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WOCN Society Ready to Address October 1 Changes Precipitated by New Reimbursement Criteria

Tuesday, September 23, 2008 General News J E 4
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MOUNT LAUREL, N.J., Sept. 22 Healthcarefacilities will find themselves under increased pressure to conduct thoroughpreadmission screenings to identify conditions that are present on admission(POA) starting next month. That's when Medicare reimbursement changeslegislated under the Deficit Reduction Act of 2005 will go into effect.Beginning October 1, if a patient develops a hospital-acquired condition thatis not POA, in-patient facilities will not be reimbursed by Medicare fortreating that condition.

This change puts the highly skilled professionals in the field of wound,ostomy and continence care in an even more important role in managing anddirecting healthcare, according to the Wound, Ostomy and Continence Nurses(WOCN) Society. Wound, ostomy and continence (WOC) nurses are uniquelyqualified to positively impact both patient care and cost containment underthe new system. The WOCN Society encourages healthcare facilities to empowertheir nursing staff to improve their knowledge in these key areas by accessingthe wealth of resources available through the WOCN.

Identifying Non-Reimbursable Conditions

As of October 1, 2008, the following conditions will not trigger a higherDRG (diagnostic related groups) classification unless present on admission:

Timely, thorough and accurate documentation of preventable conditions thatare present at the time of a patient's admission to the hospital will beexceedingly important. In addition, accurate staging of pressure ulcers andother conditions present on admission will be mandatory for properreimbursement. Since these new requirements focus on hospital qualityimprovement and risk management, it is important for quality programs to playa role in the POA reporting process.

Hospital quality programs should initiate an analysis of admissions inwhich any of the targeted conditions were present to allow for theidentification and assessment of areas where the risk of hospital-acquiredcomplications is greatest. The quality program should also closely monitor thecoding and documentation processes to ensure that both are being handledefficiently, and that areas where improvement may be needed are identified andaddressed immediately.

WOCN as a Resource

To apply the staging system used to classify specific conditions, it isimperative to have the evaluation conducted by a highly skilled professionalwho can correctly identify the anatomy of the skin. It is also important tohave an educated professional skilled at isolating the conditions uponadmission that may lead to the development of certain non-reimbursableconditions.

Nurses with a background in WOC issues are well-qualified to educateothers in the field, with a number of tools at his/her disposal that areoffered through the WOCN Society. These include Society teaching materials, animage library to help with diagnosis, evidence-based publication and ascientific journal, special conference sessions that focus on emerging topicsin the area of reimbursement, as well as knowledge gained through networkingopportunities with colleagues.

Hospitals cannot afford to ignore unconventional strategies and employmentdecisions that will ultimately enhance the health and care of patients.

About the WOCN Society

Founded in 1968, the Wound, Ostomy and Continence Nurses Society is aprofessional, international nursing society of more than 4,200 healthcareprofessionals who are experts in the care of patients with wounds, ostomiesand incontinence. The Society supports its members by promoting educational,clinical and research opportunities to advance the practice and guide thedelivery of expert health care to individuals with wounds, ostomies andincontinence. For more information, go to www.wocn.org.

CONTACT: BETH DROST -- (215) 884-6499-- Catheter-associated urinary tract infections -- Pressure ulcers (be
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