The success of an outpatient wound care program is determined by its ability to strategically manage clinical, financial, and operational outcomes. If you feel your program is not meeting its full potential, the vital first step is to identify the symptoms. Only then can you begin treating the underlying disease and ultimately heal your wound and hyperbaric program. Below, we’ve listed a few of the most common issues struggling programs are facing and the initial steps you can take to resolve them.
Increased Payer Denials
Payer rejections are a costly drain on clinic resources. Even if you’ve successfully fought a denial and recouped the reimbursement, you can not recoup the time spent on the phone, completing forms, and reviewing paperwork. To tackle increased payer denials:
- Keep your team updated on LCD/NCD changes that affect your region. Consider assigning someone to check for updates once a week, review the changes, and then communicate significant changes to the entire team.
- If your clinic is experiencing frequent denials, consider training a team member to be the designated CDI (Clinical Documentation Integrity) checker. Giving them the time, tools, and education they need can create an effective last defense for your claims.
- Retrain your team on proper documentation and the myriad of reasons it’s important, including patient safety and clinic sustainability. Documentation needs to be complete, accurate, and consistent across all clinician notes, with only established abbreviations used.
- Make sure denied claims are revisited, investigated and resolved (if possible) as a part of your team’s normal procedure. It takes time, but the investment is worth it if you can get to the bottom of the error and prevent it from occurring again.
- Work with your business office to review your minimum write-off threshold. Many wound care claims might fall underneath this threshold, leaving valuable collections on the table.
Patients that have trouble sticking to the prescribed treatment plan can extend your clinic’s average time-to-heal and cause your clinic to appear less efficient. The reasons as to why patients fall off of their treatment plans are complicated and usually have multiple causes. Every patient is different. Make sure your clinical team is working with them to try to understand what it is about the treatment plan that’s difficult for them to follow.
- Include the patient as much as possible in their treatment plan and ask about adjustments that can be made to make it easier to follow. Involving the patient can go a long way in ensuring adherence.
- Consider the health literacy of your patient. Do they fully understand the treatment and all the ways it benefits them? If not, is there a caregiver involved that can assist?
- Give your patients their treatment plan in writing along with all instructions necessary to follow it. Ask your patients if they prefer instructions in a language other than English and try to accommodate if possible.
- Be honest and upfront about the cost to their health of not sticking to their treatment plan. Layout the consequences.
- Consider having your staff enroll in classes or seminars on understanding and identifying depression or other psychological disorders and advising when it’s best to recommend a psychologist. These disorders often play a role in hindering adherence.
- Ensure the patient has the support they need to fulfill treatment plans. If your patient is missing appointments, ask if finding transportation to and from the clinic has become a challenge.
Falling Referral Rates
Referrals are the financial lifeblood of your clinic. Having a network of physicians and specialists in your area who know and trust your team is vital to keeping patients coming through your doors. Research and reach out to potential referral sources to introduce yourself and your center, educate them on the services you can provide, and gain a better understanding of their needs. Once you have regularly referring physicians, keep the relationship going with frequent and detailed updates on their patient and a seamless return to their care once the wound is healed.
- Aim to spend 15-20% of your time each week communicating with referring providers.
- Don’t let COVID-19 halt your efforts. Phone calls and video conferencing can be effective forms of communication. Develop and print high-quality marketing materials to showcase your center. If you can, mail promotional materials to prospective sources–emails are far too easy to dismiss.
- Review your website quality and digital marketing efforts. Where can you best invest in your digital presence?
- Know and understand the needs of nearby physicians, especially specialists and the ways they relate to your service line.
- Stay in contact with your referring physicians and do everything you can to make their relationship with your clinic a positive experience.
Rising Time-to-Heal Rates
Rising time-to-heal rates impact not only the health of your clinic but that of your patients as well. The risk of infection increases as the wound remains exposed. Delays can also affect your reputation with the referring physician, who may be unwilling to send additional patients if they feel they are not getting the best care. Patients put their trust in us every time they walk through our doors and we owe it to them to do everything we can to heal their wounds as quickly as possible.
- Frequently review patient outliers that fall outside of the 8 week heal-time. Review the timeline and treatments as a clinical team and consider what, if anything, could have been done differently.
- Review patient progress at 4 week, 6 week, and 8 week marks to ensure they are on track and intervene where necessary.
- Reconsider the most common products, modalities, and methods you’re using. Talk to your clinical team about what products they think work best and consider introducing new products to your team’s toolbox.
Missed Income Targets
It doesn’t matter how well trained a staff is or how remarkable the healing rates are, if a center is struggling financially it will always be at risk of closing. When a center is having trouble hitting their profitability targets, there are a few key areas we can first examine to identify the issue. Oftentimes you will find multiple issues contributing to missing income targets, but there are ways to improve the situation.
- Audit your clinic’s process for monitoring supply expenses. Ensure products are being used appropriately.
- Ensure your physician salaries are not exceeding your billable professional fees. Consider revising the position’s pay scale or RVU structure for new hires.
- Review your staffing matrix and workflow to ensure you have the correct amount of employees to match the clinic’s demand/workload.
- Review how much of your budget is going to purchased services and consider whether or not they are providing an appropriate value. Consider renegotiating those contracts or eliminating them all together.
Taking an honest, thorough look at your wound center is the first step to ensuring you’re operating as efficiently and effectively as possible. It is an investment, but one that, if done correctly, will pay you back in both time and financial stability.
Our team has helped hundreds of hospitals provide a financially sustainable program that meets the growing needs of their communities. Email firstname.lastname@example.org to discover how we are transforming how hospitals run profitable wound healing programs.