Healogics / Wound Healing Center Work

[heybrother]

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Does anyone have any feedback on contractor/panel/part time work for a Wound Healing Center, specifically a Healogics/iHeal facility?

My employer intends for this to happen, but I'm trying to go in eyes wide open. Currently private practice - really no call expectations at all right now. I give my phone number to people I operate on, elective.

I was told compensation was either hourly or billed through my clinic. I'm leaning towards hourly because I'm skeptical I want it going back through my clinic though it opens all sorts of concerns about others doing my billing.

They appear to be semi-...obsessed with HBO in the area. I have minimal interest in monitoring dives but I think that's part of the expectation.

I keep writing paragraphs about some of my specific concerns, but I'll avoid biasing anyone - just hit me with what you think.

 

[CutsWithFury]

Does anyone have any feedback on contractor/panel/part time work for a Wound Healing Center, specifically a Healogics/iHeal facility?

My employer intends for this to happen, but I'm trying to go in eyes wide open. Currently private practice - really no call expectations at all right now. I give my phone number to people I operate on, elective.

I was told compensation was either hourly or billed through my clinic. I'm leaning towards hourly because I'm skeptical I want it going back through my clinic though it opens all sorts of concerns about others doing my billing.

They appear to be semi-...obsessed with HBO in the area. I have minimal interest in monitoring dives but I think that's part of the expectation.

I keep writing paragraphs about some of my specific concerns, but I'll avoid biasing anyone - just hit me with what you think.

Every wound care facility is obsessed with getting as many patients into HBOT as possible. I do two half days of wound care a week. It's easy money. Billing is through my hospital MSG bill department. I can understand if you are apprehensive about your podiatry practice billing department bill for it because it is a podiatry practice.

The nurses do all the dressings. I just go in and do whatever procedure necessary to heal the wound. Considering the majority of my patients have neuropathy I get pretty liberal with the procedures.

I do obvious debridement of wounds. If wound is small enough I will do wound repair procedures and primarily close the wound if I can. For hammertoes with distal toe ulcerations, if formal wound care debridement does not get it done I will do flexor tenotomies in clinic as well.

Most facilities push for HBOT when the patient qualifies because the director (nurse) who is running the facility gets work related bonuses from it. HBOT is helpful for healing challenging wounds. HBOT does not eradicate osteomyelitis. I don't give a damn what the literature says. It doesn't. I've operated on plenty of patients with residual wounds who did HBOT but failed and needed further amputation. There is always chronic osteomyelitis presence in the bone margins.

Theoretically HBOT should not work in foot ulcerations if there is severe pedal/microvascular disease seen on NIVS and/or angiogram but I have had patients who appeared to be hopeless to get their wounds to heal with HBOT. Not sure there is a lot of evidence to back that up.

 

[heybrother]

Appreciate the feedback. A friend of mine is of a similar mindset - the measuring/redressing being performed by facility staff can make a lot of the encounters very straightforward. I am interested in trying to solve problems through procedures/workup that the current providers can't do.

Hopefully will learn the hourly rate at my next meeting- will answer a lot of questions for me. Sort of curious how they determine something like that. They can't pay out more than they collect so it has to be based on some sort of average provider.

I wonder if I operate on patient's I pick up from the WHC would I follow them there verse bringing them back to my office.

I'm not averse to HBO, but your comment puts a lot of what they've already said to me into perspective. I was literally shown this facility during a job interview and the manager within 20 seconds of meeting them asked me if I knew the value and indications of HBO. I've since been told that they (corporate) got in trouble years ago for pushing HBO and I should understand I'll never be forced to prescribe it.

 

[CutsWithFury]

I wonder if I operate on patient's I pick up from the WHC would I follow them there verse bringing them back to my office.

All the wound patients who fail wound care and need surgery I bring them back to wound care for further management

 

[ldsrmdude]

Does anyone have any feedback on contractor/panel/part time work for a Wound Healing Center, specifically a Healogics/iHeal facility?

My employer intends for this to happen, but I'm trying to go in eyes wide open. Currently private practice - really no call expectations at all right now. I give my phone number to people I operate on, elective.

I was told compensation was either hourly or billed through my clinic. I'm leaning towards hourly because I'm skeptical I want it going back through my clinic though it opens all sorts of concerns about others doing my billing.

They appear to be semi-...obsessed with HBO in the area. I have minimal interest in monitoring dives but I think that's part of the expectation.

I keep writing paragraphs about some of my specific concerns, but I'll avoid biasing anyone - just hit me with what you think.

I work at 2 different Healogics facilities. I bill through my hospital group, even though the facilities are associated with different hospitals. I wasn't offered an hourly salary and probably wouldn't want to do it anyways. Might be different in private practice but since I'm paid in RVU, I get paid the same whether I see the patient at the wound center or my office and I'd just as soon bill through my clinic. My wound care day is typically my highest RVU producing day because, as was mentioned, it's a lot of procedures (debridements, graft applications, total contact casts, etc) and I can usually see more patients in the wound center than I can in my office during the same amount of time. I would also rather keep the majority of my wound patients at the wound center, keeps my clinic schedule open for more stuff I'd rather see in the office. I like wound care but I like to keep it separate from my office as much as I can.

I had the same concern about HBO and my facilities also seemed to push it as well. At one point I was told that I needed to show support to the hospital by finding patients for HBO. And I was pulled aside by the previous director and asked why I didn't use HBO and that I should be using it more. I made it clear that I would use it when I thought it was appropriate but I wouldn't go out of my way to find patients that would qualify if I didn't think they would actually benefit from it. As far as monitoring dives, I'm sure you've looked at it, but while some states may not allow it for podiatrists, it seems the bigger issue is usually with each individual hospital not allowing pods to monitor HBO. Neither facility I am at allows it and honestly, I have no interest in doing it. I'm probably also the provider there that uses it the least.

As far as bringing patients back to the wound center after surgery, for me it depends. My wound centers are not near my clinic so some of my decision making is influenced by geography but in general, I have a similar feeling as @CutsWithFury in that if I bring someone from the wound center to surgery, they are typically following up there. The exception being if my surgery eradicates a wound, ie I amputate the toe they had a wound on. Then at least my wound centers don't really want them following up if they no longer have a wound. I still can for a visit or two, but they don't want them coming there for weeks on end if they don't really need wound care.

If you have other questions, feel free to PM me

 

[heybrother]

Appreciate the detailed post and your perspective. I would say I agree with essentially everything you've written. I'll be interested to see how the local dynamics play - my state's scope does allow HBO supervision, but I wouldn't say I'm in a podiatry friendly area. In line with your lack of interest in it - I feel like I've spent the last 3 years building a skill set that others don't have. I always prefer to play to my strengths and a week course in Gainesville isn't going make me an expert. My town has no shortage of specialists, assuredly there is someone more qualified. Its at a big hospital.

 

[dtrack22]

If your employer is essentially making you do it, you need to try and get an addendum added to your contract regarding compensation specifically for this wound care clinic. Unless you have a full schedule every day in clinic and/or the OR, what you bring in from the wound care facility doesn't cost your boss as much as you being in clinic. It lowers overhead. You should get a higher cut of this (or a cut in general) separate from your original contract. The boss is going to say “no” because collections are collections, and sure fixed overhead still applies. But he/she needs less of every wound care dollar you make, to cover your cost to his/her practice.

this is only slightly different than call pay in that it is during normal business hours. But similar in the sense that it doesn’t really cost your boss anything extra. At least until you are at the point where leaving clinic for wound care means 30-40 patients you can’t see that week in clinic. They shouldn’t take a penny from you for call pay and they shouldn’t take 70% of any wound care pay (like they probably are with clinic and OR collections). I know of groups where the owner takes 15-20% of the associates call pay...you can’t let em get away with stuff like that

 

[air bud]

Don't even think about supervising HBO if allowed to in your state. I assume you don't have the medical training to diagnose and treat complications of HBO. Its not worth the risk. And a few hours at healogics isn't going to cut it.
I did their course. I think they are a bunch of scumbags.

 

[heybrother]

Thanks dtrack and airbud.
-My contract and what I'm being told are in disagreement. I don't disagree with you at all. I don't want this revenue to be siphoned.
-Yeah, I don't want to have to explain in court the barotrauma I created. I do hope to hear more of what people have to say about Healogics. My residency used them, but it was dominated by a very devoted, high integrity vascular surgeon who put finding new blood flow on top.

 

[air bud]

I was also shocked at how they had all these mid levels and non surgeons doing woundcare. Seeing them use a 15 blade on a pigs foot and knowing they might be debriding wounds after a weekend course. Just blown away from that weekend. A bunch of crooks

 

[ldsrmdude]

The statement about non-surgeons with wound care is valid, I think. One of the wound centers I am at is about 50/50 between surgeons and family docs. I frequently get referrals directed specifically towards me from vascular surgery who don't really trust the non-surgeons to manage the wound. Since the family docs don't follow their wound patients if they get admitted to the hospital, I also see a lot of their patients in that setting as well. I have seen numerous wounds that just really needed to be debrided, like a true excisional debridement with a sharp scalpel, removing all of the non-viable tissue, and all of a sudden, they start to heal. I think some non-surgeons get nervous with bleeding from an aggressive debridement and think that a brief "scraping" with a cheap disposable curette is good enough.

I think non-podiatrists in general under-offload and don't appreciate some of the biomechanics that seem basic to us. I think surgeon non-podiatrists don't appreciate the biomechanics of the foot when it comes surgery. I have seen amputations/debridements from general/vascular/orthopedic surgeons that technically get rid of dead tissue and will heal, but leave patients with terribly non-functional feet. I have several patients right now like this that I can get to heal but will always re-ulcerate. Now, I'm generalizing of course and I'm sure there are podiatrists awful at wound care and family docs who are great at it.

 

[CutsWithFury]

The statement about non-surgeons with wound care is valid, I think. One of the wound centers I am at is about 50/50 between surgeons and family docs. I frequently get referrals directed specifically towards me from vascular surgery who don't really trust the non-surgeons to manage the wound. Since the family docs don't follow their wound patients if they get admitted to the hospital, I also see a lot of their patients in that setting as well. I have seen numerous wounds that just really needed to be debrided, like a true excisional debridement with a sharp scalpel, removing all of the non-viable tissue, and all of a sudden, they start to heal. I think some non-surgeons get nervous with bleeding from an aggressive debridement and think that a brief "scraping" with a cheap disposable curette is good enough.

I think non-podiatrists in general under-offload and don't appreciate some of the biomechanics that seem basic to us. I think surgeon non-podiatrists don't appreciate the biomechanics of the foot when it comes surgery. I have seen amputations/debridements from general/vascular/orthopedic surgeons that technically get rid of dead tissue and will heal, but leave patients with terribly non-functional feet. I have several patients right now like this that I can get to heal but will always re-ulcerate. Now, I'm generalizing of course and I'm sure there are podiatrists awful at wound care and family docs who are great at it.

This x 1000000000000000%

This is my reality. Our wound care center is a disgrace. It’s me and a bunch of family medicine doctors who are so arrogant and oblivious to foot and ankle anatomy/biomechanics they really shouldn’t be managing foot and ankle wounds.

Then when $hit hits the fan they tell their wound patients to go to the ER so that yours truly can deal with it. Must be nice...

I have one wound care APRN at the center who has a huge chip on her shoulder. I have found that wound care APRNs are just as oblivious and arrogant when it comes to foot and ankle ulcer management.

Another challenging aspect about these wound care facilities is that if you have a non compliant patient these facilities will not allow you to discharge the patient. They will just transfer the problem patient to another provider so they can continue to bill. It can become a medico-legal dilemma.

I had one non compliant patient who I discharged that just got transferred to one of the internal medicine providers. As expected the wound continued to get worse. Internal medicine provider just sent the patient to the ER.

I refused to see the patient since I discharged and had the patient transferred to another facility. This has been my only way to combat the wound care center from dumping patients back onto me.


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[DYK343]

I am strongly considering giving up wound care in general. Its just not worth it to me. Compliance is low. Results are "meh" because the wounds return. And the after work I&Ds with morning/lunch rounding is getting to me. It doesnt pay well considering all the work that goes into it and the rewards are low.

Bascially. I wanna be Natch. I envy Natch.

 

[air bud]

I am strongly considering giving up wound care in general. Its just not worth it to me. Compliance is low. Results are "meh" because the wounds return. And the after work I&Ds with morning/lunch rounding is getting to me. It doesnt pay well considering all the work that goes into it and the rewards are low.

Bascially. I wanna be Natch. I envy Natch.

I can count on 2 hands the number of wound patients I have treated in the last 18 months at my current job. I have had 1 inpatient consult in the 18 months at my current job. I have never had to go in to the ER afterhours other than for cool trauma in the 18 months at my current job. I go to work 3.5 days per week from 9-12 and like 1-4 with breaks in between.
Maybe you want to be Airbud?

Also, having some contract discussions with my job and they said if I were to leave they would replace me because I am overall profitable/good for the hospital/community.

 

[CutsWithFury]

I can count on 2 hands the number of wound patients I have treated in the last 18 months at my current job. I have had 1 inpatient consult in the 18 months at my current job. I have never had to go in to the ER afterhours other than for cool trauma in the 18 months at my current job. I go to work 3.5 days per week from 9-12 and like 1-4 with breaks in between.
Maybe you want to be Airbud?

Also, having some contract discussions with my job and they said if I were to leave they would replace me because I am overall profitable/good for the hospital/community.

Go to hell

 

[GreenHousePub]

I can count on 2 hands the number of wound patients I have treated in the last 18 months at my current job. I have had 1 inpatient consult in the 18 months at my current job. I have never had to go in to the ER afterhours other than for cool trauma in the 18 months at my current job. I go to work 3.5 days per week from 9-12 and like 1-4 with breaks in between.
Maybe you want to be Airbud?

Also, having some contract discussions with my job and they said if I were to leave they would replace me because I am overall profitable/good for the hospital/community.

Christ, man. Have a little humility.

 

[Scrantonicity]

Also, having some contract discussions with my job and they said if I were to leave they would replace me because I am overall profitable/good for the hospital/community.

You basically just invited someone to put out a hit on you--I'll just go ahead and send in my resumé...

 

[air bud]

But back to Healogics. Per my previous job and experience, they suck.

 

[dtrack22]

I can count on 2 hands the number of wound patients I have treated in the last 18 months at my current job. I have had 1 inpatient consult in the 18 months at my current job. I have never had to go in to the ER afterhours other than for cool trauma in the 18 months at my current job. I go to work 3.5 days per week from 9-12 and like 1-4 with breaks in between.
Maybe you want to be Airbud?

Also, having some contract discussions with my job and they said if I were to leave they would replace me because I am overall profitable/good for the hospital/community.

send me your CFOs info (maybe that regional guy who was in charge of creating the position too) so I can put them in touch with the hospital I’ve reached out to. K, thanks.

 

[DYK343]

I just put in a 16hr day with no break with exception of the 1hr Gen surg bumped me.

Damn wounds.

 

[ExperiencedDPM]

Our practice used to staff a few Healogics centers. The MDs wanted to supervise the hyperbaric dives since it paid well. As per another post above, all the crap got dumped on us and we were always getting calls from the ER and consults on these nightmares. These patients always waited until Sunday at 9 pm to show up in the ER. Then I’d have to cut late since the idiot stopped on the way to the ER to get a Big Mac and milkshake. So anesthesia wouldn’t go near them. So I would do the case at a ridiculous hour and have to be at the office at 7 am to see 56 patients the next day. So I finally convinced my partners to bail on the wound care center crap. Best decision we made.