1. Hess, Cathy Thomas BSN, RN, CWOCN

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In my previous column, Your Wound Care Department Checklist for 2015, I provided you with a CORE (CORE is a proprietary analytical process developed by the author) outline and checklist to assist in improving your processes this year. This list is not meant to be all-inclusive but a strategic starting point for you to begin mapping your process. What is important is your checklist and goals for this New Year. To help you get started, let's take this concept one more step forward and look at the importance of tracking, monitoring, and measuring the work in your department.


Tracking. The process of tracking growth is fundamental to any business unit including the hospital-owned outpatient wound care department. Managing your budget, product formulary, adjunctive therapy usage (such as cell- and tissue-based products, negative-pressure wound therapy devices, compression therapy, hyperbaric oxygen therapy), staffing, and more are critical to the bottom line. These operational items are one aspect that impacts the financial success of the department. But, if aspects like these are not tracked and managed properly, the fiscal health suffers.


In addition, it is important to have a point person oversee operational changes affecting the wound care industry (example provided below). This is important as it is operationally imperative to remain current with the clinical and operational changes for items budgeted and used within the department. Any impending changes should be reviewed with your finance team, updated within your Chargemaster (if the procedure or product impact your practice), and provided as an educational update for your staff. For example, there are a number of reimbursement changes impacting wound care in 2015, changes in reimbursement for cellular and/or tissue-based products for wounds/skin substitutes, negative-pressure wound therapy, total contact casting, and multilayer compression. It is important that you track this information and understand how the changes impact your practice both clinically and financially.


Another important aspect to track within the wound care department is patient volumes. Are you following the patient volumes and noting trends? Are patient volumes trending upward? If they are not, are you able to review the targeted patient volume reports to gain a better understanding of why your patient volumes may be trending downward or neutral? Tied to patient volumes are marketing efforts, communication with referring physicians, outreach, and so on. Are these processes in place to assist you in achieving your desired patient volumes? Just as important as tracking financial changes, tracking patient volumes is equally important to the fiscal health of the facility.


Monitoring. Monitor your department's progress for clinical and operational improvement, and yes, there is always improvement to be had! One way to monitor clinical improvement is through auditing documentation. Proactive internal monitoring and auditing are designed to test and confirm compliance with legal requirements. Auditing is done to assess the completeness of a medical record, determine the accuracy of documentation, and discover lost revenues. During a medical record audit, the documentation is examined to determine if it adequately substantiates the services billed and identifies medical necessity for the services rendered. If this process is not conducted on an ongoing basis, incorrect or inappropriate documentation and coding practices, potential risks to the organization, compliance with the organization's policies and procedures, and compliance with payer regulations may not be identified.


As a healthcare provider and a recipient of health insurance dollars, it's important for your organization to conduct internal auditing to monitor and prevent improper payments. Effective compliance auditing includes proactive monitoring and auditing, which will confirm the provider's compliance with any legal requirements. The auditing function is the check and balance for monitoring your documentation.


Measuring. Lastly, it is important to measure the successes of your department. One way to measure clinical, operational, and financial drivers within the department is through reporting. What reports drive your process improvement plans? Have you defined reports to measure and manage your daily, weekly, monthly, and quarterly requirements? How do you measure your weekly healing rates? How do you measure outcomes, benchmarks, and trends? More important, how do you measure and manage your outliers?


As an example, let's look at the impact of measuring wound healing percentages, over a given timeframe, which provides a more accurate picture of wound healing success. This type of report should compare the number of wounds healed to the total number of wounds "closed" and demonstrate how effectively the patient's wounds are managed. Query the data by reflecting on your clinical practices. Was there a delay in seeking treatment, or were the patient's comorbidities impeding the wound healing outcome, or were less than optimal wound management pathways implemented? Answering these questions assists in improving the department's comprehensive outcomes.


Track, monitor, and measure your success as you punch through your CORE checklist. Cheers!