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Optimizing Wound Care for PDGM and the Value-based Era

    Under the Patient-Driven Groupings Model (PDGM), the wound clinical grouping is one of the clinical groupings with the highest reimbursement potential. It includes cases that fall into the assessment, treatment, and evaluation of surgical wounds, non-surgical wounds, ulcers, burns, and other lesions. Improving wound care helps home health agencies build confidence to not just accept patient referrals but also promote services for wound patients from referral sources.

    The success of a wound care program is dependent on the agency’s policies and procedures, which should address wound assessment, documentation, and management, as well as skin integrity and skin risk assessment. It should also reflect the latest evidence-based best practices and incorporate an interdisciplinary approach that involves family members, nurses, physicians, dieticians, physical and occupational therapists, and medical social workers.

    Challenges to Wound Care

    Let’s take a look at some of the challenges when it comes to wound care:

    • Administering care – The challenge in itself is administering care because wounds are painful and stressful for the patient. 
    • Frequent change in orders – Knowing what plan of care to execute can get confusing when orders change frequently. Having said this, clinicians must provide wound care according to the physician or allowed practitioner’s most recent orders.
    • Ineffective treatment – Time and money can be wasted when the wrong treatment is provided or if the same treatment is prolonged without success. The key is healing patients’ wounds in a timely manner without unnecessary hospital readmissions. 
    • Limiting categories – Wounds need to be documented for their physical characteristics such as size, depth, etc. They are not as straightforward to describe, so using objective data descriptions and checkboxes can be challenging.

    Actionable Tips

    To address the abovementioned challenges, here are some recommendations:

    1. Key assessment data – Accurately assess wounds by including the following:
    • Wound type/etiology
    • Pressure injury (ulcer) staging
    • Wound location
    • Wound measurements (length, width, depth, undermining, tunneling)
    • Exudate type and volume
    • Wound edge attachment
    • Peri-wound skin appearance
    • Patient’s pain level related to the wound
    • Wound odor after cleansing
    • Presence and grading of edema
    1. Access to wound experts – Tapping the expertise of a certified wound ostomy continence nurse or a certified wound specialist can help in complex cases and can save on cost and time. This has been adopted by some big players in the industry which can provide significant efficiencies in staffing utilization and effective wound care with the right strategy.
    1. Call the physician – Do not hesitate to contact the physician if any of these symptoms are present:
    • Foul odor
    • Pus or other drainages
    • Redness and tenderness
    • Warm and/or swollen skin surrounding the wound
    1. Use photos – Include a wound imaging requirement in your documentation policy. This helps in being more objective when it comes to wound assessment, and it also makes it easier. 
    1. Use your QA program – Utilize your QA program to help in monitoring patient wound condition and proper documentation. Your QA program should help you check the occurrence of wound infections so you can promptly notify the physician for proper intervention or a new wound care order. Moreover, QA should also help check that the wound care assessment data is consistent across all documentation and coincides with the identified OASIS codes and reflects the actual patient case.

    The Key to a Successful Wound Care Program

    Wound care may seem straightforward at first glance, but there are several factors to watch out for to be compliant and pass medical reviews or surveys. On top of best practices, avoiding clinical oversight and interdisciplinary collaboration among all involved parties will not only help wounds heal faster, but will also improve patient satisfaction and reduce rehospitalizations. These components, along with clinician reeducation and training, make for a strong foundation for an effective wound care program, which can also cultivate the success of home health businesses in PDGM and the value-based care era.