A chance to heal; home health agencies can improve patient care and increase profits with telehealth wound consulting - Telemedicine

Health Management Technology, April, 2002 by Nick DiCianni, Laura Kobza

Most visiting home nurses lack the specialty skills to monitor chronic wounds adequately. The schedule for dressing changes and the dressing materials themselves may vary from patient to patient, and from wound to wound. The situation requires a WOCN, but there are countless more wounds out there than there are WOCNs to address them. Even if an agency could recruit an on-staff wound specialist, that nurse might be able to visit five or six patients per day using a traditional approach, far fewer than actually need her training and skill.

With the right clinical software and telecommunications technology, a WOCN might handle 18, 19 or 20 patients a day from Chicago to Seattle and back again.

Winning the Numbers Game

A WOCN call center in Barrington, IL has been operating since December 1998, and has performed more than 5,000 telemedical visits. Under an NIH-funded grant to review the first three years of operation, the call center recorded remarkable outcomes for several participating home health agencies. Among the results was a 100 percent healing rate for Stage II wounds compared to 41 percent based on agency chart-pulls. Similarly, 63 percent of venous stasis wounds were completely healed under the telemedicine program, versus 29 percent without it.

Better yet, the number of skilled nursing visits per case plummeted. Stage IV wounds, which required an average of 76 visits per case, now average 48 visits with telemedical monitoring. An average of 50 visits required for a diabetic foot wound dropped to 30, and an average 31 visits for Stage II wounds dropped to 11 visits.

As for PPS margins, one agency recorded an average margin of $1,009 per 60-day episode. Another saw an average margin of $1,570 per episode. Across the board, 86 percent of episodes generated positive margins.

Agencies see an average return of nearly $40,000 against a $17,000 investment per four-month commitment to a telemedicine program. With data compiled and constantly updated, current case margins can be determined and discussed on a weekly basis. The resulting information leads to better choices on a range of issues from use of products, to frequency of visits, to use of therapy and appropriate HHRG coding.

Informed decisions lead to increased margins and for home health agencies, this means the bleeding stops.

Nick DiCianni is vice president of operations, and Laura Kobza, R.N., CWOCN, is a nurse consultant, with Applied Home Telemedicine, a division of Millennium Healthcare Solutions, Edison, NJ. Contact Nick at ndicianni@mhst.com.