Pay For Performance: How Will It Impact Diabetic Foot Care?

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Basic Interventions For Diabetic Foot Ulcer Care

• Prescribe offloading
• Screen for osteomyelitis in high risk wounds
• Monitor hemoglobin HbA1c (Level of evidence = C)
• Consider the use of growth factors for Wagner grade I or II ulcers. (Level of evidence = A)
• Consider hyperbaric oxygen therapy (HBOT) for Wagner grades III and IV(WOCN). (Level of Evidence =A)

The list above represents an abbreviation of the Wound Ostomy Continence Nurses (WOCN) guidelines for diabetic foot ulcer care. They are stratified according to the American Heart Association’s “Levels of Evidence” system.

Pay For Performance: How Will It Impact Diabetic Foot Care?
Pay For Performance: How Will It Impact Diabetic Foot Care?
Pay For Performance: How Will It Impact Diabetic Foot Care?
By Caroline E. Fife, MD

How Can You Meet The Challenge Of Pay For Performance?

Clinicians cannot meet the challenge of pay for performance without a level 4 EMR. This will require an information technology (IT) investment. While this is a barrier to participation initially, EMRs will soon be known as the IT investment needed for bonus calculation.

   There are several pay for performance opportunities for clinicians. Pay for performance offers a quality incentive based on money saved. Improved quality means less litigation and pay for performance offers increased clarity about what is reimbursed. In addition, there is also feedback about clinical outcomes, which allows learning and improves outcomes. Pay for performance leads to increased consistency of care between both between clinicians and across settings.

   In preparing for pay for performance in wound care and ensuring appropriate treatment of patients at risk for developing a wound, one should emphasize the following:
   •    consistent evaluation and treatment plans;
   •    disease management to lower chronic wound risk;
   •    consistent measurement and reporting of outcomes; and
   •    consistent documentation of care;
For patients with wounds, one should:
   •    stop causes of pain and tissue deterioration;
   •    optimize the healing environment
   •    reduce pain and infection (associated with gauze use); and
   •    remove devitalized tissue which can be an infection focus.

   Physician payment is about to undergo a paradigm shift. While dramatic changes like this are difficult, pay for performance represents an opportunity for clinicians to improve patient care.

Dr. Fife is an Associate Professor in the Department of Anesthesiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Care. She is also the President of Intellicure, a wound specific EMR provider.

Dr. Steinberg (pictured at left) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.


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