The Truth About 'Wound Healing Rates'

It’s time to tell the truth about ‘wound healing rates.’ Here’s why: On April 14, the US Senate voted overwhelmingly to permanently repeal Medicare’s sustainable growth rate (SGR) formula for paying doctors. For more than a decade, we have had an annual crisis of uncertainty known as the “doc fix,” whereby Congress has postponed steep cuts to physician reimbursement for Medicare providers, creating an ever-widening chasm between the money paid to providers and the Medicare trust fund. The SGR would have required a 21% cut in physician payments to take effect April 1.

How did Congress finally get this gorilla off the back of Medicare providers? In the new legislation, professionals will receive an annual update of 0.5% each year from 2015 through 2019. In 2019, it establishes an improved incentive payment program that will focus the fee-for-service system on providing “value and quality.” This incentive payment program, referred to as the Merit-Based Incentive Payment System, streamlines, consolidates, and improves on the three current incentive programs: 1) the Physician Quality Reporting System that incentivizes professionals to report on quality of care measures; 2) the value-based modifier that adjusts payment based on quality and resource use in a budget-neutral manner; and 3) the Meaningful Use of electronic health records (EHRs) that entails meeting certain requirements in the use of certified EHR systems.

________________________________________
RELATED CONTENT
The Wound Care Clinician's Quality Reporting Survival Guide
Lessons to Learn From Federal Convictions of HBOT Fraud
________________________________________

Healthcare professionals will receive a composite performance score of 0-100 based on their performance in each of four performance categories: quality measures, resource-use measures, clinical practice improvement activities measures, and Meaningful Use of EHR measures. Professionals will only be assessed on the categories, measures, and activities that apply to them. Each eligible professional’s (EP’s) score will be compared to a performance threshold. Professionals will know the score they must achieve to obtain incentive payments and avoid penalties at the beginning of each performance period. EPs whose scores fall above the threshold will receive positive payment adjustments. EPs whose scores fall below the threshold will receive negative payment adjustments. This is a zero-sum game. The negative payment adjustments for professionals below the threshold will fund positive payment adjustments to professionals with scores above the threshold. EPs will receive confidential feedback on performance in the quality and resource-use categories at least quarterly, likely through a web-based portal. Professionals may also receive confidential feedback on performance through qualified clinical data registries (QCDRs). Needless to say, I’m paying close attention to everything they say about QCDRs since that is the way forward for wound care professionals.

Getting Real With Healing Rates
The Centers for Medicare & Medicaid Services (CMS) is developing a methodology to identify resource use associated with specific care episodes, including a method that would allow professionals to report their specific role in treating the beneficiary (eg, primary care or specialist) and the type of treatment (eg, chronic condition, acute episode). This methodology could be very important to wound care providers. We will have the opportunity to make recommendations regarding how CMS can improve risk-adjustment measurements so that professionals are not penalized for serving sicker or more-costly patients. I hope our industry is getting the message that post hoc vetting of outcomes to make healing rates appear better than they are is a bad thing to do. Sick patients cost a lot of money to CMS. Providers must report outcomes in relation to how sick patients are, or the resource use on these patients will appear inappropriate.

About 66% of patients heal (not 98%). The way to measure the skill of a wound care professional is what percentage of patients they heal when patients are risk stratified according to their likelihood of healing. It’s time to stop fudging the data on “wound healing rates.” Continuing this practice is going to hurt us all. It’s time to tell the truth about healing rates and report them by risk stratifying, which is the best way to show the value we bring to the care of patients and ensure those providers who care for the sickest patients are not penalized.

Caroline E. Fife, MD, FAAFP, CWS, FUHM, is chief medical officer at Intellicure Inc.; executive director of US Wound Registry; medical director of St. Luke’s Wound Clinic, The Woodlands, TX; and co-chair of the Alliance of Wound Care Stakeholders.