Wound care could be just the niche market you need
Kentucky facility launches program successfully
Rehab facilities can add to their bottom line and fill some empty beds or beef up their outpatient population by starting a wound care program that uses new technology and therapies.
Once physicians and hospitals see the outcomes, including faster wound healing times, the referrals will roll in. Also, outpatient rehab wound care provides patients and physicians with an alternative to home health wound care, which is limited by Medicare and other payers.
For example, HealthSouth of Central Kentucky in Elizabethtown now receives referrals strictly for wound care. When the program began two years ago, patients needed rehab first and wound care second, says Angela Jarboe, PTA, wound care coordinator of HealthSouth, a 40-bed facility. While rehab patients needing wound care still make up the largest part of the program, outside referrals have accounted for about 20%, she says.
The program was inexpensive to start, costing under $5,000, and has been profitable, she says. It has no reimbursement problems, and it provides an important community service. "Before the program started, some patients would have to drive an hour into Louisville for wound care. Others were treated unsuccessfully through home health care or their doctor’s office, and some had nonhealing wounds for three or four years."
HealthSouth patients who have a wound severe enough to require hospital admission typically stay about 10 days, but a few have needed additional outpatient treatment lasting up to 10 months, she says. One patient, whose wound was so severe she would have benefited from surgery, was in the wound care program for nearly a year. Physicians had ruled out surgery because her condition was so frail they thought she might die on the operating table. Still, the program succeeded in healing her wound. "We were able to heal her with really great help from her family, but it took a long, long time," Jarboe says.
Rehabs are natural providers of wound care services because physical therapists have always been involved in wound care, says Linda Ovington, PhD, CWS, president of Ovington and Associates Inc., a wound care consulting company in Dania Beach, FL. "Some of the higher-tech modalities, only a physical therapist can provide. Like electrical stimulation: A nurse may learn how to do that, but it’s reimbursable only for a physical therapist."
While a wound care program appears to a be an easy fit with a rehab provider, there are steps that need to be taken to ensure success. Jarboe describes how HealthSouth started its wound care program with these guidelines:
1. Form a team of interested staff. HealthSouth’s marketing department first suggested the idea of a wound care program, but before committing to it, managers met with rehab staff. "I put out a memo asking if anyone was interested in being on a wound team," Jarboe recalls.
A variety of staff, including therapists, nursing aides, and even a rehab technician, expressed interest. The rehab tech wanted to be involved at the start because wound care would require special equipment. "Our medical director also was very interested for the reason that she felt that she had an average level of education about wound care, and she was depending on the team to be abreast of all the latest and newest treatments," Jarboe says.
2. Have the team decide on wound care products. Initially, the team met weekly. Sales representatives from wound care supply and equipment companies attended the meetings, providing samples and information about their products. The sales reps and other wound care specialists recruited as educators for the team taught interested staff to perform wound care procedures.
Team members used some of the samples in providing wound care to rehab patients, and through that process, they learned which products worked best. The team also held a wound care product fair, inviting local physicians and home health professionals to attend. The fair included the products the team had decided worked best and gave the rehab staff, referring physicians, and other health care professionals an opportunity to learn more about those products.
"We were all there so people could ask us questions," Jarboe says. "We received a lot of referrals out of the fair, and we had a greater understanding of what we were trying to accomplish."
3. Write protocols, policies, and procedures. The team contacted the corporate offices of HealthSouth, which is a large health care provider based in Birmingham, AL, to review the company’s wound care manual. "It had a lot of different ideas for paperwork, a charting system, measurement guides, and protocols for policies and procedures," Jarboe says. She reviewed wound care policies from other HealthSouth hospitals, and the team combined them in writing policies and procedures for the Elizabethtown facility. "We also developed policy and procedure for the wound care team and how we would function, and that became the road map for our success. Our policy was that first off we’d obtain physician orders before we saw patients and made recommendations."
The team becomes involved only if the wound is a stage 2 or above. In a stage 2 wound, the skin is open and broken; a stage 3 is more serious, and a stage 4 wound reaches to the bone. Also, there always are two team members, a nurse and physical therapist, who first meet with a patient for wound care. The guidelines also say physical therapists should assess patients to see whether they would benefit from electrical stimulation.
4. Provide specific wound services by therapists. The Elizabethtown facility typically uses electrical stimulation on stage 3 wound patients. "We use negative polarity on infected wounds and a positive polarity to increase granulation," Jarboe says. "We also use, and I think this sets our program apart, electrical stimulation in the surrounding area of the wound."
For example, with one patient, therapists used electrical stimulation on her gluteal muscles, the site of the wound. The stimulation caused the muscles to pump the fresh oxygenated blood into the wound to help heal it, Jarboe explains.
Another service that can be provided during and after wound care is gait training. "One week, we had 11 wound patients who were not only receiving wound treatment, but we were doing gait training to prevent them from putting too much pressure on those wound areas," Jarboe says. "These types of referrals came in after the program began, and without it we would never have seen any of those patients."
Now, physicians increasingly are referring former wound patients to the facility for gait and general conditioning training that serves as preventive wound care, she adds. Therapists can provide other types of new wound care treatment as well, including a therapy involving radiant heat, Ovington says.
Augustine Medical Co. of Eden Prairie, MN, makes a dressing cover, called Warm Up, that serves as a foam hat around the wound. A warming card is set on top of the foam cover, and air is heated to 38 degrees C, which indirectly heats the tissue, she explains. "Uncovered wounds are cooler than the rest of the body, and it makes people more prone to infection."
5. Educate all staff on wound care. The team’s goal from the start was to raise the rehab staff’s education on wound care and to reach the point where all therapists would provide wound care, Jarboe says. "We wanted wound care in our facility to be everyone’s job, everyone’s responsibility, and not just the team’s. So now we are where we wanted to be in the beginning, and that is the team members consult on wound care cases but are not the only ones doing wound care."
Need More Information?
Angela Jarboe, PTA, Wound Care Coordinator, HealthSouth of Central Kentucky, 134 Heartland Blvd., Elizabethtown, KY 42701. Telephone: (502) 921-2454.
Linda Ovington, PhD, CWS, President, Ovington and Associates Inc., 429 S.E. Third Terrace, Dania Beach, FL 33004. Telephone: (954) 929-1902. Fax: (954) 929-2308.
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