Are You a Salesperson in your Own Clinic?

  Backing up a bit, we in wound clinics must start with an appraisal of the method by which we evaluate products, devices and services in the first place, and assure that we begin the process properly. The dressings that we use in the OP Wound Clinic are those that we purchase and provide incidental to the visit. The days of abundant “dumping” of large amounts of products sampled with no accountability are gone. The acceptance of samples to trial as part of a decision making process should be done with a start and end point in mind with documentation of how the dressings are used, the duration of the evaluation, and perhaps the number of patients that will be used to evaluate the product. Using case study forms are helpful to not only track the details of the evaluation, but to have as documentation of the use of the products. Clearly one cannot stock every dressing on the market, but limited trials can help to know what is available “out there”, and also provide confidence and knowledge when home care agencies, skilled nursing facilities and product suppliers such as Part B providers need to substitute with those items on their particular formularies.   Similarly, when evaluating multiple use products, usually capital equipment, it is important to have an organized plan for an objective evaluation outlining the duration of the demonstration or evaluation, the process for delivering and then picking up the equipment, with a document included that the device is in the clinic on a no charge basis for evaluation purposes only.   So we’ve done it all correctly, performed the evaluation according to the plan, whether length of time or number of completed patients, and decided that whatever it is, we want to add a new product to our stock or purchase the equipment. This is where our own sales hat needs to be nestled comfortably into place, and the process of justification begins.   In general, the question ultimately arises, “what will it replace?” As we know, wounds are dynamic, constantly change and most importantly have multiple local and patient factors to be addressed, so the “one size fits all” does not apply. Without addressing the features and benefits of all of the available dressing materials, there are some general concepts to keep in mind to assist in justifying an expanding dressing formulary:     1. Quality: This of course will be our number one goal and justification for what we need for our patients. This can equate to better quality of life by reducing odor, pain, infections, dressing changes and both direct and indirect costs. The list can go on depending on the nature of the dressing, but it can make a statement as to the level of care provided in a specialized clinic.     2. Meeting the environmental needs of the wound: The dressings that we use are incidental to the visit, but that doesn’t justify putting moist gauze on the wound and sending the patient out with orders or prescriptions. Having the dressings in the category that has been decided upon based on an assessment of the wound enables us to begin the treatment during the visit, and use the opportunity to teach the procedure to the patient and/or family. Starting the same quality of care that we expect others to provide sends a positive message to the community.     3. Color photographs: Nothing speaks louder than success stories. When conducting the product evaluation, keep photographic records of the patients utilizing the product. When the time comes to evaluate the success and compare to current products it certainly helps to jog the memory.     4. Use with wraps and casts: Longer wear dressings, or having dressings available that in the providers opinion will last and be effective for the duration of the wear time of a cast or wrap is a necessary provision in a wound clinic. Again, having options to meet variable needs is essential.   While the list is not as long and varied as the dressings, devices and capital equipment are most definitely a longer “sell” or justification process. Getting administration involved in the up front period prior to the evaluation may help in providing anticipated benefits that the clinic will realize. Usually there is a form to be signed identifying that the device is being placed in the clinic at no charge for evaluation purposes outlining the duration of the trial, and a potential cost if the equipment gets damaged or lost. Clearly, anything that provides increased revenue while providing a higher level of care is a bonus, or having a piece of equipment that is unique in a community can help to stimulate referrals.   In the current economic climate, these justifications can get tougher; many hospitals have reduced capital expenditures to essential equipment replacement only. Without question, equipment that brings additional reimbursable procedures is a plus; in a sense the device can essentially pay for itself over time. There are also often lease/purchase programs available to defray lump sum capital expenditures. We still, however, need to make our case for the clinic/patient benefits to justify the need. While not meant to be all-inclusive, some examples would be:     1. Ultrasound Therapy: The availability of the newer contact/non-contact ultrasound devices for providing wound debridement and therapy have gained in popularity as clinical use has increased and the realization of the clinical benefits are being discussed more among wound clinicians. There is a code available for the non-contact device, which makes the justification easier, while at this time there is no additional code for the contact device. The use of the contact device for debridement is inarguably a tremendous asset for patient care, but the reality is that it will not bring additional revenue into the clinic. The clinic must know their own local coverage determination in terms of using the debridement codes for the contact devices—a topic to broad to cover here. But the additional patient satisfaction piece of less debridement associated pain, reduction of surface debris, less odor, reduced infections, and ideal wound bed preparation for this category of devices as a whole is worth the time and effort of making the case for a lease or purchase. This is one category where photographs and patient testimonials can make a big difference.     2. Vascular assessment devices: Whether your needs would be better met with a transcutaneous oxygen measurement system, laser Doppler/ pulse volume recording device or some other non-invasive method of assessing flow, the good news about most of these devices is that if done by a qualified practitioner and there is a report generated to evaluate the results, there are billable codes generated. In most clinics, lower extremity disease makes up a lion’s share of the patient diagnosis mix. The ability to get early and rapid non-invasive information in order to formulate a plan of care is “priceless”.     3. Vashe Wound Therapy: forgive the use of a specific brand, but there is only one available at this point in time that is a device (there are OTC sprays and gels containing the same solution). Wound clinics cleanse all of the wounds under our care usually more than once within one visit: after dressing removal, and then again if debridement occurs. This device creates hypochlorous acid from an electrolyte solution to soak and clean wounds. In cases like this, when there is no direct reimbursement, we must look at the direct patient benefits (less odor, easier and less painful cleansing) as well as environmental benefits (no plastic bottles, less waste). The fact still remains, though that this will be an added monthly cost to the clinic. Presenting a case to add a device such as this, which is multi-patient, looking at the cost based on frequency of use may make it less painful. As an example, when we looked at the cost of the Vashe Therapy device, we determined that the monthly add on in cost came to only $1.70 per patient visit, which is easier to embrace.

Data and Documentation Systems

  If you read the Spring 2008 Issue of Today’s Wound Clinic, the benefits that an electronic medical record or computerized system of charting were well outlined. Going to a system such as this absolutely adds costs; both the recurring costs of utilizing the systems, as well as the necessary computer hardware required. Having just gone through a JCAHO survey, I can say without a doubt that having all of the required information related to pain management, medication reconciliation, the wound information, assessment of falls and evidence of abuse, and a complete patient summary made a huge difference in the surveyors assessment of our clinic. Beyond that, the systems provide data that can be collected to monitor and benchmark outcomes, provide patient mix information for possible inclusion in clinical trials, marketing information …well the list can go on endlessly. In a word, the use of these systems is priceless. So in summary, the one thing that one learns if they sit through a Sales Training 101 class is that “If you don’t ask, you won’t get”. One thing that wound care providers are known for is passionate care and patient advocacy. If better patient care, better outcomes, and improved quality of life are at the top of our justification list for anything that we want to add to our practice, it hopefully will open the door for further discussions and a positive response. Dot Weir, RN, CWON, CWS, is the Wound Care Director for Osceola Regional Medical Center in Kissimmee, Fla. and coeditor of Today’s Wound Clinic.