William J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair

William J. Ennis D.O.,MBA University of Illinois at Chicago Professor Clinical Surgery, Chief Section wound healing and tissue repair

What are the revenue streams What are the expenses How does the hospital benefit How does the individual clinician benefit How does the patient benefit

Home health program Pilot study with custom dressings Peer Review Patient safety initiative Pressure ulcer inpatient program Hospital admissions Decrease re- admission rate same Dx New patients to the facility Ancillary testing and outpatient Product formulary DME, bed rentals

Chronic wounds are treated across medical specialties, and across sites of care

Table 1. The Overall Healing Rate and the Mean and Median Time to Healing from Two Sources Community Hospital- Based Outpatient Clinic* Tertiary care Hospital Outpatient Clinic Number of Wounds 303 344 Wounds Healed 225 (74%) 252 (73%) Kaplan Meier derived mean time to healing 14± 1 12 ± 1 Kaplan Meier derived median time to healing 9 ± 1 9 ± 1 *Ref Ennis et al Ostomy/Wound Management 1998;44(11):22-39

Clinical Increase quality of care Increase patient satisfaction Increase nursing morale and job satisfaction (translates into better retention/recruitment) Reduce medico- legal exposure Improve performance on JCAHO/Public health audits Economic Decrease patient costs and LOS, increase CM Capture discharged patients into the outpatient wound clinic Consistency of product useage translates into supply chain cost savings Control durable equipment Specialty beds Neg pressure therapy pumps

" Establish a proactive inpatient wound care program to: " Aggressively manage and treat all inpatient wounds upon admission " Reduce the probability of developing wounds after admission " Stabilize wounds quickly, allowing for treatment in an outpatient setting " Reduce the increased costs to manage surgical complications " Foster strong physician and nurse involvement within the hospital 2008 Accelecare Wound Centers. All rights reserved.

1 Wound Nurse/ P.T. " 1 Full-Time Wound Nurse dedicated soley to inpatient setting " 1 Full time PT wound care clinician " Both have received extensive clinical inpatient training for complex patients 2 3 Wound Physician Team Leaders " 1 Physician from the section of Wound Healing and Tissue Repair " Rounds 6 days a week on the inpatient side " Wound Care Fellowship trained physicians " Dedicated inpatient service for chronic and acute wounds, patients admitted directly to the wound service, Internal Medicine consultation " 1-2 Floor Nurses appointed in each hospital unit as RN Champion (voluntary appointments based upon interest in wound care) " Main point of contact for the wound nurse on a daily basis " Receive additional training and support from the Wound Team " Serve as the eyes and ears of the inpatient program, initial point of contact for all UIC patients with wounds 2008 Accelecare Wound Centers. All rights reserved.

1 2 3 Wound Nurse/P.T. Wound Physician Wound Champion Nurses " Education " Initial educational training of full floor nursing staff " On-going educational training of floor staff in conjunction with hospital s training programs " Recruitment and additional training of Champion nurses (see below) " Consulting " Consult on wounds identified by Team Leaders and other floor nurses " Simple wounds: Submit recommendations for care to Attending Physician " Complex wounds: Coordinate and schedule consults for Wound Team " Education " Initially informing the physician community in the hospital of the benefits of the inpatient program " Networking on an on-going basis with the physician community to remind them of the benefits " Consulting " Rounding on inpatients 6 days a week " Review all patients marked for consult by the wound nurse or directly by a physician " Identification " Identify and mark for consultation any wounds in need of assessment by the Wound Nurse " Coordinate other floor nurses in their unit in regards to watching for wounds " Management Responsibilities of Wound Care Team " Responsible for implementing protocols recommended by Wound Physician and Nurse " Changing of bandages, application of topical treatments, repositioning of bed patients, etc. (all floor nurses responsible for this) 2008 Accelecare Wound Centers. All rights reserved.

Hospital Issues UIC Solutions " High costs of dealing with inpatient wounds due to lack of protocols " Reduce costs significantly through standardizing clinical protocols " Changes to Medicare rules, stopping reimbursement for wounds developed post-admission (effective October 2008) " Identify all wounds upon admission to ensure reimbursement " Quickly treat and stabilize wounds developed post-admission " High incidence of wounds identified upon admission or developed post-admission " Manage incidences at or below national average level 2008 Accelecare Wound Centers. All rights reserved.

E+M visits Dependent on level of comprehensive care Best consistent CPT codes to use Don t be a CPT chaser Good medicine will always be reimbursed

E+M Pt volume Reimbursed Total rev New pt 3 75 72 5,400 New pt 4 75 91 6,825 New pt 5 75 130 9,750 Est 2 608 55 33,440 Est 3 810 55 44,550 Est 4 405 72 29,160 Est 5 203 91 18,473 147,598 Assumptions - 225 new patients per year, 10 visits per case 2,250 pt visits per year 225 new pt 2,025 rv New pt 33/33/33/ Est 2-30% 3-40% 4-20% 5-10% 100% of cases are medicare

11040 50 100 5,000 11041 135 100 1,500 11042 135 180 24,300 11043 135 180 24,300 11044 50 478 23,900 Biopsy 50 100 5,000 Each add 25 55 1,375 97597 300 100 30,000 biological 200 230 46,000 161,375 3x MC 926,919 308,973

Benefits RN 85,000 29,750 114,750 RN 85,000 29750 114,750 MA 30,000 10,500 40,500 Asst 25,000 8,750 33,750 303,750

4500 4000 3500 3000 2500 2000 1500 1000 500 0 Total inpatient 1999 2000 2001 2002 2003 2004 2005 Total inpatient

Year Net Rev 1999 1,366,165 2000 1,396,770 2001 1,739,017 2002 1,971,774 2003 2,039,827 2004 2,667,362 2005 1,986,799 2006 933,460