Therapies use light, suction to speed wound healing
Improve outcomes with cost-effective techniques
New technologies for wound care in the home decrease the amount of time needed for treatment and improve patient outcomes, while helping home health agencies manage costs more effectively.
The Centers for Medicare & Medicaid Services has approved two negative pressure wound therapy systems for reimbursement in home health settings. Both treatments rely on suction applied to wounds to reduce excess fluid in the wound, improve blood flow to the wound to improve healing, and to pull wound edges together.
"Suction is suction," says Randy MacDonald, RN, CWN, a wound care specialist with Arkansas Home Medical in Hot Springs. "The major difference between the two systems is the type of dressing used," he says. The V.A.C. System, manufactured by Kinetic Concepts in San Antonio, uses a foam dressing that must be applied three times a week, he says. The Versatile 1 Wound Vacuum System manufactured by BlueSky Medical in La Costa, CA, uses an antimicrobial gauze dressing that is changed two times a week, he explains.
"My experience is that home health nurses are accustomed to using wet to dry gauze dressings and find the BlueSky system easier to use," says MacDonald. "I also like the fact that a dressing change only requires two visits per week.
"A typical wound care patient reimbursement is $1,444 per episode," he continues. "For a home health agency to make money, nurses cannot visit patients every day to change dressings, so it is important for negative pressure wound therapy to be considered," he points out. His agency has chosen to use the BlueSky system but he says many agencies have used the Kinetic Concepts product successfully.
"Education is simple and nurses or family caregivers can easily learn how to use the system," says MacDonald. "There is minimal drainage with this treatment and the gauze bandage doesn't stick to the wound."
There are a few things to keep in mind when considering a negative pressure wound therapy system, he cautions. "If the dressing is disrupted, a nurse needs to come to the home to reapply because to be effective and to reduce the risk of infection, the product should not be off the wound more than two hours during treatment," he says.
Also, MacDonald points out that there are some situations in which negative pressure wound therapy should not be used:
- tumors or active cancer in the wound;
- gross infection;
- 30% of wound tissue is necrotic.
The treatment is very effective for pressure ulcers, trauma wounds, and surgical wounds, says MacDonald. "Negative pressure wound therapy is really a home run for home health agencies," he says. "Not only does Medicare reimburse for the treatment, but the agency is able to reduce visits and improve outcomes."
Another form of treatment for wounds is looked at as some sort of voodoo by physicians and nurses initially, admits Sharon Burt, RN, CWOCN, coordinator for wound, ostomy, and Anodyne treatments at Physician's Home Health Care in Colorado Springs, CO. Monochromatic infrared photo energy (MIRE) can be used to cause red blood cells within the wound to release nitrous oxide, which acts as a vasodilator, she explains. "This increases blood flow, which speeds healing."
The light treatment also encourages the growth of collagen so that scarring is minimized, Burt says. "An added benefit is the reduction of pain," she adds.
Burt uses the therapy system manufactured by Anodyne Therapy in Tampa, FL. "There are four pads with 60 diodes to each pad, and they are sized so that you can place them easily anywhere on the body," she explains. Light from the pads penetrates about 5 cm and begins to affect the wound in just a few treatments, Burt adds.
"For most wounds, you begin treating the tunnel first. Then as the tunnel heals, you move the pads to heal the rest of the wound," she says. The effect can be dramatic, especially with diabetic patients with poor circulation that makes wound care difficult, Burt says. "One of my patients with peripheral neuropathy as a result of diabetes had a wound that would not heal after 16 months of treatment with a variety of treatments," she says. "After six weeks of MIRE, the wound had healed completely."
Because there is no electrical current or deep heat associated with MIRE treatment, it is safe to use on patients with pacemakers, metal pins or screws and defribillators, says Burt.
Even with the high degree of patient safety, there are precautions, she warns. Superficial burns can occur if you don't carefully assess the area to be treated and set the energy settings appropriately. The other potential complication is hypoglycemia, she says. "Patients with diabetes should eat before their treatments and monitor blood sugar levels following treatments to adjust their insulin," she adds. Anodyne pads should not be placed over or near the womb of a pregnant woman and should not be used over an active malignancy, Burt explains.
While Medicare does not reimburse for Anodyne treatments for wound care not associated with peripheral neuropathy, Burt's agency chose to purchase units for wound care patients. "We do not charge the patient for our use of this therapy while they are our wound care patient," she says. "We absorb the cost because it helps us control our costs in terms of fewer visits, less complications, and better outcomes for our patients."
The treatments can be administered by nurses or therapists with minimal training, so there is no need to add staff, says Burt. The machine is so easy to use that some patients who have peripheral neuropathy have purchased their own machines to treat their condition after their discharge from home care.
"While peripheral neuropathy cannot be cured, MIRE does restore sensation with regular treatments," she explains. The cost of a four-pad machine designed for frequent, clinical use is about $3,000, and the cost of an eight-pad machine designed for health care providers is $6,300, says Burt. Because Medicare will pay for some of the cost of a machine designed for patients' private use, a patient might pay about $500 for a four-pad machine intended for home use, she adds.
Although physicians are skeptical when the treatment is first suggested, Burt says they are pleased with the results. "The outcomes are dramatic, the patient is happy, and 80% of our physicians now readily accept our recommendation for this treatment," she says.
Sources and Resources
For more information about wound care treatments, contact:
- Sharon Burt, RN, CWOCN, Coordinator, Wound, Ostomy, and Anodyne Treatments, Physician's Home Health Care, 5085 List Drive, Suite 200, Colorado Springs, CO 80919. Phone: (719) 531-9585. E-mail: [email protected].
- Randy MacDonald RN, CWN, Wound Care Specialist, Arkansas Home Medical, 104 Hillcrest Street, Hot Springs, AK 71901. Phone: (501) 993-5380. E-mail: [email protected].
For product information, contact:
- Anodyne Therapy System, 13570 Wright Circle, Tampa, FL 33626. Phone: (800) 521-6664 or (813) 342-4432. Fax: (800) 496-8323 or (813) 342-4417. Web site: www.anodynetherapy.com.
- BlueSky Medical, Versatile 1 Wound Vacuum System, 6965 El Camino Real, Suite 105-602, La Costa, CA 92009. Phone: (760) 727-1477. Fax: (760) 727-0236. Web site: www.blueskymedical.com.
- Kinetic Concepts, V.A.C. System, 8023 Vantage Drive, San Antonio, TX 78230-4726. Phone: (800) 275-4524. Web site: www.kci1.com.
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