with her primary care doctor at her PCMH who reviews her hospital stay easily because the office shares the same EMR as the hospital. The hospital saved money because there was not an extended hospital stay and a necessity for advanced wound care. The patient enjoyed their experience because there was continuity of care after acute treatment. The payor is happy because they have no need for increase reimbursement and the happy patient stays with that payor. Everyone wins when the focus is on prevention.
The math is simple. Prevention + Wound Care = Quality
Prevention Is Key Our team helps hospitals and post acute care facilities reduce preventable injuries. Our consultants are wound specialists and prevention experts helping to improve the quality of life for your patients.