Published in Wound Care on July 02, 2024
When considering diversifying your business in wound care, primarily with the surgical dressings category, it’s important to reflect on where your business is currently, as well as the present environment of the wound care market.
While there are certainly benefits to growing in this space, there are some challenges when it comes to billing for surgical dressings. However, to be successful in the wound care market, consider this five-step approach to breaking into the wound care space, from building the logistics of your program focusing on LCD/PA to developing a formulary, and taking your wound care program to market by focusing on what is important to your referral sources.
Step 1: Review the Market Space
It’s important to identify the surgical dressings market demand. Strategies for success include:
- Market Research: Identify needs and evaluate existing patient populations. Wounds are everywhere. You can also look at who you’re currently serving to determine if there is an overlap in your existing patient population.
- Referral Sources: Interview existing and prospective referral sources. Who would that be?
- Team Knowledge: Evaluate your current team to ensure they understand medical policies and can engage with clinicians and referral sources. If they can’t, consider investing in developing this knowledge or hiring someone who does understand this area.
Step 2: Develop Your Best In-Class Wound Care Program
Start from scratch with building the logistics of your program by focusing on local coverage determination/prior authorization (LCD/PA) to building out a formulary based on cost-effectiveness and resource availability. From there, you can determine the order process that works best for your business and referral sources.
Basic Coverage Criteria
Understand when surgical dressings are covered (e.g., after surgical procedures or debridement).
Surgical dressings are covered when one of the following are met:
- Required for treatment of a wound caused by, or treated by, a surgical procedure, OR
- Required after debridement of a wound (surgical, mechanical, chemical, or autolytic)
When documenting requirements, specificity is crucial; including details on both primary and secondary dressings. Primary dressings are applied to wounds directly, while secondary dressings protect and secure the primary ones.
Product Considerations
Some products are not covered but may be necessary for patients, including:
- First aid type bandages
- Small adhesive bandages (band-aid type)
- Skin sealants or barriers
- Wound cleansers or irrigating solutions
- Solutions to moisten gauze (i.e. saline)
- Topical antiseptics or topical antibiotics
- Enzymatic debriding agents, gauze or other dressings used to clean or debride a wound
- Silicone gel sheets
- Non-elastic binder for extremity
Be sure to let your patients know that these are still available to them, they will just need to pay out of pocket for them.
Medical Documentation Requirements
Develop a checklist for documenting wound details, including:
- Debridement/surgically created wound
- Wound etiology (type of injury, such as a pressure injury, venous insufficiency, etc.)
- Location of the wound
- Wound measurement (length x width x depth)
- Depth demonstration (if wound is open)
- Amount of drainage (minimal, partial, heavy)
- Staging/grading/classification (full thickness/partial thickness)
- Wound treatment per wound – be sure to include the following in the documentation:
- Item description (HCPCS)
- Frequency of change (amount per dressing change)
- Primary/secondary dressings
- Dressing size (if applicable)
Product Criteria and Allowables
Break it down by category. Dressing types can be categorized by drainage (collagen, composites, foams, etc.). Determine optimal dressing change frequency based on thickness and allowable quantities, as well as when NOT to use specific dressings.
Building a Wound Care Formulary and Addressing Error Rate
Once your formulary is built, inform referral sources about your choices.
Step 3: Finding the Right Partners
The next step is to find mutually beneficial partnerships with suppliers and referral sources who align with your goals and benefit both parties and patients. Consider factors beyond price, such as:
- Cross-Reference Support: Develop a formulary by comparing different manufacturers and their cost-effectiveness.
- In-Service Training: Train your team on the formulary and its rationale to generate referral leads. Provide the necessary marketing materials to effectively communicate your offerings.
- Patient Engagement Programs: Communicate your formulary choices to clinics and engage with patients effectively. If you have a program where you educate and assist patients, then make sure to communicate that to your clinics.
Step 4: Focus on Your Team Training
Train your sales and marketing teams to be order makers, not order takers. Thorough and continuous training is essential to instill the core value propositions deeply into the team's approach. By transforming your sales and marketing personnel to be educators themselves, they can effectively communicate the benefits of products and services; fostering ‘up-caring’ practices that are instrumental in securing profitable orders and building valued partnerships.
Additionally, leveraging the expertise of vendor partners and resources like the VGM members-only portal can greatly enhance the educational framework. Focusing on the three key areas below ensures a well-rounded training that covers clinical aspects, reimbursem*nt processes, and the nuances of sales and marketing, equipping the team with the knowledge to excel:
- Wound Care Disease State – Clinical Training
- Surgical Dressing Program and Product Category Training – Reimbursem*nt Training
- Referral Engagement – Clinical, Reimbursem*nt, Sales/Marketing Training
Step 5: Building a Surgical Dressing Referral Base
To build a robust surgical dressing referral base, formulate a strategic game plan. Acting as a reimbursem*nt consultant for surgical dressings can establish credibility and trust. It's crucial to set realistic expectations with referral sources and not shy away from holding them accountable. Regular service check-ins using HME provider report cards are essential for maintaining quality service. Additionally, developing a monthly focus area can help in staying on track and continuously improving the referral process.
Looking at the Entire Patient
While there are certainly challenges to the wound care space, this five-step approach to breaking into the surgical dressings category can help.
There are many different products, and documentation requirements can be confusing. However, use the tiered formulary approach and determine your criteria based on the LCD and PA. Break it down by product category.
Billing for surgical dressings involves detailed documentation and an investment in staff training. By utilizing the various educational resources from your partnerships, you can train your team on wounds from a clinical and reimbursem*nt perspective to be able to navigate through a wound assessment.
Surgical dressings may not always seem profitable due to errors in claims and reimbursem*nt challenges, but it can be very profitable if you stick to a tiered formulary and educate your referral sources on requirements.
Knowing whom to call for referrals can be challenging. However, wounds are everywhere!
Most importantly, look at the whole patient, not just the “hole” in the patient. A holistic approach to patient care is essential. Rather than focusing solely on the specific ailment or condition (“the hole”), consider the patient as a whole. This means addressing physical, emotional, and social needs to ensure optimal outcomes. By doing so, we can provide comprehensive care that truly benefits the individual.
This article originated from a presentation given at the 2024 VGM Heartland Conference by Amanda Smithey, CWCMS, Senior Manager Advocacy and Strategic Partnerships – HME Division at McKesson, and Heather Trumm, BSN, RN, WOCN, Director of VGM Wound Care. For questions about developing a wound care program or billing for surgical dressings, contact Heather Trumm at heather.trumm@vgm.com.
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- vgm
- wound care
