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:
• Prevalence by 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 is not 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 care nurses
• <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
• 17K pressure 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:
• Dressing changes 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
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 Management Software
• 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.
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 foot ulcers
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 wound treatments
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 wound treatments
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
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.
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
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 | Return on 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
