Honest Wound Care

To see what is right and not do it is a lack of courage.       – Confucius      Providing the best evidence-based wound care is the goal of all who care for patients with wounds. We try to choose the best treatment for the patient based on the patient’s condition and circumstances. Recently, I have discovered that there are some in wound care who choose treatments based on how much they receive in payment. If there is a decision among therapies, the one with the most reimbursement will be selected whether or not it is the most effective. We must be stewards of our resources and make wise decisions regarding cost; however, the patient must always come first! How can any healthcare provider justify such an action? There are even suggestions that when two equally effective therapies are available, some will choose the one that pays the most.      Other instances of increasing financial rewards from providing care involve coding and billing procedures. I know there are instances when “creative coding” of certain procedures and products will result in more reimbursement. This is subtly known as “up coding” or “maximizing one’s coding.” I am as frustrated with the coding and reimbursement system in wound care as everyone else, but coding for procedures not done or stretching the diagnosis or treatment code to justify a higher payment are not wise actions and will not go unnoticed forever: once identified, these actions will be deemed fraudulent for which the penalties are severe, especially since most instances involve government-controlled insurance programs. Unfortunately, there are those in industry who may encourage marginal coding practices in an effort to sell more of their product. Some practitioners attempt this to improve their bottom line financially. I strongly discourage this practice no matter who suggests that it is a reasonable thing to do, because it is not legal and it certainly is not right.      Healthcare providers, for the most part, are the most honorable and ethical people in medicine, but sometimes it is easy to be led to the edge of honesty by those who are claiming to help us. From there it is easy to slide into wrongdoing. I know that it is frustrating to receive less and less reimbursement for our work and to struggle continually to have sufficient funds to provide evidence-based care for all of our patients. Remember that right is right and wrong is wrong no matter the circumstance. Mark Twain said, “Always do right. This will gratify some people, and astonish the rest.” Be ever vigilant of what is right and what is wrong with the administrative side of wound care. It is as important as the patient care portion. We need to astonish as many people as possible. Terry Treadwell, MD, FACS woundseditor@hmpcommunications.com