Wound Care Training/Treatment

[Momentum70]

I'm in an underserved(limited physicians) area which can have problems when trying to get specialty services. We have a wound care clinic, but it can be tough to get patients into it, or limited in how often they can be seen when they are set up. I'm at an IRF and I always have a few patients here with stage IV pressure wounds, post surgical wounds requiring wound vacs, etc. Our wound care nurse isnt bad, he is self taught and been doing the job a little over a year, but mainly just does a lot of dressing changings, nothing like sharp debridement. We also have a few therapists that have done pulse lavage in the past, but currently not allowed as there is no physician oversight.

So a few questions I have and thought here may be a good place to start.

1) Do any PMR docs here do wound care, or have you heard of PMR doing it?

2) Any suggestions on where to start for training, im thinking along the lines of courses/conferences etc?(I have below 0 interest in going back into a fellowship type of a job)

3) Can it be billed when a person is inpatient? Im thinking worse case scenario if I was to do it, then may change some of my level 1 and 2s up to 3s based on time billing.

Thanks for any help

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[DMBandFan86]

You can take a wound care course to help with knowledge. Pretty much any doctor can get board certified in wound care if you meet the minimum requirements. If you want to do wound care surgery and debridement I would personally do more training or let a surgeon handle it. If you end up making a wound worse then you will get fried.

But I was just curious about you taking stage 4 wounds on IPR. I have been trained to mostly not take them and wait until they heal a bit. Maybe that is specific to SCI, which they also talked about at AAPMR this year. I honestly haven’t been referred a stage 4, but are people taking those the IPR on a regular basis and getting them to discharge home after?

 

[Momentum70]

You can take a wound care course to help with knowledge. Pretty much any doctor can get board certified in wound care if you meet the minimum requirements. If you want to do wound care surgery and debridement I would personally do more training or let a surgeon handle it. If you end up making a wound worse then you will get fried.

But I was just curious about you taking stage 4 wounds on IPR. I have been trained to mostly not take them and wait until they heal a bit. Maybe that is specific to SCI, which they also talked about at AAPMR this year. I honestly haven’t been referred a stage 4, but are people taking those the IPR on a regular basis and getting them to discharge home after?

I dont get them often, but I do get a few. There was a bigger influx of those stage 4s after Covid as I had a lot of bad cases of covid neuropathy and disuse/critical illness myopathies from being in hospital 1-3 months. Ive had a lot of really good outcomes with the ones below medicare age with private insurance so I can keep them 3-4 months. I dont plan on taking anyone to the OR, im talking more about removing small amounts of dead tissue as they heal. We also get some pretty bad post surgical wounds. Most of our bad wounds were people that were too low functional, went to LTACH first, have slowly gotten better and now coming to IPR prior to going home.

As for what we do now, we will sometimes send to wound care clinic when they are in rehab, or set them up to be seen 1-3 times a week after they get out of rehab.

 

[cowboydoc]

The WCPC course is good. It teaches to the certification exam. I didn’t take the test or certify, as it is a money grab like most things in big medicine. Most of what I learned was exposure in residency.

I was formerly the wound care director at a nursing home. I got paid for visits and a director stipend. Most debridements weren’t paid in the SNF level of care. It made sense for the facility because of transportation costs and preventive care keeping patients from getting expensive wounds that would come back to bite the facility.

 

[Momentum70]

The WCPC course is good. It teaches to the certification exam. I didn’t take the test or certify, as it is a money grab like most things in big medicine. Most of what I learned was exposure in residency.

I was formerly the wound care director at a nursing home. I got paid for visits and a director stipend. Most debridements weren’t paid in the SNF level of care. It made sense for the facility because of transportation costs and preventive care keeping patients from getting expensive wounds that would come back to bite the facility.

Thanks, and I also dont care about any certifications as I am the same mind set that its a money grab. Ill spend my CME stipend on more courses and less tests though. 🙂