Straight Talk Tuesday

Every Tuesday this month we’ve been having some straight talk about a US Wound Registry Quality Measure. In the Jan/FebTWC January_February 2013 Cover 2-13 issue of Today’s Wound Clinic, Darlene Carey discussed the results of a pilot study of 3 quality measures: 1) vascular screening of leg ulcer patients, 2) venous ulcer compression at each visit, and 3) diabetic foot ulcer off-loading at each visit. I bet you are saying to yourself, “That is such a lame project. I already do all those things consistently.” Well, do you know how your data really looks?

It’s important to note that when it comes to quality measure data, one of the elements is getting the documentation right as to what you did. It’s not enough to DO something– you have to convey that you did it. I also want to be quick to add that in the quality measure world, you can “pass” a measure even if the patient doesn’t want the treatment because you can designate several possible reasons for NOT providing something such as: 1) a medical reason why it’s a bad idea (e.g. arterial disease is a good reason not to provide venous compression), 2) patient factors (e.g. the patient said “no”), or 3) system reasons (e.g. you were out of total contact casting material today). In other words, you don’t have to worry that you won’t pass quality measures because patients refuse things or there are extenuating circumstances you can’t convey easily. Having said all of that, I’ve seen the data from a lot of wound center visits and things are not going as well as they should be. It still seems pretty hard to “do the right thing.” It’s not going well out there in the area of vascular screening and diabetic foot ulcer off-loading. I can tell you that this is one of the reasons Medicare is requiring pre-authorization for hyperbaric oxygen therapy of diabetic foot ulcers in 3 states. Just saying.