by Caroline Fife, M.D. | May 28, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
I am wondering how many of you have seen a change in your practice with the advent of the Affordable Care Act? Am I the only one who has noticed that more and more patients are coming in saying, “Doc, I can’t afford for you to [fill in the blank with any procedure].”...
by Caroline Fife, M.D. | May 27, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
One last case to get you thinking about the difference between TCOM and perfusion pressure is that of a 35-year-old female pharmacist who underwent incision and drainage of a left index finger abscess 3 months before I saw her. The day after the I&D a dark...
by Caroline Fife, M.D. | May 25, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Pressure Cooker: Rethinking Pressure Ulcers, Quality Payment Program, US Wound Registry
Last month, on April 15, CMS issued a proposed rule [CMS-1622-P] outlining 2016 Medicare payment rates for skilled nursing facilities (SNFs). The policies set out in the rule would continue the shift in Medicare payments from “volume to value” that is being...
by Caroline Fife, M.D. | May 21, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
Did anyone ever think they would look back fondly at traditional Medicare? It’s clear to me that the Medicare “replacement plans,” which are increasing rapidly in adoption, are not following Medicare coverage policy but the policy of the private payer. We will look...
by Caroline Fife, M.D. | May 20, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Don't Miss This, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
This is the photo of a 30-year-old white male with a one-year history of a small non-healing ulcer on the dorsal aspect of his right great toe. He was followed for a year at another wound center in my city, using a variety of topical products. I follow the “wounds...
by Caroline Fife, M.D. | May 14, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
Today I had to write a letter to a NPWT company in order to prevent that therapy from being discontinued. The patient is a quadriplegic with an ischial pressure ulcer. I’ve been seeing him for the past 4 months and have managed to keep him out of the hospital,...
by Caroline Fife, M.D. | May 13, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Miscellaneous Musings, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
Last week I told you about the case of a 55 year old man with rest pain and a TCOM of 35mmHg on his anterior leg. Because he had been sleeping in a chair due to rest pain, he had some edema of his leg. In order to know whether a low oximetry value is due to ischemia...
by Caroline Fife, M.D. | May 6, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy, Don't Miss This, Pressure Cooker: Rethinking Pressure Ulcers, US Wound Registry
I thought I’d spend the month of April thinking about vascular screening. Last week I saw a 55-year-old man who suffered a minor scratch on his left shin 6 months earlier. He is a heavy smoker. Before the injury his walking was limited by claudication. After the...
by Caroline Fife, M.D. | Apr 28, 2015 | Pressure Cooker: Rethinking Pressure Ulcers
I recently attended the American Professional Wound Care Association meeting where Kevin Yankowsky of Norton, Rose, Fulbright, talked about the criminalization of adverse events including pressure ulcers. The National Quality Forum lists Stage 3 and 4 pressure ulcers...
by Caroline Fife, M.D. | Feb 10, 2015 | Pressure Cooker: Rethinking Pressure Ulcers
It’s time for some straight talk about the pressure ulcer staging system. I don’t have much hope that anyone will make the changes that need to be made, but let’s at least be clear about a few things. Stage 3 and 4 pressure ulcers form from the inside out, the way an...
