When Dr. Maria Santos (name changed) approached us, she had a familiar problem. Her 4-physician primary care practice in Palm Harbor was referring out nearly every wound patient — and watching thousands of dollars leave her capitation pool each month.
Twelve months later, her practice had retained over $152,000 in wound care costs and added new revenue streams. Here's how we did it.
Practice Profile
- Type: Family Medicine
- Location: Palm Harbor, FL (34684)
- Physicians: 4
- Patient Panel: 3,200 patients
- Payer Mix: 65% Medicare Advantage, 25% commercial HMO, 10% other
The Challenge
Like many primary care practices, Dr. Santos' group had defaulted to referring nearly all wound patients to external wound care centers. The rationale was reasonable: chronic wounds seemed complicated, liability concerns were real, and the practice lacked formal wound care training.
But the financial impact was significant:
55
Wound patients referred annually
$4,200
Avg. cost per referral
$231K
Annual referral cost
0
Wounds treated in-house
When we analyzed the wound types being referred, we found that the majority were manageable in primary care:
- Diabetic foot ulcers (Wagner 1-2): 22 patients
- Venous leg ulcers: 18 patients
- Pressure injuries (Stage 1-3): 8 patients
- Surgical complications: 4 patients
- Complex wounds (appropriate for referral): 3 patients
Of 55 annual wound referrals, at least 52 (95%) could potentially be managed in-house with proper protocols and training.
The Solution
We implemented our comprehensive wound care program over 6 weeks:
Week 1-2: Assessment & Planning
We conducted a detailed analysis of the practice's wound referral patterns, staff capabilities, and EHR system. We identified specific protocol gaps and training needs.
Week 2-3: Protocol Development
We created customized wound care protocols including:
- Assessment templates integrated with their eClinicalWorks EHR
- Treatment algorithms for diabetic foot ulcers, venous ulcers, and pressure injuries
- Clear escalation criteria (when to refer)
- Documentation templates for proper billing
- Patient education materials
Week 3-4: Staff Training
We conducted two half-day training sessions for nursing staff covering:
- Wound assessment and photography
- Staging and classification
- Sharp debridement techniques
- Dressing selection and application
- Compression therapy
- Patient education
Week 4-5: Supply Chain Setup
We established relationships with wound care supply vendors and created an initial inventory of essential dressings and equipment.
Week 5-6: Launch & Support
The practice began managing wound patients in-house with WCHMO providing direct support for the first several cases. We were available for real-time consultation on complex decisions.
The Results
Twelve months after implementation, the results exceeded expectations:
38
Wounds managed in-house
69%
Reduction in referrals
$152K
Annual savings
913%
First-year ROI
Financial Breakdown
| Category | Before | After |
|---|---|---|
| Annual wound referrals | 55 | 17 |
| Referral cost | $231,000 | $71,400 |
| In-house treatment cost | $0 | $26,600 |
| Net annual savings | $152,000 |
Investment and ROI
- Program setup investment: $15,000
- First-year savings: $152,000
- First-year ROI: 913%
- Payback period: 6 weeks
Additional Benefits
Beyond the direct financial impact, the practice experienced:
- Improved HEDIS scores: Comprehensive Diabetes Care score improved 8 percentile points
- Higher patient satisfaction: Patients appreciated convenient in-house care
- Staff satisfaction: Nurses valued the expanded skillset and capability
- Practice differentiation: Word spread that the practice handles wound care in-house
"We were nervous about taking on wound care, but the training and protocols made it straightforward. Now I can't imagine going back to referring everything out. The financial impact alone is significant, but it's also better for our patients."
Keys to Success
Several factors contributed to this practice's successful implementation:
1. Leadership Buy-In
Dr. Santos championed the program from the start, which helped get nursing staff engaged and motivated.
2. Proper Training
The nursing staff received hands-on training, not just lectures. They practiced techniques and felt confident before treating patients.
3. Clear Protocols
Staff knew exactly how to assess wounds, what treatments to use, and when to escalate. There was no guesswork.
4. Ongoing Support
The monthly consulting retainer provided a safety net. For complex cases, staff could get expert input quickly.
5. Quality Tracking
We tracked outcomes rigorously. Healing rates, infection rates, and patient satisfaction were all monitored.
Lessons Learned
Key takeaways from this implementation:
- Start with simpler cases: Build confidence with straightforward wounds before tackling complex ones
- Documentation matters: Proper wound documentation enables correct billing and protects against liability
- Patient education is crucial: Healing requires patient compliance at home
- Track your results: Data drives continuous improvement and proves program value
Could Your Practice See Similar Results?
While every practice is different, the fundamental opportunity exists anywhere wounds are being referred out. If you're an HMO-contracted practice currently referring most wound patients, you're likely leaving $75,000-200,000 on the table annually.
Here's how to find out what's possible for your practice:
- Use our ROI calculator to estimate your potential savings
- Schedule a free consultation to discuss your specific situation
- Request a referral audit to understand your current wound care costs
Ready to Write Your Success Story?
Find out how much your practice could save with in-house wound care.
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