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Wound care post-PPS: are these vendors showing the way?

Wound care programs are claiming results that seem made to order for PPS (Packets Per Second) The measurement of activity in a local area network (LAN). In LANs such as Ethernet, Token Ring and FDDI, as well as the Internet, data is broken up and transmitted in packets (frames), each with a source and destination address.  

Post-acute care providers have, to some extent, felt under siege since the advent of the Medicare Prospective Payment System (PPS) in their lives. The novelty and complexity of the new reimbursement rules have, by various accounts, flummoxed more than a few (and the rules aren't even finalized yet). A result, for some, has been a pulling back from the delivery of more costly forms of care - less contracting, less purchasing, perhaps even less care - at least until some sense of financial confidence returns. By the accounts of several observers in the field, wound care has been no exception to these trends.

There is no shortage of companies, however, that are still offering this service and are trying to demonstrate that the most cost-intensive way, at least up front, might actually be the best way to survive and prosper under PPS. The companies range from small to large, from itinerant clinical consultants to national firms providing inpatient referral resources.

The 155-bed Whitehall Boca Raton skilled care residence in Boca Raton, Florida Boca Raton ("bōkə rə-tōn") is a city in Palm Beach County, Florida incorporated in May 1925. As of the 2000 census, the city had a total population of 74,764; the 2006 population recorded by the U.S. Census Bureau was 86,396. , has engaged a physician who provides team intervention to manage its wound care.

Heading up its "wound team" is Louis A. Viamontes, MD, president and owner of Wound Clinics of America. based in Stuart, Florida, the independent firm currently maintains wound management contracts at 20 nursing homes throughout Florida, from Jacksonville in the north to South Beach in Miami. He also plans to deploy clinical programs in three New Jersey facilities early this year. A board-certified vascular surgeon with 20 years' experience, Dr. Viamontes makes weekly visits to Whitehall Boca Raton and the other facilities his company serves.

Others on the wound team include Dr. Viamontes' clinical registered nurse/wound care specialist, Suzanne Artz, RN, CWS CWS Chicago White Sox
CWS College World Series
CWS Church World Service
CWS Child Welfare Services
CWS Canadian Wildlife Service
CWS Community Water System (EPA)
CWS Canada-Wide Standard
CWS Compressed Work Schedule
; Whitehall's restorative nurse, Gloria McCann; and registered dietitian registered dietitian,
n See dietitian, registered.
 Lori Bender, RD, CDE (1) (Computer Desktop Encyclopedia) What you are reading at this very moment. See About this product.

(2) (Common Desktop Environment) A user interface for desktop computing from The Open Group.
, LDN LDN London
LDN Loi sur la Défense Nationale
LDN Listed Directory Number
LDN Lynds' Dark Nebula
LDN Low Dose of Naltrexone
LDN Licensed Dietician/Nutritionist
LDN Local Directory Number (Cisco)
LDN Lebanon Daily News

McCann, who has become familiar with Dr. Viamontes' protocols, evaluates and initiates wound treatment for residents who are admitted between Dr. Viamontes' weekly visits. She generates a list of residents who are to be seen during wound rounds, gathers their medical records and is responsible for requesting orders from attending physicians for Dr. Viamontes to evaluate and use in treating the residents' wounds. (Physicians who choose to provide their own wound care are offered suggestions and recommendations by the team.)

Suzanne Artz assists in the physical assessment, while Gloria McCann provides pertinent clinical information and assists in the documentation process and in developing a positioning, pressure reduction and continence continence /con·ti·nence/ (kon´tin-ens) the ability to control natural impulses.con´tinent

1. Self-restraint; moderation.

 management program.

Prior to wound rounds, dietitian dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease.

di·e·ti·tian or di·e·ti·cian
A person specializing in dietetics.
 Lori Bender gathers all of the weights for the residents, pertinent laboratory results such as serum albumin serum albumin
See seralbumin.
 or prealbumin, and recent dietary and fluid intake, and calculates the nutritional requirements nutritional requirements,
n the food and liquids necessary for normal physiologic function.
 for each resident.

A physical therapist provides information related to the residents' physical activity and progress, and any positioning or orthotic orthotic /or·thot·ic/ (or-thot´ik) serving to protect or to restore or improve function; pertaining to the use or application of an orthosis.

Of or relating to orthotics.
 devices that might assist in their care. At Whitehall, the nurse and aide caring for each resident are also encouraged to attend rounds for their patients.

During Dr. Viamontes' rounds with the team, he enters all patient and wound information into a laptop database, enabling him to generate various printed reports and statistical analyses for Whitehall staffers to use on the spot. Wound rounds include a systems review, physical examination, and nutritional and physical therapy assessments, as well as complete assessment and measurement of each wound. Dr. Viamontes addresses the wound etiology, including contributing and exacerbating factors, and then develops a plan of care that might include additional vascular studies, positioning and pressure reduction strategies, nutritional intervention and adjunctive physical therapy treatments.

Dr. Viamontes has developed his wound management protocols over the past 20 years and, based on more than 2,000 wound assessments a month, has access to an extensive wound outcomes database. He has found that the choice of wound care products is more critical for outcome in a stage II pressure ulcer Pressure ulcer
Also known as a decubitus ulcer, pressure ulcers are open wounds that form whenever prolonged pressure is applied to skin covering bony outcrops of the body. Patients who are bedridden are at risk of developing pressure ulcers.
 than in a stage III or IV pressure ulcer. His data show, for example, that more than 98% of the stage II pressure ulcers treated with the Smith + Nephew products he prefers (Skin Prep[TM] and Allevyn Adhesive[TM]) resolve within 8 to 10 days, while 16% of those treated with a hydrocolloid hydrocolloid /hy·dro·col·loid/ (-kol´oid) a colloid system in which water is the dispersion medium.

1. A substance that forms a gel with water.

 progress to a stage III or IV.

With a wound-resolution time averaging 28 days for every wound treated, a decrease in the number of wounds progressing from a stage II to a III or IV, and a decrease in nursing time with the three-times-weekly dressing changes, Dr. Viamontes' program has reported significant overall cost savings. Total cost for treating a stage II pressure ulcer to healing is about $38, he reports, which includes the product used as well as the nursing time devoted to wound care.

Moving up the organizational scale, Derma der·ma
See dermis.


the corium, or true skin.
 Sciences, Inc., a vendor of wound management services based in Princeton, NJ, reported a test several months ago of its Optimum Outcomes Wound Management System applied by the Bayada Nurses Home Health Specialists agency in New Jersey. The system includes Derma Sciences zinc-nutrient-formulated products, combined with staff education, wound-specific care plans, protocols and outcome measurement tools. For the test, physicians and home health nurses used conventional treatments for such wounds as decubiti, stasis stasis /sta·sis/ (sta´sis)
1. a stoppage or diminution of flow, as of blood or other body fluid.

2. a state of equilibrium among opposing forces.
 ulcers, ischemic Ischemic
An inadequate supply of blood to a part of the body, caused by partial or total blockage of an artery.

Mentioned in: Antiangiogenic Therapy, Subarachnoid Hemorrhage, Ventricular Fibrillation

 ulcers and surgical site wounds for 30 days; after this time, if the wound had not healed, they adopted the Optimum Outcomes system. The result, according to the company, was a quadrupling of wounds healed and a decrease in average time for wound closure from 61 to 29 days. Average cost to heal a wound dropped from $5,500 to $1,825, and the number of home health visits required dropped from 68 to 25, according to the Bayada results.

At the opposite end of the continuum-of-care spectrum are the Wound Care Centers operated by Curative Health Services health services Managed care The benefits covered under a health contract , based in Hauppauge, NY. Some 130 such centers are affiliated with acute care hospitals throughout the United States, and the company has been expanding into other care settings. The company features treatment with Procuren, a growth factor solution, but also brings to bear a broad armamentarium ar·ma·men·tar·i·um
n. pl. ar·ma·men·tar·i·ums or ar·ma·men·tar·i·a
The complete equipment of a physician or medical institution, including drugs, books, supplies, and instruments.
, including assessments with laboratory, radiologic, nutritional and vascular studies; surgical treatments; infection control; pressure relief measures; and basic skin care. The company claims an 80% cure rate for wounds that had been otherwise resistant to therapy.

All of these approaches share two things in common: (1) each features a proprietary and/or brand name product, and (2) they apply focused, multidisciplinary techniques for the sole purpose of wound assessment and healing. Proprietary products are what they are - either they prove themselves in the "heat of battle" or they don't. But every facility has within its control the ability to organize or contract appropriate staff and technology to optimize wound care. It might seem an expensive way to go in these days of PPS-inspired fear and confusion. But it just might, in the end, be the key to success.

Richard L. Peck is editor of Nursing Homes/Long-Term Care Management. Myra Gross is a writer based in Plantation, Fla.
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Title Annotation:wound care programs in nursing and long term care facilities in wake of the Medicare Prospective Payment System
Author:Gross, Myra
Publication:Nursing Homes
Date:Apr 1, 1999
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