Pioneers Memorial Healthcare District (PMHD) is a 107-bed acute care facility about 60 minutes north of the Mexico/California border. The hospital opened in 1950 and boasts of its history of innovation and commitment to expand services for all residents of the Imperial Valley.
PMHD had an existing contract with another management company which was no longer meeting their needs. While the program had been generally successful, a burdensome risk-share model with high costs and a declining value proposition prompted a move towards self management. They chose Wound Care Advantage to provide ongoing management consulting services to assist in the operations of the program and provide additional help as needed.
The program has been successful across all measures and remains profitable, competitive, and continues to grow. Ongoing changes occurring at the center have demonstrated the value of building a strong consulting partnership.
Since transitioning to WCA, the program faced the loss of a long-standing clinical coordinator and the retirement of the medical director. WCA assisted with the training of the new clinical coordinator and continues to work with the medical director to ensure Clinical Practice Guidelines are followed and stay relevant.
Approximately a year into the contract, the hospital reached out for assistance due to an increase in denied claims from both CMS and private payers. WCA assisted with a preliminary review and offered solutions for improving the hospital’s denial rate. We worked with the clinical and medical staff to fix documentation issues and offered recommendations to the business office to help decrease denial occurrence and improve revenue cycle processes.
PMHD continues to benefit from the partnership with Wound Care Advantage in having a strategic partner that can address concerns related to all aspects of outpatient wound care and hyperbaric medicine. By lowering their monthly management fee, the hospital now has additional funds to put back into the wound care program and is considering an inpatient partnership with WCA to provide wound treatment support across the continuum of care.