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WOCN / CMMI Long Term Care Project

Pressure ulcers, complicated ostomies and fistula can be a challenge to treat and manage in the long-term care facility (“LTC”) setting. LTCs do not have a wound/ostomy care specialist, or even a staff member trained in wounds or care of patients with complex bowel and bladder diversions. The lack of certified wound/ostomy care professionals in these facilities can lead to an increase in:

  • Complications from pressure ulcers and skin breakdown;
  • Postoperative complications from complex ostomy dysfunctions;
  • Hospitalizations/re-hospitalizations; and
  • Increased morbidity and mortality.

As a result, WOCN is working with additional stakeholders on a proposal to be submitted to CMMI which would allow reimbursement of WOC nurses’care for LTC patients without direct supervision of a physician.  This would allow WOC nurses  to conduct routine wound/ostomy treatment on a proactive basis, which will result in fewer patient transports, fewer outpatient/hospital stays, less interruption in care, and better overall care for the patients.

The Center for Medicare & Medicaid Innovation (the Innovation Center, or CMMI) supports the development and testing of innovative health care payment and service delivery models. The Innovation Center allows the Medicare and Medicaid programs to test models that improve care, lower costs, and better align payment systems to support patient-centered practices. The Innovation Center carefully evaluates innovative reform efforts widely used in the private sector, and is unique in its ability to develop provider-proposed approaches and quickly adjust models in response to feedback from clinicians and patients.

 

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