Question: We have a patient who was admitted to service following a revision of a pedicle or flap graft (procedure code 86.75). At recertification, this wound is being called a dehisced surgical wound as it was at start of care. Prior to the first flap procedure, the wound was originally a pressure ulcer. The depth is 2 cm and the wound bed is 50/50 granulation/hard black eschar. Wound length is 7cm, width 2cm. Does this remain a dehisced surgical wound or is it now a pressure ulcer since the flap procedure has failed?

Answer: OASIS C guidance indicates that this wound is no longer a pressure ulcer once a flap procedure has been performed. It is a surgical wound. If the current wound began with dehiscence of the flap, it is still a dehisced wound. If the flap had healed and subsequently broken down, it would be a pressure ulcer.

This scenario brings to light an unanswered dilemma …

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Home health providers: Are you in a ‘black box?’

Medicare spends about $12 billion a year on “potentially preventable” hospital readmissions, according to MedPAC. With the feds hankering to cut health care costs, it’s only a matter of time before Medicare starts bundling hospital and post-acute care, experts predict. That means hospitals and HHAs need to learn how to communicate and cooperate with one another better if they’re going to be profitable.

Cleveland Clinic thinks integrated electronic health records will be key to helping health systems thrive as bundling looms, reports CMIO Magazine. (If you’re like me and scratching your head about what ‘CMIO’ means, it’s ‘Chief Medical Informatics Officer.)

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We’ve got the links to help you prepare — plus one attorney’s advice for protecting your HHA.

Home health agencies and hospices may not technically be under Recovery Audit Contractor reviews just yet, but current issues that at least one RAC is investigating are already affecting them.

Health Data Insights, the RAC contractor for Region D, posted 66 new approved issues for review in January. Most of them apply to hospitals, but HDI is also approved to review durable medical equipment topics. And two of the new DME issues will affect HHAs and hospices, too.

Issue #1: The Centers for Medicare & Medicaid Services approved “DME while in Hospice” as an issue on Dec. 22, 2009. The RAC will look for DME claims improperly paid for beneficiaries in a hospice stay. This could cause suppliers to come knocking on hospice doors for payment for claims dating as far back as Oct. 1, 2007.

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Oncologists, hospice providers & palliative caregivers shouldn’t miss this eye-opening op ed piece.

While most Americans fretted about the ‘death panel’ discussions that surfaced during last year’s health care reform debate, hospice providers — and perhaps the patients and families they served — might have had a different perspective.

In a recent opinion piece published in The Los Angeles Times, columnist Meghan Daum ponders how ‘hope, medicine and managing death’ converged for her against the backdrop of the health care reform debate. As the politicos debated endlessly on C-Span, Daum was right in the center of a medical crisis involving her 67-year old mother, who died from stage-four gallbladder cancer the day after Christmas.

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