Healing Smarter With NPWT: Where Patient Outcomes Meet Economic Value, Part 1

Host Jonathan Johnson, MD, welcomes Cindy Miller, RN, and Yesenia Banks, CPC, to explore new findings on an all-in-one negative pressure wound therapy dressing. Discover how extended wear improves workflow efficiency, saves nursing resources, and delivers significant cost savings across acute and home health care. 

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This podcast is for educational purposes only.

Dr Jonathan Johnson: Welcome to another Wound Care Wednesday. Now, this is your go-to podcast for all things wound care-related, healing, and innovation. Now, whether you're a health care professional, a caregiver, or just passionate about the advancement of wound management, you're in the right place. So grab your coffee, grab your water, or grab your glass of wine, and let's get rolling. I'm your host, Dr Jonathan Johnson, also known as Dr Wounds, and we're joined today by guests Cindy Miller and Yesenia Banks, who are here to share the story behind a recent study and the implications for quality care delivery and how clinicians can integrate the study findings into their practice. 

We're diving into a timely and important conversation, one that coincides with the recent launch of Solventum's V.A.C. Peel and Place dressing. Now, this is an all-in-one, extended-wear, negative pressure wound therapy dressing designed to simplify application, improve workflow efficiency and extend wear time up to 7 days. This innovation comes at a critical time across both the acute and home health settings. Clinicians are being asked to do more with less—less staff, less time, and tighter budgets. That's why the findings from this great poster we're discussing today, which is called Evaluating the Health Economic Value of Implementing an All-In-One, Extended-Wear Negative Pressure Dressing, are so impactful. Today we’ll unpack what these findings mean in real clinical terms, how workflow efficiencies translate into better patient care, how extended wear impacts outcomes, and what these results suggest for hospitals and agencies navigating resource challenges in today's wound care market. 

So before we get started, I'd like to introduce two awesome members of the Solventum team. Our first guest, who is a superstar in her own right, is Yesenia Banks, and our second guest is Cindy Miller. Glad you guys were able to join us today. 

Yesenia Banks: Yes, thank you for having us. 

Dr Jonathan Johnson: Great. Okay, so before we get started, Yesenia, tell me a little bit about the Solventum story, how you got involved, and why you're passionate about wound care. 

Yesenia Banks: Oh, I could be here all day. So I will start a little background about Solventum. So we have evolved. We started, go back to KCI company and the V.A.C. was created over 30 years ago. KCI was acquired by 3M in 2019. And last year, April of last year, the medical division spun off from 3M to its own company, and that is when Solventum was born. Our mission statement is to enable better, smarter, safer health care to improve lives, and I will say that that is something that we are constantly striving for. So I'm happy to be with you today. 

Dr Jonathan Johnson: Great, great. And so tell us a little bit about the goals and results of the poster that we discussed in the introduction. 

Yesenia Banks: Sure. So the poster really showcased potential time and cost savings when switching from the V.A.C. Peel and Place dressings from traditional advanced wound dressings or our traditional negative pressure wound therapy dressings. It used economic modeling. It provides budgetary insights for home health organizations by calculating health economic scenarios based on customized inputs. It looked at material and staffing costs on the acute side. So it really gave an insight as to the savings in supply costs as well as staffing, staffing time reduced by switching over to the Peel and Place. 

Dr Jonathan Johnson: Great. Awesome. One of the major things about wound care and research and understanding where we are in the world of wounds is new topics, new products, and new research will always be evolving, so it’s always great to have new concepts focused on improving clinical wound care. 

So let’s talk a little bit to Cindy. Cindy, tell us a little bit about your role at Solventum, and help us understand why workflow efficiency matters in wound care.

Cindy Miller: Thank you, Dr Johnson. I’m a registered nurse, and I’ve been a nurse for 47 years. I’ve been with Solventum for 33, since the early KCI days. And my current role, I'm in the medical department in a global role. And my title is director of Medical Affairs, chief of Nursing for the Advanced Wound Care Division. And I am extremely passionate, as you are, about helping our patients get better as quickly as we can. 

Dr Jonathan Johnson: Great. So can you describe some of the clinical challenges with new dressings, as it was designed? Go ahead. 

Cindy Miller: Yeah, no, thank you for that. So when we first launched back in 1995, can you believe it's been 30 years, sir, we revolutionized wound care, because back then we were doing TID, wet-to-moist gauze. It was such a huge quantum leap. But even to this day, as wonderful it is and all the data that's out there that points to improved healing outcomes and avoidance of complications, it's still a very challenging dressing to apply because you have to cut the foam, you have to know where to put it, how much to put in, keep count, get a seal, apply everything, turn the V.A.C. on, and then you get to rinse and repeat it 3 times a week. 

And so, with what we were mentioning earlier, that we have less staff, we're asked to do more, I've never had a director of nursing say to me, “I just have too many nurses. I have no idea what to do with them.” We're short-staffed, and our patients are becoming increasingly complex. So as we listen to folks, such as yourself and different clinicians across the globe, we were hearing things consistently, and that's like, “I love what I see in the way of outcomes, but it's so hard to teach and to get someone up to speed, especially for as many wounds as I see in my practice.” 

And so, we wanted to do several things. We wanted to make it easier to apply. One of the biggest things we wanted to do was remove the chance of a retained piece of foam. Those sentinel events should never happen, yet we know that unfortunately, even with all the care, that can be something that occurs. So we wanted to do that as well as increase the wear time because when traditional Granufoam is left in the wound, the granulation grows up into the foam and it can be very challenging and painful to remove that. 

Dr Jonathan Johnson: Got it. 100% makes sense. So, if we're looking at some of the clinical pearls that we need to focus on when utilizing the V.A.C. in our clinical practice, tell us a little bit about those pearls. Tell us a little bit about how we can effectively utilize the V.A.C. to improve wound care healing rates. 

Cindy Miller: Such a wonderful question. And we know that wound healing involves the wound contracting over time as granulation occurs. Wound contractions, one of the things that happens naturally. We can expedite that by having the negative pressure, that mechanical force and draw that pulls the edges of the wound up and in towards the center. And with the new V.A.C. Peel and Place, instead of having to go through all that arduous training and counting and removing and the patient's pain, we now have a cover dressing, sir. It takes less time to put this V.A.C. Peel and Place over a wound, an appropriate wound, than it does to put alginate in the wound and slap a foam on top. It's under 2 minutes. And so what it's allowed us to do is treat more wounds easier for the clinician, easier for the patient because there's no tissue ingrowth into the foam because of the way it's constructed. It's easy to apply, very easy to remove, and many of our patients report 0 in their pain score compared to what they had reported before. 

Dr Jonathan Johnson: Wow, that's amazing. That's amazing. So, one of the major factors that I think you're saying is that, number one, we're reducing the amount of time for placement of the V.A.C. We're focusing on, number one, the patient's quality of life and reducing pain with the decrease of the number of dressing changes. And we're also looking at economic savings. 

So that transitions to another great question. Yesenia, tell us a little bit about some of the economic advantages of using the V.A.C. as well as some of the time savings that clinicians definitely need to get back as far as being able to save their time as they see patients in different locations, et cetera. 

Yesenia Banks: Sure. That's a great question. So we'll start with home health. We hear, and I stay up to date with all of the proposed changes, and currently, home health, there is a proposal to cut some of their Medicare reimbursement. And so they're looking at just reductions in what they're going to be paid for. And staffing continues to be a challenge. So by a nurse going out to the patient's home potentially once a week versus the 3 times a week, it allows a home health agency to schedule that same nurse to go see other patients. 

But in addition to that, the time involved, like Cindy mentioned, is much less. There's less arts and crafts. So being able to schedule more patients to be seen by that nurse in a day has been a game changer for us and has been a game changer for many home health agencies. And I just want to add in, when a clinician orders the V.A.C. for a patient, we get that order, we verify the patient’s benefits. And when we go through that process of verifying the patient's benefits, we then send the device, the dressings, and the canisters to the patient's home. So one thing that is helpful to the home health agencies is that there is no supply cost to that home health agency. We send the supplies to the patient's home. 

Now, if that patient is not being followed by a home health agency, that patient can bring their dressings and canisters and the device to a wound care center or a physician's office. And so again, the wound care center, the physician's office does not have that out-of-pocket supply cost. And the patient with the Peel and Place is not having to make those frequent visits to their provider if they’re not being seen by the home health agency. 

So many different aspects of cost savings, not only to the clinicians but to the patients, whether it’s time involved to go back to their wound care center or potentially out-of-pocket costs since they’re utilizing less dressing, so potentially less out-of-pocket for them.

Dr Jonathan Johnson: So Cindy, tell us a little bit about which wounds we can use our Peel and Place V.A.C. on.

Cindy Miller: Thank you, sir. It is a dressing on extension under the FDA clearance process, but, and so therefore it has the same type of wound indications and contraindications. However, the selection of the wound must be pretty crisp. And what I mean by that is we don't ever want to ask a technology to do more than it was designed to do. And so to that point, because it pulls the wound up to itself to the dressing, while the dressing is making a footprint, like if you walk in wet sand on the beach, you'll actually see the imprint of the wound once it's pulled down. We can use V.A.C. Peel in Place on wounds up to 6 centimeters deep, no tunnels whatsoever because of the way it works, and there's no foam in the wound. We don't want to snip the opening of that tunnel closed. So no tunnels whatsoever. And it can scoop into undermining up to 2 centimeters. So if you have all those, you have an indicated wound column, you don't have any of the contraindications, no deeper than 6, no tunnels, and undermining up to 2, you're good to go. 

Dr Jonathan Johnson: Awesome. So, and then the traditional contraindications of a V.A.C. system still apply, correct? 

Cindy Miller: Yes, sir. Yes, sir. 

Dr Jonathan Johnson: Active infection is an issue. If we see extensive bony or vascular appearance at the wound base, we know that those are still contraindications, correct? 

Cindy Miller: Well, yes, there's things like active untreated osteo, there's the malignancy in the wound, there's eschar in the wound. And it can be used with discretion if there's deeper structures, but you do need to follow the clinical guidelines so far as multiple layers of a non-adherent before you put the Peel and Place over. So it's up to the clinical acumen of the treating physician or health care provider. And we look forward to helping anyone that’s not had a chance to use this to learn the sweet spot of where to use it and where to go with traditional V.A.C.

Dr Jonathan Johnson: Perfect. And then Cindy, also help us understand which providers can actually utilize and place the V.A.C. Some folks may not understand that a, what I was going to try to say is like some folks, and I've seen in facilities at times where the LPN is trying to place the V.A.C. Is there any contraindications there or does it need to be a… 

Cindy Miller: Well, I don't know if it varies state by state with LPN or LVN, but one of the things that makes this so easy, if they are licensed to perform that activity in their state, then this is so easy to do. And it certainly needs to be under the auspices of supervision of an RN or a PA or NP or someone like yourself, but it just makes it so simple to apply. It does require a physician’s prescription, and it does require that 125 negative pressure, whatever the choice is. It can be used between negative 75 and negative 150 millimeters of mercury, this particular dressing. 

Dr Jonathan Johnson: Got it. Okay. Perfect. So Cindy, help us understand a little bit about the Peel and Place dressing in an acute surgical or in the operating room for those that are doing a lot of complex surgical procedures on patients. Tell us a little bit about how that resource can be utilized to help those patients heal effectively. 

Cindy Miller: Thank you. That's such an important question because time is money in the OR. Anesthesia, the more they're under anesthesia, the higher the risk factor for different problems. So what we're finding that our surgeons are using this especially on is to bolster a split-thickness skin graft. That's phenomenal because if a normal skin graft bolster application with traditional Granufoam takes you 12 minutes, this is under 2 minutes. You don't have to put anything down over to protect the graft. And you'll surprise anesthesia, say, “Okay, we're ready.” 

So they're finding that wounds that have been debrided and have adequate hemostasis, we're seeing a lot of benefit with the traumatic injuries or complex dehiscences that have been debrided. And because it works differently, it pushes down on the periwound skin while it pulls it up, sort of like Chinese cupping, where they put the glass bulb on the back, the soft tissue distortion pulls at a deeper cellular level than traditional Granufoam. And we're seeing a very rapid volume filled, anecdotally so far, but we are getting some posters and some things out there to really look at the difference that we're seeing in volume fill. 

Dr Jonathan Johnson: Great. Great concepts. I mean, one of the major issues we see from a surgical standpoint in the operating room are: What can we use if we have an infected wound or an infected post-surgical site that we need to clean out, but we don't want to close the wound from a primary closure standpoint, right? We may want secondary intention, tertiary intention. We can utilize the V.A.C. in that specific situation. So that's a great resource to know for those surgeons out there as well. 

So we've talked a little bit about the different places of service. And as we know, health care is really shifting towards the home health way of practicing medicine. Tell us a little bit about the Peel and Place dressing and how it's utilized in a home health setting and what are some of the advantages of utilizing it there. 

Cindy Miller: Yes, thank you. What an important question because anytime someone's cared for in their home, I think they feel more comfortable, they're more relaxed, their emotional status is better. And when we look at wound care, if you're going through painful dressing changes 3 times a week, and you're having to make sure that the door’s unlocked or you've got somebody there with you for when the home health nurse is going to show, to be able to take that and remove much of the discomfort, because it's just a cover dressing, to remove that discomfort both on application and removal, which we’re hearing over and over anecdotally from our patients that’s no pain or maybe “I had a 1 and before it was an 8,” that’s a huge benefit to the patient. Also, it’s able to be left in place for longer, which makes it easier for the patient, and scheduling the home health nurse to come out, is such a game changer for the home health agency. And the training doesn't have to be as specific. They could send someone out there that does a V.A.C. dressing change maybe twice a month, and this one's so easy. And if it's easy, sir, it's less chance for an adverse placement, a variability in clinical application. You literally center it over the wound, peel off the backing, place it down, get a seal. The hole's already pre-cut, so you don't even have to cut that. You could do this dressing application with no scissors whatsoever. 

So it's just so beneficial for the patient. And then because things are going better, their quality of life—get up, be able to move around the house, not have to worry so much. And when they go out, because this is also, ActiV.A.C. is our most common therapy unit to be used in the home, but Peel and Place can also be hooked up to our disposable Prevena Plus pump that is a disposable unit. So let's say you're bolstering a graft and you're just going to send them home. You could just send them home on the Prevena Plus and bring them into your clinic next week and take it down. It's just so many variable, wonderful things we're finding out. 

Dr Jonathan Johnson: So Yesenia, being a reimbursement and coding expert, tell us a little bit about how the Peel and Place dressing is advantageous from a coding perspective, a reimbursement perspective. How do these data points translate into value for hospitals and specific home health agencies? 

Yesenia Banks: Sure. Great question. So in an inpatient setting, the usage of negative pressure wound therapy is not separately reimbursed. But we've talked quite a bit about the time saving, less supplies needed, less dressings needed. So from an economical standpoint, there are definitely benefits. In a home health setting, when a home health nurse goes out to the patient's home and changes the back dressing, it's considered one of their nursing visits. We've talked about the benefits of having to go to the patient's home less times per week. And they are not paying for the dressings. We're billing directly to the insurance company. 

Now, when the patient goes to a wound care center/physician office, the patient will bring their dressings and canisters with them. So there is no supply cost to a wound care center/physician office. The wound care center/physician office can bill. There are designated CPT codes for dressing changes. There's 2 of them: 97605, 97606. The difference between the two codes is the size of the wound. And so those codes can be used when the dressing change is done at a wound care center/physician office. Now, it's important to note that Solventum obtains any prior authorization requirements from the insurance company for the device, the dressing kits, or the canisters. It's important to just remind wound care centers and physician offices that if they are billing for—which they should be—billing for the dressing change with those CPT codes, to just check to see if there's any prior authorization requirements for those codes specifically. Since we're not billing for them, it's important for them to check benefits, just like they would for all of the other services/procedures that they are billing for out of that care setting. 

Dr Jonathan Johnson: Got it. Got it. Makes sense. Well, thank you for helping us understand that reimbursement and coding side, which is very important, right? I mean, I think the entire point of our poster is looking at economic viability for wound care and health care in general and also making sure how it positively affects our patients. 

So it seems as if workflow and cost efficiency are two of the major advantages utilizing the V.A.C. system. So tell us a little bit about the advantages of using the V.A.C. system in specific places of service—the hospital versus the short-term stay versus a SNF versus home health? What are the advantages in these specific places of service to utilizing the Peel and Place dressing? 

Yesenia Banks: Sure, I can answer that. So in the acute setting, as you mentioned, inpatient hospital, SNF, perhaps in LTAC, in those care settings, the facilities are paid a bundled rate to care for that patient during the time that they are there. And included in that bundled rate is any supplies that are used. So by utilizing less dressings, there's less cost to them. And then in addition, as we've mentioned throughout this podcast, is the less time involved in the application. So less supply cost to them. They are paying for the dressings in those care settings, but less nursing time. And then one thing, and Cindy might have mentioned this, one thing is less time involved in training nurses to apply the Peel and Place dressings. Because it is easier to apply, there is less training involved, which is helpful as we see turnover in nursing positions. So that is something that I also want to point out. But in the acute care setting, again, less supplies ordered, less time involved. And then as I mentioned in the home health setting, they do not have that supply cost, since we are able to bill the insurance company directly, home health agencies, wound care centers, mobile wound care providers, physician offices—they do not have that supply cost. We bill the insurance directly. And if there's any out-of-pocket cost for the patient, we're able to bill and arrange any financial arrangements with the patient if it is necessary. 

Dr Jonathan Johnson: Great concepts. Thank you for that answer. So what we want to do to wrap everything up today, tell us a little bit about what the listeners, providers, and/or colleagues would really want to take away from the poster that we've discussed today during the podcast. 

Yesenia Banks: The big two takeaways is less cost, less supply cost, less time involved, less nursing time, which all equal savings for the patient as well as the clinician. The biggest impact that we've seen in a post-acute setting in a home health, wound care setting is just the reduction in nursing time involved to apply this, it would be the biggest cost savings. We know that that is a big factor when they're scheduling their team. And so that is one of the big takeaways of the poster is just highlighting the efficiency in using this new dressing. 

Cindy Miller: Yesenia, I agree. And Dr Johnson, what we've been so thrilled about besides the ease of use and the cost and the time savings and workflow efficiency is the patient experience. Their ability to not have to suffer as they do sometimes with a Granufoam removal, those that have been on V.A.C. before are so delighted. They're delighted they only have to come into clinic or the doctor's office once a week, if that's their clinical choice to do it once a week, and their ability to get on with their life, working adults, people that live a long way away from the clinic, there's so many side benefits from the patient's point of view. We're just delighted to bring this to market. 

Dr Jonathan Johnson: So that's a great note to end on; turning evidence into action. What we've heard today reinforces how innovations, like the V.A.C. Peel and Place dressing, can simplify workflows, reduce costs, and ultimately free up clinicians to focus more on what matters the most: patient care. A big thank you to Cindy Miller and Yesenia Banks for joining us and sharing their perspective on this important new research and to the Solventum Corporation for sponsoring today's episode and supporting ongoing innovation in wound care. Now, we discussed the poster presentation, and we would like every one of the listeners to go to the website for the poster link and understand more about the V.A.C. Peel and Place and how workflow and economics has positively impacted wound care based on this research. So we'd like to thank all of you for joining us today on another Wound Care Wednesday. I’m Dr Jonathan Johnson, also known as Dr Wounds, and we will see you on the next podcast.