November 1: Five New Regulations to Watch for in 2018: CMS Reimbursement
November 8: The March Continues: Five Things I’m thinking about for 2018
November 16: Five Ways to Sink a Sub: What Wound Care Nurses Need to Know about Skin Substitutes in 2018
November 30: Despite The Controversy, HBOT Remains a Viable Treatment Modality: Five initiatives to watch for in 2018
December 13: Losing REMs over RCM? Here are Five Tips for Smoother Revenue Cycle Management in 2018
As the end-of-year countdown begins, we’re looking at changes that will impact the wound care industry in 2018. For the next several weeks, we’ll be running a series of insightful blog posts from our team of experts. This entry is from Nick Keezer, CTO.
There’s probably no need to spill more digital ink on the tug of war between healthcare and technology. Suffice it to say that while I’m not predicting we’ll look back to 2018 as a watershed year, the slow march of progress will continue. Here are five things I’m thinking about:
Telemedicine comes to wound care. Kind of.
The dream of telemedicine -- “Meet with your doctor! On demand! From home!” -- remains elusive, though it’s not for a lack of trying. The hardware and platforms are there, the tech is there, but the “last mile” is a real challenge, and regulatory and reimbursement questions are slowly clearing up but remain cloudy. These issues alone are enough to keep telemedicine -- in the context of replacing the in-person visit -- a niche service in the immediate future.
But the possibilities that telemedicine opens are much broader. We are pursuing other models and use cases that are achievable today, and we expect others to do so as well. One example: WCA is working on a pilot program to use telemedicine for diabetic patients to consult with registered dieticians during their visit. We know nutrition is critical for healing and we have RD capacity in the network, but an in-person visit isn’t always a practical option. Telemedicine provides a way to effectively allocate those resources and could be a model for bringing other specialities into the wound clinic as well.
Digital imaging technology will be everywhere.
Anyone looking for advanced image analysis in wound care has no shortage of options to choose from. Not surprising, when you consider that image recognition and analysis has been a major focal point for the broader technology industry over the last several years. It makes sense for healthcare tech companies to repurpose those efforts, and perhaps no other specialty has wound care’s unique combination of need (we have a very visual specialty) and benefit (accurate measurements, consistency of measurement, etc.) that this technology can provide. Adoption has been slow, but expect the pace to pick up as these startups figure out how to work in healthcare, where the challenges are much different than in technology.
Workflow first, then technology.
The first two items touch on this indirectly, but it's a recurring theme I've seen from many companies bringing something new to wound care: the technology comes before the workflow. As a developer myself, I get it. It’s easy to look at a problem, develop a solution, and assume the market will be there if the solution is good enough. There are startups out there doing super cool things, but “super cool” isn’t enough on its own.
If there’s one thing I’d like to see happen in 2018 (consider this more request than prediction), it would be for developers to think about workflows earlier in their lifecycles. When we evaluate anything, we start with clinic workflow. The margins in wound care are small, and the money is in volume, so anything new we look to introduce has to 1) not interrupt flow, 2) work with what we already have (the healthcare industry, by and large, does not value “disruption”), and 3) be cost-neutral at worst. Any offering that meets those requirements has a chance; otherwise they’re behind the count before even getting to the plate.
One size still doesn’t fit all.
One EHR to rule them all? It’s a proposition that the Big Time EHR players are happy to sell, but who wants to let facts get in the way of a good pitch? Outpatient wound care is still a specialty that benefits from a speciality documentation system. The compromises that have to be made to workflows and the loss of (really important!) functionality like clinical benchmarking and outcome tracking aren’t -- in my eyes -- worth giving up for the sake of homogeneity or relatively minor cost savings.
Next-generation interoperability standards hold a lot of promise. I like where enterprise EHRs like Cerner and Athena that have embraced a role as a platform provider are going: the vision of extending a system’s capabilities simply by installing an app from a marketplace is undeniably appealing. 2018 won’t be the year of the future: even on relatively open EHRs, third-party applications are far from plug and play and there’s no reason to think the current sparks of FHIR adoption will expand to a conflagration this year. Specialty still has a place.
Find smart ways to capture the value in the margins.
It’s easy (and fun!) to search for and be seduced by that “next big thing” that will change wound care, health care, the world, for the better. But at least in wound care, there’s still plenty of value to be captured in the margins in more mundane ways.
Consider missed visits. Our benchmark made-visit rate at a well-performing program is 90%. Increasing that by just 1% at a center with average volume can account for upwards of $20,000 in additional revenue over the year. It’s worth making the investment to track cancellations and no shows and to send appointment reminders and reschedule missed visits. We use our business intelligence tools to do this automatically, but programs with some excess employee capacity could do it manually and still see a healthy return.
Referral management is another opportunity. By tracking and analyzing referral activity and focusing on “high quality” referring partners (this, basically, is what our FlightPlan system does), directors and liaisons increase the effectiveness of their community education efforts. Worth doing, when adding just one new patient per month can generate on the order of an additional $50,000 per year.
Final Thoughts
Technology doesn’t have to be the proverbial square peg in the round hole of the wound clinic or the hospital in general. If you can, as Bruce Lee suggested, “be like water,” there are opportunities for improvements and advances by working with the system instead of fighting against it.
