HEALTHCARE AT HOME:
THE  ROWAN TECHNOLOGY REPORT

by Darcey Trescone

With the arrival of PDGM in 2020, agencies gained the ability to receive maximum reimbursement for care they provide to wound care patients. CMS data demonstrates that the wound care clinical grouping is one of the clinical groups with the highest reimbursement potential.

 

Because of this PDGM provision, it has become critical to focus on episode management, especially with wound care patients and their potentially rising acuity levels. Implementing evidenced-based care and developing clinically sound operational processes for care management are keys to remaining profitable when servicing this complex population's needs.

A continually evolving healthcare regulatory environment, coupled with advances in biotechnology, have advanced how chronic, non-healing wounds are treated. One of those advances is virtual wound management. Based in Savannah, Georgia, Corstrata is a specialized telehealth services company that offers wound and ostomy nurses with virtual access to certified specialists.

Corstrata uses virtual wound management to provide both nurse and patient with convenient, improved access to wound experts while reducing the number of required in-home visits, accelerating the time to heal, and improving overall outcomes.

"Our wound and ostomy offering provides the expertise needed in home health and hospice," explained Corstrata CEO and Co-Founder Katherine Piette. "Identifying the correct etiology of the wound, staging it appropriately, and utilizing proper, advanced wound care supplies can decrease supply costs as well as the number of nursing visits required per week." According to Piette, it really is a simple process:

1. The home health or hospice nurse uses the Corstrata application to photograph the wound. The application auto-measures the wound's length and width and has an overlay feature that ensures every subsequent wound picture is taken from the same distance and angle. The nurse at the bedside then documents a thorough, guided wound assessment.


2. Corstrata provides a certified wound or ostomy clinician within the state where the patient resides to evaluate the wound pictures and relevant patient documentation. The wound nurse ensures the correct etiology is identified, the staging of the wound is accurate, and affirms or recommends an evidenced-based treatment plan is in place (including what dressings should be used and the frequency of dressing changes). Additional recommendations to minimize further insults to the wound or interventions needed are provided as well.
   

If Corstrata's recommendation decreases nursing visits by 1-2 per week, that improves an agency's profitability for that episode. We have customers that are experiencing this, and we are seeing the demand for these services increase.

In a study published in 2018, researchers determined the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by setting. Using 2014 Medicare data, they demonstrated that Medicare expenditures related to wound care were far more significant than previously recognized, with care occurring predominantly in outpatient settings. Wound care data in this study included all types of surgical and non-surgical wounds.^1. Medicare expenditures have only increased since this data analysis was done.

In summary, the study found Medicare spending for wound care by type of service in 2014 was as follows:

• Hospital outpatient estimates were $9.9 billion if the principal diagnosis was wound and $24.3 billion if the principal or secondary diagnosis was wound.¹

• Home Health estimates were more than twice as high ($1.5 billion) as that of a SNF ($700 million) if the patient’s principal diagnosis was wound.¹

• Home Health and SNF estimates were equal ($3.3 billion) if the principal diagnosis or any secondary diagnosis was wound.¹

• Hospice estimates were $4.3 million if the principal diagnosis involved a wound and $207 million if the principal or secondary diagnosis involved a wound.¹

"There is an existing market share in home health and hospice and a significant hospital outpatient market share to consider when providing wound care in a home-based setting," explained Kathy Pruitt, Corstrata VP of Sales for Post-Acute Providers and Virtual Health Partners. "Newer models of care are emerging, such as SNF at Home and Hospital at Home, that will require home health and hospice agencies to care for higher acuity wound patients. These are important factors when considering the spend required to manage a wound within an episode. Our virtual wound management solution has helped some Corstrata clients to decrease wound supply costs by 30%, decrease the number of home visits by 50%, and decrease wound healing time by 30%."

Pruitt added, "Most technology offerings in our industry lack the ability to provide direct access to a wound and ostomy certified nurse (WOCN). They offer great technology but not the consultation that home health and hospice nurses need to make good decisions around the care required to treat the wound effectively and efficiently."

 

Intrepid's Experience

Julie R. Erickson, MHSA, BSN, R.N., COS-C, BCHH-C, is the Director of Professional Development & Clinical Excellence for Intrepid USA. She told us, "We have been partnering with Corstrata to provide evidence-based wound treatment recommendations for our home health and hospice patients for over a year. We can photograph wounds directly into the app, which avoids HIPAA concerns, and we receive thorough, easy-to-follow recommendations from their board-certified wound and ostomy nurses. The report produced from each weekly assessment/consultation is easy to upload into our EMR and very suitable for sharing with physicians and other primary providers."

CEO Piette confirmed Intrepid's experience. "Statistics show that pressure ulcer treatment costs could be as high as $11 billion annually across all settings. One million people in the United States have an ostomy, and there are 130,000 ostomy surgeries performed in the U.S. each year. 1 in 4 diabetics will develop a foot ulcer, while 1 in 4 diabetic foot ulcers results in an amputation."

She continued, "Additionally, the industry regularly sees high rehospitalization rates for ostomy patients - the 30-day readmission rate of colostomy patients is at 19%, while that same rate for ileostomy & enterostomy patients is 29%. Since ostomy nurses are very scarce, this is a pain point for many home health and hospice providers that is tough to overcome."

Some critical indications of ineffectiveness related to wound care include higher-than-average rehospitalization rates for surgical infections, issues with negative pressure wound therapy, and continued worsening of a chronic wound like a diabetic or venous ulcer. The CEO continued:

"The challenge is less than 0.2% of all nurses are wound care certified. Depending on the geographic region, a qualified wound-care nurse may cost more than $100,000 to employ after benefits and taxes. Even if an agency's census supports having a wound care nurse on staff, productivity can be impacted as census fluctuates. The chances are good that wound nurses may not feel fulfilled when there are not enough wound care patients to allow them to utilize their expertise, and they are instead assigned to other nursing functions. Our offering provides agencies just the right amount of wound care nursing expertise based on their patient needs within their census, without the cost of recruitment and retention of an already scarce resource."

"There are 15,000 certified wound care nurses, and 90% of those nurses work in an acute care setting. There are simply not enough certified wound care nurses to meet the demand, which is why we have developed our technology-enabled service offerings. Corstrata provides the solution for wound image capture, and the expertise of certified wound and ostomy nurse consults as needed, allowing an agency's nurses to deliver the most up to date, evidence-based care to its wound patients."

Corstrata told us that its virtual wound management consults create efficiencies for an agency's nurses and improve wound healing for this complex patient population.

• Corstrata's board-certified wound & ostomy clinicians use both live video and wound images to evaluate a patient's wound and recommend the most effective treatment for better outcomes, improved patient quality of life, and lower overall cost.

• Corstrata's mobile app allows a patient, a caregiver, or an onsite nurse to easily take wound photos, document the wound's status, and initiate a live video call with wound experts.

• Through the cloud-based telehealth platform, Corstrata's experts can monitor the wound's progress and recommend treatments that promote healing. Corstrata's HIPAA compliant technologies facilitate documentation, which reduces provider legal liability.

• Corstrata also works in a direct-to-consumer model with Ostomy patients to troubleshoot ostomy issues and provide education regarding the patient's ostomy appliance.

 

Manage Legal Liability

According to the Agency for Healthcare Research and Quality, pressure ulcers are the second most common claim after a wrongful death. Between 2009-2012, the highest award from wound care litigation was $178 million. Evidence-based treatment is what defense attorneys research and look for in these cases, and our existing software systems do not address this specifically.

"The Corstrata clinical management team have all served as wound care legal experts," Piette elaborated. "We know and understand how to minimize wound-related liability risks for providers. Our best practices include consistent and standardized documentation, as well as recommendations for the latest best-practice treatments and supplies."

Intrepid's Erickson concurred: "The Corstrata staff are quite accommodating to our clinician and care center needs, providing urgent consultations while the nurse is in the home when needed for highly complex wound patients. They have worked with us to develop the least disruptive processes to our busy nurses' daily workload. Working with Corstrata increases our ability to competently manage complex wound patients safely and effectively, allowing the patients to stay at home, where they want to be."

Piette summed up with a hint of justifiable pride. "From hospital-to-home to medical home and other care settings, Corstrata's experienced, board-certified wound and ostomy care clinicians work with an agency's nurses to provide the best in class wound care at a lower cost. Corstrata also works with payers to create wound and ostomy care management programs, manufacturers to support education and use of wound and ostomy products, and patients to educate and prevent recurring issues."

 

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¹ Nussbaum S, Carter M, Fife C et al. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value in Health. 2018;21(1):27-32. doi:10.1016/j.jval.2017.07.007

 

About Corstrata
Corstrata is a specialized, telehealth services company targeting the wound and ostomy marketplace by offering virtual access to certified specialists. Corstrata serves the care provider through best practice consultation, care plan development, and formulary knowledge to lower costs, improve patient satisfaction, and improve outcomes. Corstrata partners with providers to assist in new care delivery models - hospital-to-home, SNF-at-home, and more. Alternatively, Corstrata offers direct to patient/family education consults for greater adherence in the home, supporting the interests of the provider and payer (available in limited markets).
corstrata.comcorstrata.com

 

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at darcey@tresconeconsulting.com.

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com