Working In Synergy to Heal [WISH]: Practice Innovations NPWT + KYLON®️ + Vaporous Hyperoxia Therapy + CAMPs, a Medicare cost analysis.

Introduction: Complex, non healing skin injuries and wounds pose significant physical, emotional and financial challenges for patients, caregivers, clinicians and payers.Methods:83 year old diabetic female (A1C10) with RA on leflutemide presented with bilateral LE ulcerations with exposed bone on the left and exposed achilles tendon and muscle on the right.  She had been treated with serial debridements and autolytic dressings for the previous two months.At the initial visit, the patient underwent biopsy for histology and PCR analysis. The initiation of a smaller profile single use NPWT generator and Y connector reduced her to 1 device to carry.  Near infra-red spectral imaging was performed as it was unclear if she had signifiant arterial disease needing intervention.  She was started in vaporous hyperoxia therapy (VHT) and certified for a cellular based skin substitute. Wound bed preparation was initiated using the FDA cleared hooked nylon fabric finger cot to stimulate granulation formation and reduced biofilm burden.Results:The violaceous ulcerations measured 56sqcm (R) and 72sqcm (L). pathology revealed calcinosis cutis with periintimal calcium deposits throughout the dermis and hypodermis vasculature.  there was no findings to suggest pyoderma gangrenosum   her tissue oximetry was 80% within her wound beds and periwounds.  PCR was negative on the L with Enterobacter on the R- Moxifloxacin daily was prescribed for 7 days.  Biweekly VHT with serial wound bed preparation was performed until a clean, uninfected wound bed showing granulation was achieved.  By week 3 she was ready to receive skin substitutes.  She was consented to recieve a single layer - spongy, wet prep placenta membrane to her R calf and received a tri-layer dehydrated placental membrane to her L calf.  Two applications of grafts were deployed.  She required hospitalization and a subactute stay during weeks 4-10 for hyperglycemia and presycope-falls during which she continued to receive her NPWT and VHT treatments under The WISH Clinic's direct involvement at her SNF. Diabetic meds adjusted. NIRS imaging was performed at each in clinic visit to assess the wound bed tissue oximetry and thermal thumbprint over the course of healing which reinforced the continuance of the care plan.Economic analysis of the above approach revealed a total spend of XXXDiscussion: Our approach is feasible and economically sustainable for Medicare beneficiaries when adminstered within a comprehensive, community connected advanced wound management program.  Value-based methodolgies and innovations are synergistic and deliver cost efficient, successful outcomes in at-risk, high utilizing patients across the continuum.References:TBD