From the Editor: Wound Care Coverage Playbook

  I am writing this at the end of a grueling day in clinic. I stayed late to see a woman with cancer. I had to keep my staff overtime, and for that I will catch a lot of grief from administration tomorrow. No matter how idealistic our commitment might be to patient care, if we can’t pay the bills, we can’t keep the clinic doors open. This issue of TWC is devoted to various aspects of reimbursement. One of the challenges in creating a treatment plan for this poor woman is that nearly every aspect of the complex world of wound care is affected by Medicare Local Coverage Determinations (LCDs). These often poorly understood policies produced by Medicare contractors are the "fine print" that determines whether, when, and how a service will be covered. In a lot of ways they are like the tax code. No one really WANTS to know what is in it, but everyone has to follow it. These often arcane documents determine what you can and can’t do for a patient (if you want to get paid, that is) and can make or break a clinic’s bottom line financially. Kathleen Schaum and Donna Cartwright’s incredible “Wound Care Coverage Playbook” on LCDs will explain everything you need to know (but were afraid to ask) about Medicare coverage policy.

  This poor woman’s husband had been buying her wound supplies (using their limited funds) at the pharmacy. They have private health insurance but one ever told them that her dressings would be covered as part of their durable medical equipment benefit. While we as providers know this, there are complex rules governing the provision of dressings that even many wound care clinicians don’t understand. Thanks to Dot Weir and Pam Scarborough’s enlightening article on the Medicare Part B Surgical Dressing Policy, you will have a better understanding of these issues.

  It took me more than an hour to see this last patient because not only did she have a pressure ulcer, a malignant wound from her tumor and lymphedema, but she had mystery ulcers in both of her armpits. I have seen a lot of hidradenitis suppurativa so it was not a difficult diagnosis, but it is safe to say that a doctor who does not practice full time wound care might have done some head scratching. Michael Molyneaux discusses the “Pillars of Success” in the wound center looking at key areas to enhance your clinic’s performance. This is part of the ongoing series on the “Decline and Fall of the Dabbler.”

  Did I mention that the unfortunate patient with all those problems (including active cancer on chemotherapy) was also pregnant? When is the last time you saw a randomized, controlled trial in wound care on pregnant patients? Or, even better, how about pregnant patients with cancer? Tom Serena provides a look at the limitations and challenges of wound care research in another of his humorous and insightful articles. And if after reading all of this you are feeling overwhelmed at the daunting task of running your wound center, you may want to look again at the management company option. The Product RoundUp section takes a close look at several wound center management companies. Regardless of whether you choose to use an outside management company or to manage your own clinic, you will need a way to manage your data. This month’s Clinician’s Report provides and in depth survey of Scheduling/Software Solutions by a variety of electronic medical record or data management companies.

  It is a fact of life that, “We have to do well to do good.” We hope this issue of TWC will enable you to thrive financially so that you can stop worrying about your bottom line and spend your time caring for your patients, however challenging the patients may be.

Caroline Fife, Co-Editor of TWC, cfife@intellicure.com