Module A: Pathophysiology and Prevalence of Wound Care

CE Credits: 1.0


This module introduces the scope of wound care in our healthcare system—and the surprising challenges it presents. It begins by detailing the two kinds of wounds: acute wounds (such as those from surgical sites, burns and other traumas) and chronic wounds, such as those caused by diabetes or pressure ulcers. Next, the module explores how hospitals should properly document for wounds and their causes, since documentation relates directly to whether the hospital can be reimbursed for costs.

Learning objectives: After completing this module case managers will be able to:
» Discuss the prevalence and cost of wound care
» Describe the effect of documentation on reimbursement
» Discuss how CMS guidelines affect reimbursement
» Identify strategies to avoid recovery audit contractor (RAC) audits


Advance your professional practice: Case managers play an important role in wound care by acting as advocates for patients. By understanding the prevalence and risk factors for wounds—in particular, chronic wounds—we can support other healthcare team members to help prevent wounds that have high costs for patients and healthcare organizations in terms of morbidity, quality of life and non-
reimbursable costs.

Improve organizational performance: Because so many wounds are related to hospital stays, it is crucial that all transdisciplinary team members know the risks for such wounds, which very often can be prevented. By understanding how quickly such wounds can become serious, and understanding the most effective ways to document such wounds, we can reduce the negative outcomes from such wounds and increase the hospital’s chances of being reimbursed for such care.