Week #1 Introduction

The history of wound care can be traced back to as early as 1550 when the Egyptians documented the use of natural remedies to expedite the healing process (Brown and Gibran, 2012). However, it wasn’t until 1871 that a Swiss surgeon named Jacques-Louis Reverdin developed and used the first skin graft on a human patient (Alrubaiy and Al-Rubaiy, 2009). Since than there have been substantial advancements made to the skin grafting technique, creating what is now considered to be a routine and crucial treatment option for enhancing the healing process of chronic non-healing wounds. Although this therapy is very effective it comes at a very high financial price. As of January 1^st 2014 the Center of Medicare and Medicaid Services (CMS) issued an update for the reimbursement of “biologicals” (also known as skin grafting) changing it from a fee-for-service model to a bundled payment plan (McCurdy, 2013).

Reimbursement for the use of biologicals is an extremely relevant topic to my current clinical site, a wound care clinic, as we routinely treat patients with chronic non-healing wounds. These wounds can occur despite proper treatment by the clinician due to a number of reasons such as ischemia, infection, neuropathies, pressure, circulation deficiencies, and radiation toxicity (Canonico, Campitiello, Della Corte and Fattopace, 2009). These chronic wounds can cause the patients to experience a decreased quality of life related to a number of side effects including but not limited to: excessive pain, increased drainage and odor, as well as psychological distress from a decreased body image (Hopman, Buchanan, Van Den Kerkhof, and Harrison, 2013). In a small prospective study evaluating the impact of skin grafting of chronic wounds, it was identified that all participants had a significant reduction in pain and drainage within fifteen days of the procedure and 88.5% had complete closure of the wound within twenty-one days (Canonico, Campitiello, Della Corte and Fattopace, 2009).

The fee-for-service model allows a healthcare provider to charge services that are provided to a patient separately thus increasing the amount of reimbursement that provider may potentially receive. Schroeder and Frist (2013) identified the fee-for-service method as being inefficient for delivering effective care to patients and may promote a problematic financial incentive for the provider, which are directly linked to the increased cost of healthcare in the United States and is ultimately non-sustainable method.

In an effort to reduce the cost of healthcare, CMS has converted many reimbursement plans to a “bundled payment plan”(McCurdy, 2013).  The bundled plan is based on calculations of the cost for the course of treatment for a particular ailment; the average of which becomes the amount a provider will be reimbursed for treating that same ailment (Weeks, Rauch, Wadsworth, and Weinstein, 2013). However, the challenge with this payment plan for wound care will be to ensure that the bundled reimbursement allotted for the various ailments will allow the provider to at least recuperate the cost of the supplies utilized, otherwise providers may opt not to use these effective (and expensive) therapies.

Reference

Alrubaiy, L., & Al-Rubaiy, K. K. (2009). Skin Substitutes: A Brief Review of Types and Clinical Applications. Oman medical journal, 24(1), 4.

Brown, D. A., & Gibran, N. S. (2012). History of wound care. Handbook of Burns Volume 1: Acute Burn Care, 1, 325.

Canonico, S., Campitiello, F., Della Corte, A., & Fattopace, A. (2009). The use of a dermal substitute and thin skin grafts in the cure of “complex” leg ulcers. Dermatologic Surgery, 35(2), 195-200.

Hopman, W. M., Buchanan, M., Van Den Kerkhof, E. G., & Harrison, M. B. (2013). Pain and health-related quality of life in people with chronic leg ulcers. Chronic diseases and injuries in Canada, 33(3), 167-174.

McCurdy, D. (2013). CMS issues final medicare OPPS, ASC policies for 2014. Mondaq Business Briefing. Retrieved from: http://www.highbeam.com/doc/1G1-352498673.html

Schroeder, S. & Frist, W. (2013). Phasing out fee-for-service payment. The New England Journal of Medicine, 368(21), 2029.

Weeks, W. B., Rauh, S. S., Wadsworth, E. B., & Weinstein, J. N. (2013). The unintended consequences of bundled payments. Annals of Internal Medicine, 158(1), 62-64.