Ancillary Services to Maximize Your Wound Care Practice

At the American Academy of Podiatric Practice Management Conference, Jonathan Moore, DPM, MS, MA addressed how DPMs can incorporate ancillary services to best serve their wound care patients and practices. Podiatry Today had the chance to learn more about his experience on this topic and options providers might consider.

Q: How can wound care ancillary services provide value to patients and to podiatric practices?

Wound care ancillary services constitute an extremely valuable part of a podiatric practice both clinically and financially, says Dr. Moore.
 
“In our practice, for many years we have utilized these services to help grow our practice financially, but moreover, they have helped grow patient loyalty to our brand,” he explains.
 
Dr. Moore shares that among the top opportunities within this category is the dispensing of wound care DME products.
 
“A podiatric physician is allowed to dispense wound care products like collagen powder, foams, and alginates with the place of service 12 (home),” he says. “Furthermore, one is allowed to dispense up to a one-month supply for those patients with a qualified full-thickness wound. Collagen products do not require a full-thickness wound, but most all other products require this in your documentation.”
 
In Dr. Moore’s experience, he finds that with collagen powder (A6010), a physician can net upwards of $700.00 per patient, per wound if one dispenses a one-month supply. He adds that in his observation, foams, collagens, and alginates all reimburse well, and over time, could generate an extra 20-30K per year net with just 1 patient per week. Another option he shares is utilizing kits, like those produced by AMERX Health, which allows providers to dispense collagen and other wound products conveniently and compliantly. Moreover, Moore notes that wound care products even with delivery to the patient’s home through Amerx Health Patient Direct program.
 
“Furthermore, diabetic footwear in my practice is still a remarkably financially rewarding venture,” says Dr. Moore. “Yes, despite audits and issues with obtaining MD-signed CMNs among other challenges, we have department leads that handle and navigate those challenges to keep all of our 10K-plus patients with diabetes in excellent footwear. While many in our profession are abandoning this service, we continue to thrive. The key is to put someone in charge of handling the retrieval of documents and ordering.”
 
Moreover, he adds that vascular testing is a tool his practice has used for many years, which he views as an excellent way to build revenue that would otherwise go out of the office.
 
“We still use the PADnet (Biomedix) machines in our offices with great success,” he says. “We have never lost an audit or had any challenges with our documentation. That is key. Make sure you document vascular symptoms (these tests cannot be performed and reimbursed as a screening tool) and have a printout of the test in your chart for which you have established a treatment plan.”
 
Another tool Dr. Moore shares is the Arche Healthcare comprehensive diabetic foot exam (CDFE) program.
 
“This is a proprietary software system and tool kit that allows you to perform true CDFEs that demonstrate to your patients their risk through visually based tests and educational materials,” he explains. “Furthermore, by recording your CDFE through Optyx, (Arche’s technology platform on a tablet) you are actually measuring outcomes over time and stratifying your patients for payers. We never advocate performing an evaluation and management service for CDFEs without symptoms or a legitimate finding, but when our patients with diabetes come into our office for at-risk care or for any other issue, we ascertain their problem list and, in most cases, we can identify a valid change to constitute the billing of a 99213 or -4 with a CDFE.”

Q: What are some additional examples of wound care ancillary services that DPMs might incorporate?

Dr. Moore shares that in his experience, Helix Collagen Powder by AMERX reimburses over $35.00 per gram and, as one is allowed to dispense a monthly supply of collagen per wound per month, net revenues for a one-month supply can top over $700.00.
 
“This is a win-win for the patients and providers to keep the patients out of the hospital and/or the wound care center,” he says.
 
Many patients with diabetes have neuropathy that can take a toll on their gait and balance, he adds, and these patients have a much higher likelihood of falling…in many cases over 10 times more  likely. Moore, the inventor of the Moore Balance Brace, cites several recent studies he has observed that demonstrate reduced risk when utilizing an appropriately designed AFO. Moore, notes that the newly designed Moore Balance Brace through Orthotica Labs can make a significant difference in the lives of these patients and help grow revenue. Specifically, he cites the lightweight all-leather design and true extrinsic post at the heel to maximize postural stability as key features.
 
“One pair of Moore Balance Braces costs around $695.00, while the reimbursement is more than triple the cost,” he explains. “Performing a fall risk assessment, and documenting the patient's biomechanical and musculoskeletal deficiencies is key, along with regular DME supplier standard documentation.”

Q: What challenges do you feel DPMs face in including these types of services in their practices?

As with all ancillary services and DME dispensing, knowing the rules and having the appropriate documentation are key, shares Dr. Moore.
 
“I have always advocated promoting a key person in your practice to handle AFO casting, DME shoes, and all things DME compliance,” he says. “This person will pay for themselves quickly. Let them go to AAPPM meetings and be involved in the process. Allow them to get their shoe-fitter certification or even allow them to become a Certified Pedorthist. Knowing the rules, documenting, and making sure your patients are taken care of and happy will make these services work and thrive in your practice. Obviously, the payors have planted land mines with frivolous audits and wasteful programs like Same/Similar, however, we have overcome Same/Similar with our team anticipating the need for redetermination and be familiar with what documentation is needed to be reimbursed.”

Q: Anything else you’d like to add?

Dr. Moore says that attending a meeting, being able to ask questions, and being involved in dialogue with doctors that have overcome the same challenges is the most valuable tool to help grow your practice. However, he advises doctors to let their practices work for them, and not the other way around.
 
“Build a practice that allows you the lifestyle you want,” he says. “Most importantly, always put your patients first. Be mindful that you are in a customer service business and that your patients want excellent service, friendly staff, and convenience. Stop sending your patients all over town for services you can offer right in your office.”
       
Dr. Moore discloses he is a consultant for ARCHE Healthcare, Amerx Health and is the inventor of the Moore Balance Brace made by Orthotica.