Although it is not yet commonplace, the idea that skilled nursing facilities can set up wound care clinics as freestanding businesses is gaining traction in some circles.
Based on the volume of cases, experience in detecting certain nuances of pressure ulcers and success rates in healing advanced wounds, SNFs should be primed to establish themselves as wound care specialists, offering a service component to other providers the same way many currently do with rehabilitation services, some experts believe.
Before deciding whether the field is ready to develop a commercial wound care segment, consider what constitutes a quality program: clinical expertise, full complement of products, innovative treatment options, high-caliber staff training methods and consistently excellent outcomes.
The consensus among industry observers is that the best skilled nursing facilities already have these procedures in place and that quality wound care is a priority for their residents. Demographics undoubtedly have allowed SNFs to become experts in wound treatment. Pressure ulcers are an unfortunate complication of the infirm and bedridden in a geriatric environment no matter how much care is provided.
Setting up shop
If a long-term care facility has assessed its capabilities for treating advanced wounds and the clinical team is equipped to handle additional patients, setting up a wound care clinic seems like a natural progression—one that can become a self-sustaining revenue source for the organization. Margaret Falconio-West, vice president of clinical nursing for Mundelein, IL-based Medline, believes the concept has merit.
“In many situations, the types of patients that long-term care facilities are treating have been discharged from a hospital with wounds that require specialized treatment,” she says. “These patients also tend to have chronic or acute conditions that require specialized treatment in addition to the wound itself. With the proper staff, training and treatment measures in place, long-term care facilities can market themselves to discharge planners to attract these types of patients. They can also offer better treatment to their long-term residents.”
Wound treatment centers are an established part of the provider continuum and SNFs have historically referred patients with problematic wounds due to diabetes, chronic pressure ulcers or circulation problems to them. But Falconio-West questions why SNFs need to do this if they have the resources on-site.
“Sending these residents outside of the facility to treat chronic, non-healing wounds is disruptive to the residents and has a negative impact on their quality of life,” she says. “With the clinical staff, service and treatment tools available onsite, residents no longer have to be sent out for care and instead can be provided with a high continuum of care within the facility.”
She stresses that the best facilities never get complacent about wound care and periodically review all procedures to maintain the highest level of care possible.
“Understand the full scope of the patient’s needs,” she says. “Mobility, age, nutrition, continence, disease and other factors all have a part to play in how wounds heal, so it’s important that facilities have the right skilled staff in place to treat the complexity of a patient’s needs and utilize high-quality products to help promote wound healing.”
Success for a SNF-based wound treatment center hinges upon effective marketing to key referral sources, says Bilray Sewell, business unit manager for Jacksonville, FL-based Gulf South Medical. Facilities that have the know-how, patient volume and resources are equipped to take wound care to the next level, he notes.
“The template is there,” Sewell says. “If they have a wound care team and established protocols, they can use those protocols to measure their impact with outcomes. If the administrator can show the results of their program, they can connect with the right referral sources in hospitals and physician community. If I’m a hospital and know that a nursing home has a post-acute wound care program in place, it’s another option to consider.”
A top-notch clinical team is integral to the SNF-based wound care center’s reputation, Sewell says, noting that it should have a physician team specializing in high-grade wounds, including a surgeon, podiatrist and dermatologist.
“You also need nurses and therapists, but it is imperative that physicians be involved,” he says. “You need to attract and even more importantly, retain key personnel. That gives you the edge.”
Being a self-sustaining operation also requires strict attention to costs and selecting products that maximize value without sacrificing clinical efficacy.
“There is an outlay of costs associated with higher-end wound care products, but if using these products can heal a wound in five days rather than 10 days with a lower cost product, you can realize cost savings in staff time while improving outcomes by minimizing risk of infection,” Sewell explains.
New business model
Optimal product utilization is critical to an efficient wound care operation. “Unit-dose” business models—like the one developed by Little Rock, AR-based Advanced Tissue—are designed to provide precision treatment for patient wounds, explains President Kevin Lamb.
“It is natural to assume that using more products will help a wound heal faster, but consistency is the true key to proper healing,” Lamb points out. “Unit-dose packaging limits the ability to overuse products.”
Due to unit-dose distribution’s ascribed costs, facilities that decide to establish a freestanding wound care clinic might find it to be a strategic hook for referral source marketing. Used for decades in pharmaceutical supply, the unit-dose concept has evolved in wound care alongside the technological evolution of applications and dressings, Lamb believes.
“We have mechanisms to ensure the facility’s formulary requirements are met,” Lamb says. “Unit-dose also ensures gives management the tools to measure whether nurses are actually changing dressings as ordered.”
Because of Medicare Part B regulations, Advanced Tissue delivers physician-prescribed products directly to beneficiaries, whether they reside in their own homes or in a nursing home. From this standpoint, SNFs can serve as a wound treatment provider without having to handle the often complex Part B billing.
Prognosis on potential
Freestanding wound care clinics, which can use sophisticated techniques, such as hyperbaric oxygen treatments, represent a successful niche service for some healthcare companies, Lamb said. But he’s hesitant to recommend that SNFs pursue this business.
“Nursing homes typically don’t want to disclose that they have wounds in their facilities because it can lead to the perception that they provide less than quality care,” he says. “I don’t know if it would be seen as credible business practice in the same way as rehab because they are entirely different modalities.”
Conversely, Falconio-West believes that quality care is what ultimately attracts referral sources and suggests that facilities adopt a multi-dimensional approach as a marketing strategy.
“Provide a wide range of treatment options,” she says. “Similar wounds tend to respond to similar treatments, but not always. Look at each individual patient’s nutrition and overall health goals and adopt treatments specific to them.”
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