As we evaluate wound care programs across the country, we often hear this question from hospital executives: “We see a lot of patients in our clinic, but we aren’t making any money. Why?” This post highlights three key areas that hospital leadership should understand about wound care program finances.
1. Understand wound care revenue sources
Outpatient wound care revenue is realized from two primary sources: wound net revenue per visit and hyperbaric net revenue per visit. Your wound care revenue should largely be driven by procedures generated from a provider-based clinic with a low percentage of E&M level charges. Your HBO net revenue comes from the facility fee charged for each hyperbaric visit. The program should be sustainable based on these two numbers alone and not dependent on inconsistent revenue from other sources like cellular tissue products.
If you’re not sure if your per visit revenue is in line with national standards, we can provide a financial proforma for your facility. Knowing where your program should be is a helpful first step in diagnosing the disconnect.
2. Control your supply expenses
Supplies for the wound care service line come from advanced wound care dressings, total contact casts, and cellular tissue products, to name the most common. For outpatient wound care, most dressings are bundled into the cost and not independently reimbursable. The biggest exceptions to this rule are cellular tissue products and it’s here where costs can quickly skyrocket.
An effective evaluation of cost vs. efficacy for all products is essential. This is where an outside perspective can be helpful which is why our CNO reviews all new products for our partners and passes along helpful guidelines and considerations to make supply decisions easier to navigate.
3. Review documentation regularly
Wound care documentation is heavily regulated by both Medicare and private payers. In recent years, documentation guidelines have become noticeably more rigorous as payers are scrutinizing utilization of hyperbaric oxygen therapy and cellular tissue products. We recommend conducting regular documentation reviews of the service line, ideally occurring before the superbill is dropped and the charge ever begins the revenue cycle process. However, for this to work, the documentation of your providers and nursing staff must tell the same consistent story for each wound.
We provide regular documentation reviews for our hospital partners across the country across multiple EHRs and work tirelessly with Medicare and private payers to understand documentation requirements. If you’re struggling with documentation, our expert revenue cycle team can provide guidance and support.
There is no reason for a hospital to diagnose revenue concerns without expert guidance. Wound Care Advantage can provide the strategic consulting your hospital needs to bring financial strength to your program. If you would like to discuss the challenges facing your wound program, please call 888-484-3922 or email a member of our Business Development team, at firstname.lastname@example.org.