I got this letter today and have redacted all the identifiers. I’d like to know what people think…
Dr. Fife,
I am the manager of a hospital-based outpatient wound department (HOPD). We are part of a large healthcare system, and in speaking to my counterparts at other HOPDs in our system, we’ve realized that an increasing number of our patients are being treated by “mobile wound care companies” staffed by NPs or MDs, who are applying CTPs/skin subs on patients in the home setting. Here are just a few of many examples:
- We discovered that a patient we recently began to see in the HOPD had received 10 applications of a CTP/skin sub from a mobile wound care company. However, the patient didn’t even know they had been treated with a CTP. It is very concerning that the patient was not aware that they were even receiving this treatment.
- Another patient new to our HOPD is a quadriplegic with multiple pressure ulcers who, according to the family, has been receiving CTPs at home by a mobile wound care company on the sacral ulcer. The wound did not improve with this treatment. No diagnostic testing was done before the CTPs were applied, and we are currently working up the patient for a likely case of osteomyelitis of the sacrum.
- One of our doctors signed orders for skilled home health services. The physician received a call 3 weeks later from an NP employed by [Name redacted], a mobile wound care company and was informed that CTP/skin subs were being placed on the wound in the home setting. We later had to readmit the patient to manage this foul smelling, necrotic wound which in truth, was never a candidate for a CTP, besides which, the patient is in hospice. It is not clear to us how the mobile wound care company got involved in the care of our patient, but we suspect that there is a link between the mobile wound company and the home health agency who was supposed to be carrying out our wound care orders (and wasn’t).
- We discovered that another of our wound center patients was receiving CTPs/skin subs in the home, and we called the Home Health agency that was supposed to be caring for the wound to ask how a third party became involved. It seems that a nurse working for the Home Health agency called the “mobile wound care” company and referred the patient without our knowledge.
In our limited experience with these companies, the patients were not properly evaluated for a CTP/skin sub and none of them were really candidates for this expensive therapy. Therefore, it is not surprising that none of the patients we have seen who were treated with CTPs/skin subs at home have improved as a result.
Even more concerning, it appears that Home Health agencies are taking it upon themselves to refer our patients to these third-party companies, which then begin treatment in the home with CTPs/skin subs. How can this can be stopped? Is it legal?
Sincerely,
[Name redacted]
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
Dr. Fife,
During the pandemic I reached out to the CMO at Palmetto because we had patients who were mid graft treatment and were no longer able to come to clinics to carry out their plan of care. I received a written response that these CPT codes were not payable in the home setting because of the surgical nature and the inability to create a clean or sterile environment in that setting. I believe ALF was the exception since it is technically a facility. So, the way these companies are getting around that is by setting up mobile units, so the care is not technically in the home setting. Grafting is the only way to make this type of practice lucrative since you would spend half of your dad driving. Also, I heard about some of these companies having PMPM contracts with payers like Florida Medicaid, which also bypasses the standard practice restrictions. Those are my limited insights though. Unfortunately, if the patient does not know they received gafts they would not be able to tell a clinic and this situation could easily result in a denial.