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GPT 2016 Presentation
- 1. Telewound Management: AModel for Value-Based Care 7th Annual GPTTeleHealth Summit March 3rd, 2016
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- 3. The Problem |Overall wound cost & prevalence Wound Type Cost ($BN) Patients (000’s) Pressure Ulcer 11.6 2,500 Diabetic Ulcer 13.0 4,000 Venous Ulcer 3.5 600 Increasing prevalence: • Aging population (10K baby boomers turn 65 each day) • Increase in prevalence of diabetes and cardiovascular diseases • 8% annual growth Multiple providers impacted: • Skilled Nursing Homes • Home Health Agencies • Prisons • Hospices • Small, Rural Hospitals • LTACs • Capitated or Risk Based Delivery Models
- 4. Pressure Ulcers: • Prevalenceby setting: • 15% hospital patients • 29% LTC patients • 2.5M pressure ulcers treated annually at cost of $11B (US) • Facility acquired pressure ulcers: • CMS “never event” • Hospitals – currently not reimbursed by CMS • LTC Facilities – not reimbursed beginning 2017 by CMS • 60,000 US patients die every year from pressure ulcers • Cost of care ranges from $20K to $150K The Problem | By wound type
- 5. Diabetic Ulcers: • 25%of diabetics develop foot ulcers • 23M diabetic (5% of population) • Each year 5% of diabetics develop foot ulcers with 1% (>86K ) requiring amputation at cost of $38K/amputation Venous Ulcers: • Affects 600K annually • $9,600/ulcer to treat • Equates to $2.5-3.5B annual problem Surgical Wounds: • 71.5M surgeries per year The Problem | By wound type
- 6. Home Health • 33% home health patients have wounds • 42% multiple wounds • 40% surgical wounds • 25% vascular leg ulcers • 25% pressure ulcers Hospice • 35% hospice patients have wounds • 50% pressure ulcers • 20% arterial ulcers • 30% mixed (surgical, stasis, skin tears, & tumors) SNF • ≈ 20% SNF patients have wounds The Problem | By provider
- 7. Wound Care isnot a discrete medical specialty • Lack of formal wound management & training • Decreases access to evidence-based wound care • Decreases adoption of evidence-based wound care • Produces large variability in wound care practices Wound Care practice often relies on: • Personal experience with wound treatment • Opinion of colleague(s) The Problem | No designated specialty
- 8. Certified wound carenurses • <0.2% of all registered nurses • Nurse treatment time limits effectiveness: • On site can treat 5-6 patients/day • Remotely can treat 15-20 patients/day • Annual salary & benefits: $90K Certified wound care physicians (MD, DO, DPM) • 368 physicians in the U.S. • Wound education: American medical students are inadequately trained in wound care. * *Annals of Plastic Surgery. 2007 Jul;59(1):53-5. The Problem | Scarcity of wound specialists
- 9. Risk Exposure • 17Kpressure ulcer related lawsuits filed annually • 87% of settlements/verdicts reached in favor of the patient • Pressure ulcer lawsuits in acute & long-term care are increasing • Judgments as high as $312M The Problem | Risk exposure
- 10. • Time: • Dressingchanges are time consuming • Lack of knowledge & education about: • Basic wound evaluation/assessment • Wound treatments & management practices • Wound prevention protocols • Use of advanced supplies and treatment modalities • Lack of standardization of: • Wound measurements • Wound outcomes/metrics • Wound quality reporting The Problem | Barriers to wound care
- 11. The Problem |High cost of wound care • Materials (dressings & therapies): • Can reduce material costs by: • Improving healing times • Prevention of acquired pressure ulcers • Nursing time: • Dependent on: • Dressing change frequency • Number of wounds • Associated wound documentation time • Can reduce nursing time by: • Improving healing time • Use of advanced dressings • Use of advanced therapies • Preventing acquired pressure ulcers • Providing streamlined wound software • Wound related hospitalizations: • Can reduce hospitalizations: • Using evidence-based best practice guidelines • Using wound certified clinical experts • Using advanced wound treatments Wounds represent 4% of total healthcare costs
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- 13. Telewound Model Increasing accessto higher level of wound care Our goal is to HEAL Not just treat
- 14. Telewound Model |Pairing technology with wound expertise TECHNOLOGY Wound Imaging Video Conferencing Wound Software WOUND CARE SPECIALISTS Lower Costs Improved Outcomes Reduced Liability • Proprietary Evidence-Based Best Practice Algorithms • HIPAA Compliant • Color-Corrected Wound Images • Standardized Clinical & Financial Reporting • Interdisciplinary Wound Care Team • Certified Wound Care Clinicians • Data Warehouse • Predictive Analytics • Costs & Outcomes Modeling
- 15. Telewound Model |Hub for wound care coordination Hospice Wound Care CoordinationHome Health Hospital LTAC SNF Clinical Quality Outcomes Wound Care Cost Per Patient Predictive Analytics Evidence Based Protocols Comprehensive Data Warehouse to Drive Evidence Based Best Practices through Predictive Analytics Leverage for Value Based Payer Contracts
- 16. Telewound Model Wound ManagementSoftware • Automatic Wound Measurements • Wound Image Correction • Wound Image Magnification • Evidence Based - Best Practice Wound Treatment Algorithms • Wound Reporting • Standardized Wound Metrics Video Conferencing HIPAA Compliant Real Time CORSTRATA Wound Expert Provider’s Nurse at Patient’s Bedside
- 17. Telewound Model |Basics • Identify wound etiology • Etiology drives: • Treatment • Recommend evidence based treatments • Treatment protocol drives: • Dressing type • Frequency of dressing changes • Advanced treatment modalities • Monitor wound progression • Telehealth wound rounds with facility clinician • Recommend treatment changes as indicated
- 18. Telewound Model |Provider models Comprehensive Wound Management • Services: • Formulary Review • Wound Consultations • Pressure Ulcer Prevention Program • Staff Education • Policy & Procedure Review • Pricing Model: • SNF/LTAC = PPD (per patient per day) • Home Health & Hospice = tiers based on ADC (average daily census) Wound Consultations • Services: • Identification of Wound Etiology • Treatment Recommendations • Pricing Model: • Per consult
- 19. Telewound Model |Accuracy & patient satisfaction In-person wound assessment vs. wound image assessment accuracy* • Literature review indicates: • Wound image assessments are accurate for all types of chronic wounds – diabetic foot ulcers, pressure ulcers, vascular ulcers & mixed wounds • Direct and electronic wound assessments were similar for slough, necrosis, & granulation tissue Telewound produces high patient satisfaction* • According to literature review *Moore Z. et al, eHealth in wound care – overview and key issues to consider before implementation, Published Journal of Wound Care, 2015, 24, S S1-S44.
- 20. Telewound Model |Clinical effectiveness & costs analysis Literature review indicates telewound care*: • Improves wound outcomes • Healing time rate • % of wounds healed • Decreased amputations • Reduced number of hospitalizations • Increases effective use of scarce wound experts • Provides patients access to wound experts (especially for underserved & rural patients) Literature review indicates that Telewound care*: • Reduces treatment costs • Reduces transportation costs • Reduces wound consultation costs *Moore Z. et al, eHealth in wound care – overview and key issues to consider before implementation, Published Journal of Wound Care, 2015, 24, S S1-S44.
- 21. Telewound Model |Cost analysis Literature review indicates that Telewound care*: • Reduces treatment costs • Reduces transportation costs • Reduces wound consultation costs Literature review indicates that Telewound care*: • Reduces treatment costs • Reduces transportation costs • Reduces wound consultation costs *Moore Z. et al, eHealth in wound care – overview and key issues to consider before implementation, Published Journal of Wound Care, 2015, 24, S S1-S44.
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- 27. Telewound Model |Results • Reduction in SNF nursing time cost • Reduction in frequency of daily dressing changes • Saved nursing time & dollars on average ~ $400/week for a 100 bed facility • Reduction in Home Health nursing costs • Reduction in number of nursing visits (4-6 visits per episode saving on average ~ $750 per episode) • Increase ability to educate patient/caregiver for dressing changes through Telehealth • Reduction in treatment associated transportation costs • Reduction in cost per treatment transporting patient to wound care center ranges between $500-$700 .
- 28. The Results|Diabetic footulcers Diabetic Foot Ulcer (DFU) Prevention Program • Diabetic patient stratified for risk of DFU & amputation • High risk patients: • Perform daily self foot exams • Forward daily photo of feet soles • Take foot dermal temperatures • Forward dermal temperatures • Daily images & temperatures monitored by wound care expert • Images and/or temperatures trigger early intervention • Off-loading shoe • Accommodative dressing
- 29. The Results|Advanced woundtreatments Advanced Wound Treatments Designed to: • Control wound environment for optimal healing • Maintain proper moisture balance • Fight infection and prevent biofilm formation • Protect skin around wound Specialized treatments: • Stimulate tissue growth and healing • Enzymatically debride • Provide substrate for tissue growth
- 30. The Results|Advanced woundtreatments New Treatment • Revolutionizing debridement of wounds in LTC • Monofilament technology • Allows the bedside nurse to debride • Painless • Used in conjunction with other debridement modatlities Before After
- 31. The Results|Advanced woundmodalities • Ultrasound debridement • Negative pressure wound therapy • Electromagnetic wound stimulation • DNA guided wound therapy
- 32. Biofilm The Results |DNA guided patient specific wound care
- 33. The Results |DNA guided patient specific wound care Large, retrospective study compared healing outcomes in three large cohorts of wound patients • Standard of Care (SOC) Group: • Traditional Culture • Systemic ABX • Group 1: • Molecular Diagnostics Culture • Systemic abx • Group 2: • Molecular Diagostics Culture • DNA Guided Personalized Topical Abx *Dowd S, Wolcott R, Kennedy J, Jones C, Cox S. Molecular diagnostics and personalized medicine in wound care assessment of outcomes. J Wound Care. 2011; 20(5):232-239. DNA Guided Antibiotics Study
- 34. Wound Management |DNA guided therapy Study 1378 patients; 7 month study period • Control (SOC) - (244/503) 48.5% completely closed Group 1- (298/479) 62.4% • Group 2- (358/396) 90.4% Time to complete closure (compared to SOC Group): • ñ26% in Goup1 • ñ45.9% in Group 2 Opportunity to heal: • Patients in Group 2 >200% better opportunity to heal compared to other two cohorts. *Dowd S.Wolcott R. Kennedy J.Jones C. Cox S. Molecular diagnostics and personalized medicine in wound care assessment of outcomes.J Wound Care 2011: 20(5):232-239.
- 35. Virtual Wound Managementfor Value-Based Models
- 36. Value-Based Models |Types New care delivery models: • Accountable care organizations (ACOs) • Medicare/Medicaid dual eligible state demonstration projects • Bundled payments: • Medicare bundled payment care initiatives (BPIC) • Insurer (payer) initiatives • Other models: • Shared risk • Shared savings • Capitated/episodic payment • Readmission reduction programs • Community based care transitions program • Adjunct to chronic care management • State innovation models
- 37. Value-Based Models |Prevalence 50% of Medicare spending will be VALUE BASED by 2018
- 38. Value-Based Models |ROI Hospitals: • Current: Reduction in readmission penalties Reduction in bed days • Future: Bundled reimbursement Home health & hospice agencies: • Current: Increase in staff capacity (caseload) Reduction in SN visits/episode Savings on FT wound care nurse Improvement in wound related quality outcomes • Future: Bundled reimbursement Readmissions penalties Skilled nursing facility: • Current: Reduction in wound formulary costs Savings on FT wound care nurse Improvement in wound related quality outcomes • Future: Bundled reimbursement Readmission penalties
- 39. Value-Based Models |ROI • Hospitals: • Reduce preventable 30 day readmissions for CMS designated diagnoses with associated penalties (all cause) • Physicians: • Reimbursement for Medicare care management fees § Chronic care management fee (2015) § Medicare transitional care management fee • Managed care contracts (Medicare advantage, Medicaid, commercial payers) § Chronic care management fees § Incentive based contracts • Post Acute: • Increases staff capacity, lowers cost of care • Increases quality outcomes • Reduces 30 day hospital readmissions & ER visits • Care transitions to home • Bundled payment initiatives
- 40. Ancillary Benefits of VirtualWound Management
- 41. Ancillary Benefits |Improved Quality of Life Chronic Leg Ulcers: • Improvement in: • Pain • Odor • Infection control • Depression • Pressure Ulcers: • Improvement in: • Severe pain • Odor • Mobility • Diabetic Foot Ulcers: • Reduced fear of amputation • Improved range of activity
- 42. Ancillary Benefits |Workforce *The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 2013 National Workforce Survey of RNs • Avg. RN Age = 50 • % working RNs > age 50 = 53% Older wound care RNs are attracted to virtual model: • Eliminates physicality of nursing • Allows for continued passion to improve care and educate provider staff
- 43. Benefits | Returnon investment Telewound Return On Investment • Decreases overall wound management costs • Improves wound quality outcomes • Improves patient quality of life • Reduces days to healing • Decreases number of facility/provider acquired pressure ulcers • Lowers incidence of wound associated infections • Generates wound formulary savings • Reduces need for transportation of patient out of facility or home for wound care • Increases competency level of provider CNAs and clinicians
- 44. Katherine F. Piette CEO& Founder CORSTRATA Katherine.Piette@CORSTRATA.com (800) 566-1307 www.Corstrata.com