Understanding Wound Care Center Certifications

  Our increasing societal age and prevalence of diseases such as diabetes and peripheral arterial disease is causing a rise in chronic wound sufferers. As a result, we are also seeing a rise in the number of outpatient wound clinics and hyperbaric facilities. How does a patient know if they are being cared for by qualified clinicians in a center, that know to provide care that meets or exceeds established standards? There are several certifications available for individual clinicians that lend credibility to their knowledge; however, there are very few options to identify a wound clinic or hyperbaric facility as a credible program meeting quality care standards established and evaluated by an outside agency.

  Wound clinics and hyperbaric facilities interested in being validated as a quality care program should consider one or both of these options:
    • Disease Specific Certification (DSC) in Wound Care through The Joint Commission (TJC).
    • Clinical Hyperbaric Facility Accreditation Program through the Undersea & Hyperbaric Medical Society (UHMS).

  These organizations focus on the quality of care delivered by the wound clinic or hyperbaric facility as a whole. Reaching this level of recognition does take time and money, but the rewards are worthwhile to the facility and the patient.

Taking a Closer Look: TJC DSC

  Wound care certification through TJC was developed out of interest from the wound care community. It is part of their core DSC program and initiated at the request of the wound clinic. The goal is to assist wound clinics to provide safe and highly reliable quality patient care. This is achieved by ensuring the clinic has:
    • Qualified, competent care providers.
    • Standardized care delivery processes through Clinical Practice Guidelines (CPG).
    • Performance measurements to monitor, analyze and use to improve outcomes.

  Beyond the obvious clinic distinction, this certification process provides guidance to a clinic on how to structure the wound care program. It gives the clinicians implementing the standards a common goal to work toward which enhances team cohesiveness and cooperation. Ultimately through implementation of the CPG and use of performance measures to improve outcomes, the clinic continuously betters itself and improves the quality of care delivered to its patients. Once certified, wound clinic administrators can use the certification as a marketing tool to their referral and payer sources validating and communicating the strength of the program and the quality of care provided to patients. Some TJC DSC certified clinics have successfully used certification in negotiations with payer sources to enhance reimbursement.

Eligibility Requirements:

  When considering application for TJC DSC in wound care, it’s important to have all stakeholders engaged in the process from the beginning. The CPG should be implemented consistently throughout the program and incorporated into the everyday workflow. Basic eligibility requirements include:

    • Be in the United States, operated by the U.S. government or operated under a charter of the U.S. Congress.
    • Have served a minimum of 10 patients served at the time of the on-site review.
    • Be a program within a Joint Commission-accredited organization when the organization is eligible for certification.
    • Utilize a standardized method of delivering clinical care based on CPG and/or evidence-based practice.
    • Utilize performance measurement to improve its performance over time. Four months of performance measure data must be available at the time of the initial certification on-site review.

  The initial application process can begin by going to https://www.jointcommission.org/certification/seeking_dsc_certification.aspx. The time from application receipt to the time of on-site review is approximately 4-6 months. Pricing is dependent upon the number of certified programs within the organization, but the average cost is about $4850. There is no application or deposit fee for current Joint Commission customers. According to Donise Mosebach, RN, MS, CEN, Field Director for TJC, “there are many resources to assist with successfully obtaining DSC certification for Wound Care. Starting with the Business Development team who will answer questions and assist with the initial application to the Account Executive who will be your on-going primary contact for all issues related to certification. Additionally, current DSC certified customers have volunteered to assist other organizations that have questions about the certification process, their own program needs, sharing tools, etc. Joint Commission customers have access to additional free tools such as the Leading Practice Library, which highlights and shares practices gathered from other programs across the country. The Joint Commission Center for Transforming Healthcare is also a free resource that includes the Targeted Solutions Tool™ which is an application that guides health care organizations through a step-by-step process to accurately measure their organization’s actual performance, identify their barriers to excellent performance, and direct them to proven solutions that are customized to address their particular barriers.”

Perspectives From a Surveyor:

  To get the perspective of the on-site surveyor, TWC asked TJC wound care surveyors Wanda Huffstetler, MSN, RN, BC, WCC and Sherry Smith, RN, MSN, MBA for their input on several questions:
      o What are some of the key elements a surveyor looks for during the onsite review?
    • Adherence to the chosen CPG.
    • Assessment of wound progress.
    • The results of and response to individual patient risk assessments.
    • Patient education assessment and implementation.
    • Competency of team members.
    • Coordination of care with referral systems as needed.
    • Data integrity.
    • Emergency plans for hyperbaric issues.
    • Upkeep of equipment when applicable.
    • Rationale for choosing performance indicators and how this is reported and utilized in the program design.

      o What are some of the common areas noted as being in need of improvement?
    • Care does not include the patient’s co-morbidities. The Wound Care Center does not focus on the co-morbidity disease process in terms of wound development. The Wound Care Center places this responsibility with the primary physician solely.
    • Missing assessment of unaffected extremity in a population that is vascular compromised
    • Incomplete patient education assessment and implementation.
    • Patient education is not individualized to the patient and based on the patient’s identified risks.
    • Missing documented time out for debridement.

      o Do you have any advice to the center seeking certification for the first time?
    • Use the 5 primary focus areas of the standards, found in the DSC certification manual, as your starting point.
    • Perform a Mock GAP analysis against the standards.
    • Have a champion and MD leadership as well.
    • Network with like certified organizations.
    • Please don't cancel or lessen the clinic appointments when notified we are coming- we want to speak with patients and family members.
    • Ask the staff to relax.

  The vision of The Joint Commission is that “All people always experience the safest, highest quality, best-value health care across all settings.” The DSC certification program is an avenue for organizations to structure their patient care in a manner that supports this vision. From a marketing perspective, the DSC certification program identifies your center as a quality program as a whole, which gives patients, referral sources and payer’s validation that they are participating in a high quality program.

Taking a Closer Look: UHMS Clinical Hyperbaric Facility Accreditation

  By creating a national clinical hyperbaric facility accreditation program that started in 2002, the UHMS has responded to the recognized need by various regulatory agencies to assure that the quality of care across the continuum of clinical hyperbaric facilities is achieved and maintained.

  Equally important are the advantages that an individual clinical hyperbaric facility may realize. Though not all-inclusive, some of the more immediate are:
    • Improved quality of care.
    • Increased efficiency at the facility level.
    • More effective risk management programs.
    • Possibly lower liability insurance premiums.
    • Staff motivation and esprit de corps.
    • Maximized public relations and marketing efforts.
    • Ability to recruit and retain quality staff.
    • Develop alliances with other provider groups.
    • Establish credibility of legitimate non-affiliated outpatient facilities among their professional referral base.

  As a member of The Joint Commissions’ Liaison Network, the UHMS has recently achieved recognition as a complementary accrediting body. TJC complementary accrediting body recognition is reserved for those specialties with considerable technical complexity; it recognizes TJC’s limited expertise in a complex and technical medical subspecialty such as hyperbaric medicine. This in no way precludes a survey by TJC of a UHMS accredited facility but rather the survey may not address the more technical aspects of the hyperbaric medicine department. On a quarterly basis the UHMS sends an updated list of UHMS accredited facilities that are also TJC accredited facilities.

Eligibility Requirements

  Any clinical hyperbaric organization that meets the Undersea & Hyperbaric Medical Society’s Survey Eligibility Criteria may apply for an accreditation survey. A clinical hyperbaric facility is eligible for an accreditation survey by the Undersea & Hyperbaric Medical Society if it:

  1. Has been providing hyperbaric treatment services for at least one year before applying for an on-site survey.

  2. Is either a legally constituted organizational entity that provides hyperbaric treatment or other health care related services, or a sub-unit that primarily provides such treatment services within a legally constituted organization that may be, but not need be, health or hyperbaric related.

  3. Is in conformance with all applicable federal, state and local laws and regulations.

  4. Provides medical and hyperbaric care that is under the direction or supervision of a physician or group of physicians who accept responsibility for medical and hyperbaric care.

  5. Provides the signed Application for Clinical Hyperbaric Facility Accreditation Survey, the Clinical Hyperbaric Facility Accreditation Presurvey Questionnaire, and other documents as required in advance of the survey.

  6. Pays the appropriate accreditation fees.

  7. Acts in good faith in providing complete and accurate information to the Undersea & Hyperbaric Medical Society during the pre-accreditation, accreditation and reaccreditation process.

  With the exception of the consensus-based staffing and training standards, the UHMS has not created its own standards to assess the basis for accreditation. The standards and guidelines from other organizations such as TJC, AAAHC, etc., that have been referenced by the UHMS are continuously monitored for revision.

Consultation Surveys:

  The UHMS provides specific Consulting Surveys by special request. Such informal surveys are designed to meet the special needs of a hyperbaric facility by assisting the facility with understanding the survey probes, the survey process and to help prepare for accreditation, or to achieve conformance with a particular standard or guideline.

  A Consulting Survey does not result in an accreditation decision. Though problems are identified and recommendations provided, the consulting report is strictly for the use of the requesting facility. The needs of the facility will determine the length of the survey and the number of consultants provided. This type of consulting survey will almost always require a site visit for which the requesting facility will incur a cost based on the published fee schedule.

Accreditation Fee Schedule:

  Application fee - $495 (non refundable).
  Survey fee - $3500 plus survey team travel expenses.
  Reconsideration fee - $500 for documentation review only. $1000 if onsite visit is required plus travel expenses.
  Consultation Survey fee - $1500 plus travel expenses.
  In order to maintain currency of accreditation, an accredited facility must undergo full and regular surveys every three years.

Perspectives From a Surveyor:

  W.T. Workman, MS, CAsP, CHT-A, FAsMA (Tom) is the Director of Quality Assurance and Regulatory Affairs for the UHMS; as a surveyor he listed the following areas frequently needing improvement for first time surveys:
    • Currency of CME – evidence of ongoing activity in Medical Staff Office.
    • Documentation of safety drills.
    • Bulk oxygen systems and safety, signage, and security.

  As a result of the accreditation process, he reports improvements in the following areas:
    • Increase in certification of the hyperbaric staff (certification as CHRN/CHT by the National Board of Diving and Hyperbaric Technology).
    • Quality Improvement initiatives have been dramatically improved.
    • Execution and documentation of safety drills are a priority focus.

  He offers this advice for centers seeking accreditation for the first time:
    • Preparation is key – a multidisciplinary effort by department staff as well as other departments that work with the center.
    • As much detail as possible should be provided when completing the Clinical Hyperbaric Facility Accreditation Presurvey Questionnaire; this document helps the center focus on what is needed for accreditation and provides an introduction for the surveyors.

  Finally, the survey process is not an inspection; the surveyors are consultants for improvement.

In Summary

  Now that wound clinics and hyperbaric facilities are all the rage, it’s imperative that true centers of excellence be validated as quality care programs that meet quality care standards established and evaluated by an outside agency. The Joint Commission and the Undersea Hyperbaric Medical Society are two outside agencies with established programs to evaluate and verify quality wound care and hyperbaric programs. While cost and resources can be a challenge, the benefits make the process worthwhile and provide a sense of confidence in the patients seeking care at such facilities.

Trisha Carlson, MSN, MBA-HCM, RN, CWCN, DAPWCA is a Today’s Wound Clinic Editorial Board member and is the Vice President of Clinical Education for National Healing Corporation. She speaks, writes and serves as a legal consultant in wound care. For more information she can be reached via email at trisha.carlson@nationalhealing.com.

John Duffy, MSHCA, RN, CHRN, CNA, BC is the Director of Safety for National Healing Corporation. He serves as faculty for a UHMS approved introductory course in hyperbaric medicine and speaks at national conferences on topics related to hyperbaric safety. For more information he can be reached via email at john.duffy@nationalhealing.com.