Entering the Wound Care

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Entering the Wound Care Bariatric Markets

• Heather Raub BSN, RN, CWOCN
• Director of Wound Care and Bariatrics
• VGM Associates

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Overview

• Investigation
• Wounds
• Bariatrics
• Entering the Market
• Who to Market to

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Wounds

• Wound problems present as long as man has been on
  earth
• Oldest documentation of wound management -1500BC
  Egyptian medicine
• Oiled frog skins, honey, lint, animal grease to
  heal

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There have always been wounds

• Seems to be more attention on wounds and wound
  care lately

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WHY???

• MONEY!!!!!

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Stats

• Venous Stasis Ulcers
• Cost 5 Billion for overall cost
• 80 of the time the ulcer recurs
• One ulcer costs between 2,000-10,000(to heal
  each episode)
• May be the most common chronic wound

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• Pressure Ulcers cost US 12 Billion
• Average charge per case40,000
• More common in elderly(gt65 y.o.)
• 2.5 million patients treated yearly in US for
  pressure ulcers in acute care
• 24 of skilled patients develop a pressure ulcer
  at some time

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Diabetic Foot Ulcers

• Cost U.S. 5 Billion
• 17 million people in US with Diabetes
• 20071.6 million NEW cases of diabetes in people
  20 years and older
• 15of diabetics will have a foot ulcer at some
  time in their life.
• Most common reason for hospitalization
• DFU account for 80 of wound care costs

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Why Increasing Problems

• On the radar screen!
• CFOs, Administrators, insurance companies
• Average life-span increasing
• As we age, develop more health issues
• Skin gets thinner more vulnerable
• Growth of Diabetes
• Tripled in past 2 decades (Advanced Medical
  Technology Association, 2006)
• More Education
• Internet, etc.

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Whats Involvedwith Wound Care?

• Transition into.

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Its not just a dressing

• Advanced Wound Dressings
• Support Surfaces
• Nutrition
• Compression
• Advanced Modalities
• Blood Flow
• Oxygenation

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• It also involves

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Multidisciplinary Team

• Pharmacists
• Certified Orthotist/Prosthetist
• Podiatrist
• Lymphadema Specialist
• Risk Managers
• Social Workers
• More??

• Patient
• Aides
• Physicians
• Nurses
• PT/OT
• CWS
• CWOCN
• Diabetes Educators
• Case Managers

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Theres NO money in WOUND CARE!!!!

• In one area of wound care there is good
  reimbursement

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Support Surfaces

• This is a huge area of wound care and a positive
  revenue stream
• E0373 - Non-powered advanced pressure reduction
  air mattress costs 714.42
• Medicare reimbursement 614.47(IA) -capped
  rental at 13 months
• This is not including supplies, labor,
  transportation, or any additional costs.

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Bariatrics
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Bariatrics

• Bariatrics is the branch of medicine that deals
  with the causes, prevention, and treatment of
  obesity. Overweight and obesity are rising
  medical problems of pandemic proportions.
• Obesity is one of several factors contributing to
  chronic diseases such as heart disease, cancer
  and diabetes.
• Increasing weight issues affect all age, ethnic,
  racial, and socioeconomic groups

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Why all the Attention to this issue?

• MONEY!!
• STATS!!

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• Approximately 300,000 deaths/year
• Obesity shaves 3-20 yrs off a persons life
• 129.6 million are overweight
• 64.5 of US adults with BMI gt25
• 61.3 million are obese
• 30.5 of US adults with BMIgt30

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MONEY

• 122.9 billion
• Direct costs 64.1 billion
• Heart disease 8.8 bil
• Osteoarthritis 5.3 bil
• Indirect costs 58.8 billion
• 39.3 million workdays lost
• 239 million restricted activity days

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What does Bariatrics entail?
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Multidisciplinary Team

• DME Products
• Counseling
• Nursing Aides
• Transportation
• Dietary consults
• Exercise
• Physician

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Bariatric Products

• Medicare will reimburse for
• Walkers
• Hospital Beds
• Bedside Commodes
• Trapeze Bars

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Example of Bariatric Beds

• E0303 - 258.38 to 303.98 (depending on state)
• E0304 - 655.07 to 770.67 (depending on state)
• 600 lb bariatric bed (E0303) costs the dealer
  about 1,455. Dealer gets paid 3,358.94 (with
  20 co-pay) or 2,687.15 at 80.
• 1000 lb bariatric bed (E0304)
• costs the dealer about 4,700.
• Dealer gets paid 8,515.91
• (with 20 co-pay) or
• 6,812.73 at 80.

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So

• Why should youthe DME get involved with these
  types of patientsin this business???

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1. You probably are already involved with these
types of patients

• 2. Statistics

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AND
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• DME/HME providers play VERY important role in
  wound care/bariatric process
• First responders
• Intricate part of multi-disciplinary team to keep
  costs down and healing rates up!!!

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Do you ever deal with.

• Respiratory patients high risk for wounds
• Sleep patients usually overweight
• Diabetic patients high risk for wounds and
  bariatric problems
• Rehab patients high risk for wounds

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• What do I do if I want to enter the wound
  care/bariatric market(s)??
• What first???

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Overview

• Current Referral Sources
• Use your current referral sources.
• New Avenues
• What new referrals might be available to you?
• Your Offerings
• What new offerings will you have to market?
• Work Your Plan
• How to effectively work your plan for Wound Care
  and Bariatric market entry.

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• Go to your current referral sources

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Who are your referral sources?

• Hospitals
• Homecare agencies
• Discharge planners
• Wound care nurses
• Wound care clinics
• Bariatric Centers

• Rehab centers
• Long term care facilities
• Podiatrists
• Plastic surgeons
• Burn units

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Whos on a Wound Care Team?

• Physicians
• Nurses
• PT/OT
• CWS
• CWOCN
• Diabetes Educators
• Case Managers
• Social Workers

• Pharmacists
• Certified Orthotist/Prosthetist
• Podiatrist
• Lymphadema Specialist
• More??

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New Avenues

• Entering a New Market Will Allow You toMarket
  to New Referral Sources

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• Bariatric Center
• DME products
• Skin Products
• Absorbent products
• Nutritional products
• Diabetic Centers talk to nurses who see
  patients and order consult
• Shoes
• Hosiery
• Skin Care Products
• Socks
• Hospice

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• Hospital
• Beds
• Negative Pressure
• Wound Dressings
• Cancer center
• lymphadema pumps (certified fitter)
• mastectomy products, wigs
• Hosiery
• Long term care facilities/Nursing Homes

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• Home Health
• Dressings
• Negative Pressure wound therapy
• Rehab center
• OP
• Wheelchairs
• Podiatry Offices
• Outpatient Clinics
• Plastic Surgeon
• Eating Disorders Unit

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• Marketing Your Services

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• Mail, e-mail, flyers, pound the pavement
• Keep record of referral sources
• Spreadsheet of services and products you have
  provided
• Walk ins once you get them in- give them a
  reason to come back

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Now Getting the Business

• Where do you start???
• Top decision maker
• Who is that??
• ASK!!

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Decision Maker

• It may be
• CFO
• DON
• PT
• OT
• Physician
• Head Nurse

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1. Find out who that person is
2. Set up an appointment to discuss potential
   business

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Ask these questions

• Why do they go with the competitor?
• Is their facility willing to look at other
  opportunities?
• Would they be willing to look at your products
  and services??

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• Compare products your company provides vs.
  products they are already purchasing
• Take one products line
• Financial analysis what are they spending by
  outsourcing vs. what you can bring

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• How much do they pay?
• Are they contracted? When is their contract up?
• What are the top reasons they do business with
  ABC Medical?
• You can go above and beyond what ABC Medical
  provides

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Product Lines

• Support surfaces
• Wound dressings
• Negative pressure wound therapy
• Bariatric products
• Hospital beds

• Nutritional products
• Bariatric products
• T-pump
• Compression

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Work with your local rep

• Local reps know their product features and
  benefits more than anyone else.
• Get them to make sales calls with you
• Clinical studies
• Cost Analysis

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• No Local Rep??
• Dont know what products and services are
  better??
• Call me at VGM and I can help get you that
  information

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WHY YOUR COMPANY???

• Customer service is your priority
• You have been in business for x years
• Can save the caregiver time and the patient money
  through your deeper offerings and categories and
  superb customer service.

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• You are 24/7
• You are a one stop shop
• You are friendly and easy to work with
• Competitive Pricing in all areas
• You KNOW the Home Care Business!

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Long Term Care Facilities

• Market to them
• Reduce the facilities FTAGs
• Reduce their costs
• Better compliance
• Greater employee satisfaction

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What can help you?

• Persistence!!
• VGM Manufacturers call VGM to get info
• Wound Care and Bariatric Division
• www.vgm.com/woundcare
• VGM Education great for referral
  sources-educate the docs/nurses/therapists you
  want business from!!!

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What if they say NO?

• Ask for a trial run with a product line
• Great for showing them how your products and
  services differ from the competitor
• If they arent satisfied move on
• If they are happy go to the next product
  category

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Why does all this make sense??

• Patients you already see
• Why not be a one stop shop for them?
• US Demographics
• Stats

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VGM is a resource for YOU!

• QuestionsQuestionsQuestions...
• call and ask

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Thanks!!

• Heather Raub RN, BSN, CWOCN
• Cell Phone [phone]
• Heather.raub_at_vgm.com

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References

• Advanced Wound Management Healing and Restoring
  Lives. Advanced Medical Technology Association,
  June 2006.
• Ovington, L.G. (2002). The evolution of wound
  management ancient origins and advances of the
  pas 20 years. Home Healthcare Nurse. 20, pp
  652-656.
• Sipos, P., Gyory, H., Hagymasis, K., Ondrejka,
  P., Blazovics, A. (2004). Special wound healing
  methods used in ancient egypt and the
  mythological background. World Journal of
  Surgery. 28, 211-216.
• Eastman-Mendez, S. (2005). New Advances in Wound
  Therapy. Taken from www.wounds1.com/hero/hero.cfm
  /8/1 on 1/23/2008.

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• National Pressure Ulcer Advisory Panel, taken
  from wwww.npuap.org/s3i.htm on 1/23/2008
• Baharestani, M.M, Blackett, A., Coutts, P.,
  Emmons, P., Falconio-West, M., et al. (2007).
  The Wound Care Handbook.
• Acute and Chronic Wounds
• Garner, L.M. (2003). Wound Care, Prospective
  Payment System, and the Wound Ostomy, Continence
  Nurse. Home Health Care Management Practice,
  15 (4), pp. 325-329.

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• Kerstein, M.D. (2002). Wound Management Presents
  Financial and Outcome Challenges Safety
  Matters. Healthcare Purchasing News. Retrieved
  on 12/10/07 from http//findarticles.com/p/article
  s/mi_m0BPC/is9_26_/ai_91653594/print.
• Source SEARCH for Diabetes in Youth
  Study.NHWNon-Hispanic Whites AAAfrican
  Americans HHispanics APIAsians/Pacific
  Islanders AIAmerican Indians (graph of
  diabetes).