In 1997, the risk manager and hospitalists for Torrance, Calif.-based HealthCare Partners Medical Group noticed several cases of hospitalized wound patients whose conditions could have been treated better on an outpatient basis, which would have improved care and potentially saved money for the patients and the group practice.
The patients, whose wounds just weren't healing, had been admitted multiple times.
But at the time, HealthCare Partners, with 300 physicians and 1,900 employees spread over 30 Southern California clinics, lacked a uniform systemwide wound-treatment protocol.
Enter podiatrist Anthony Martin, who began to champion a community wound-care clinic concept he'd heard about.
As Martin conferred with other physicians, former risk manager Ann Whitehead, and other staffers, he began to drive the program, recalls William Chin, M.D., HealthCare Partners' executive medical director.
"When you have an enthusiastic thought leader as well-respected by the organization as Tony Martin is, it's not a tough sell," Chin says. "He had the passion, zeal and enthusiasm to make it happen. And they knew what he was pushing was good for the patients and the physicians. He wasn't building his own monument here."
In April 1997 the company opened its "Integrated Wound Care Program" at its Alhambra, Calif., clinic and began collecting data.
From February 1996 through February 1997, 52 patients were admitted to the hospital for a total of 194 days at a cost of $194,000. By March 1998, those figures had dropped to 21 patients hospitalized for a total of 60 days at a cost of $60,000, a savings of $134,000. Nursing home admissions and costs for wound care at nursing homes also decreased significantly, with a total estimated annual savings of more than $300,000.
The program has expanded to three clinics and will be integrated throughout the practice's 30 sites, Chin says.
Here's how it works: When a patient is admitted with a wound as part of the overall medical condition, the hospitalist can call the wound clinic to evaluate the patient and, if necessary, begin treatment aimed at aggressively treating the wound and decreasing the hospital length of stay. It's an evidence-based approach that eliminates anecdotal and experimental treatments for wound care, streamlines care, standardizes protocols and contains costs, Chin says.
"Our treatment is faster and safer," Chin says. "And there is a reduction in litigation associated with wound care."
Chin says the program called for a change in behavior by clinicians, but the doctors quickly bought into it. Outcomes improved, doctors could deal with difficult patients more easily, and lengths of stay decreased, reducing costs.
Robert Montgomery, M.D., medical director of Meritcare Health System in Fargo, N.D., and a judge for the MODERN HEALTHCARE/MMI "Excellence in Healthcare Risk Management Awards," says wound care is "a real-life problem we physicians all face, and (HealthCare Partners) dealt with it."