The Evolving Role of Wound Care in Long Term Acute Care

With the FY 2020 phase out of blended payments beginning October 1, 2019, most LTACHs have begun severely limiting, or eliminating altogether, non-qualifying LTACH admissions. As expected, this has greatly reduced the number of wound related DRGs admitted and discharged from long term acute care hospitals. As these patients are more and more often cared for in other settings one might reasonably expect that the importance of wound care in the LTACH would be decreased. While some facilities diversify their scope of service to include co-located skilled nursing facilities or inpatient rehab beds, others have developed outpatient wound centers to meet patient needs.

As a company devoted exclusively to wound care, across the continuum of care, it is obvious to us that the severe wounds we formerly cared for are no longer commonly seen as the primary reason for admission in the LTACH. We do care for them in many other levels of care that we previously did not. However, rather than the loss of primary wound care admissions resulting in a decrease in the incidence of wounds in the LTACH setting, the new LTACH admission criteria appears to have resulted in an equal and often increased incidence of wounds in the nearly two dozen LTACHs WoundCentrics serves. In addition, in the dozens of acute care hospitals we provide care in, we see qualifying patients with wounds go unreferred or unaccepted by our LTACH partners.

Even in those LTACHs where the incidence of wounds has decreased, the DRG case weight changes almost always result in equivalent or greater financial returns in response to wound care than were previously seen with DRG changes related to patients with primary wound care related DRGs. Consider the two examples below;

A 592 DRG (SKIN ULCERS WITH MCC) HAS A CASE WEIGHT OF 0.9629 AND IF DEBRIDED WOULD BECOME A DRG 570 (SKIN DEBRIDEMENT WITH MCC) WITH A CASE WEIGHT OF 1.2916. WITH THE LTACH-PPS STANDARD RATE OF $42,677.64 THAT WOULD INCREASE THE DRG PAYMENT BY $14,028.34

A DRG 207 (RESPIRATORY DIAGNOSES WITH >96 HOURS VENTILATOR SUPPORT) AND A CASE WEIGHT OF 1.8628 WOULD BECOME A DRG 166 (OTHER RESPIRATORY SYSTEM OR PROCEDURE WITH MCC) IN MOST CASES AND CARRY A CASE WEIGHT OF 2.3392. THE RESULTING DRG PAYMENT WOULD INCREASE BY $20,331.27. PATIENTS WHO DID NOT MEET THE 96 HOURS OF VENTILATOR SUPPORT SUCH AS DRG 208 ($47,966.25 INCREASE) OR DRG 189 ($58,792.72 INCREASE) RESULT IN AN EVEN GREATER IMPACT

As you can see, wound care still has an important role to play in the LTACH.

We invite you to stop by the WoundCentrics booth while at the Fall NALTH Conference or grab one of our team members any time during the conference and let us give you some examples of the real life experiences our LTACH partners have seen in their facilities this year.

Company Contact
Ken Rideout, Development
kenrideout@woundcentrics.com
Cell / Text: 281-989-5398