Key Takeaways
- Interdisciplinary care > multidisciplinary care—true collaboration requires communication, not silos.
- Mobile wound care logistics matter: preparation, supply management, and environmental conditions affect care delivery.
- Regulatory knowledge (F-tags) is essential in long-term care to avoid penalties and maintain contracts.
- Short-term cost concerns can worsen long-term outcomes if advanced therapies are underused.
Transcript
Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text.
Catherine Milne:
Welcome back everyone to Wound Conversations, the podcast where wound care professionals come together to learn, share, and advance the practice of healing. I'm Cathy Milne. I'm a wound care nurse practitioner, and I'm also the co-chair of WoundCon and the clinical editor of Wound Source. Today and as in all of our episodes, we're here to share actionable insights from leaders in wound healing. Today, we are pleased to welcome back Pamela Scarborough, PT, DPT, MSCWS, FAAWC, and all around Guru of Wound Care. We spoke with her a couple episodes back about the importance of the concept of mobile wound care. Today, we're going to dive into the day-to-day workings and how it all operates. Let me tell you a little bit about Dr. Scarborough. So Dr. Scarborough is the director of education and the fellowship program for the United Wound Healing. She brings over 40 years of experience across the healthcare continuum.
Pamela is a very sought after national speaker on wound prevention and management. She's an entertaining speaker too. I always go to her lectures because they're great. She's the co-founder of the Wound Care Certification Prep Course, a valued faculty member for WoundCon and the SAWC. And if you don't know what that means, it's the Symposium for Advanced Wound Care. And she has been a contributor to WoundSource. Welcome back, Pamela.
Pamela Scarborough:
Thank you, Cathy. Appreciate that so much. So what do you think we want to talk about now, Cathy?
Catherine Milne:
Well, I want to tell you who's bringing this to you and to all our audience. And WoundConversations is brought to you by WoundSource, the trusted resource for wound care professionals and WoundCon, your connection to global virtual education and wound management. So let's get started with the episode because we want to listen today and apply tomorrow. We asked you this last time, but we're going to ask again in case we have any new listeners. We'd like to kick things off by asking our guests about their wound care why. And so now I kind of want to make it more specific to mobile wound care. What attracted you to that?
Pamela Scarborough:
Another great question. I was that physical therapist in the long-term care facility that was doing what I could, but I didn't have providers in the long-term care facility. I didn't have my WOCN nurses. Physical therapy was doing the wounds primarily, the debridement, that kind of stuff, and then the nurses were doing the dressing changes. And we were desperate. We were desperate for providers who understood this specialty. Our medical directors didn't understand it. The people that were putting the patients and the residents into the nursing home, they didn't understand the wounds. I'm that person that's, again, frustrated with not having access to the people that have the knowledge to come in and help us. And when I had the opportunity to work with a mobile wound care group, it struck me that I could make a difference by teaching the mobile wound care group, the providers how to go to the basics of wound management.
So I got into this for mobile wound care because I once again was that person that needed the provider's support, knowledge and help in wound medicine to be able to do this better in the facility. So that's why one of the reasons that I love mobile wound care and came to support it at the end of my career, I'm going to support mobile wound care until I finish my career.
Catherine Milne:
You mentioned something really interesting, and that's collaboration because PT isn't, I don't think, and same with the dieticians. I don't think that these specialties are really appreciated enough in the mobile wound space. So they aren't appreciated in long-term care or even in home health. And so it's a real challenge when you say, "Hey, I think I can help you help your patient." So how do you go about doing that?
Pamela Scarborough:
Well, I have to teach you about physical therapy first.
Catherine Milne:
Okay.
Pamela Scarborough:
That's where we have to start. And by the way, physical therapy is the only profession right now that requires integumentary as part of your curriculum to get your doctorate. You have to have a semester of the integmentary system, which is wound care. And we even have wound care fellowships and physical therapy, and we have wound care rotations in physical therapy. What is so negative to me is the therapist not being utilized. For instance, here's a perfect example. When we look at venous insufficiency, the cornerstone is compression, but if you want to get the best outcome for that compression, you do exercises in compression, whether they're bedbound exercises, chair exercises, or walking, which is the best in compression. However, our nurses and our physicians and our NPs and our providers, none of our providers are doing exercises. We're leaving out a quarter of our treatment for venous insufficiency and lymphedema and phlebolymphedema.
And there's also a component in there even for arterial insufficiency at sometimes. So the other thing that we don't realize is that the therapist can do legally conservative sharp debridement. So when we look at collaboration, we need to get outside of our credential and see what the other credentials can bring to us by licensure, by reimbursement. There are several methods for reimbursement for physical therapy, including therapeutic exercise, which is the biggie that we leave out of our wound care plan, Cathy.
Catherine Milne:
So why do you think management teams of skilled nursing facilities and home health agencies underutilize the physical therapist?
Pamela Scarborough:
I think it has two components. One is the physical therapist. They only want to do whatever they think they want to do. I was an orthopedic physical therapist, a sports medicine physical therapist, a cardiac rehab physical therapist. I've specialized in all of those now wound care physical therapist. And I had to learn what each of these teams that I was on, what everyone else brought. We don't do that. We still stay in our silos. We say we're multidisciplinary and say, multidisciplinary isn't great. Interdisciplinary is great. Multidisciplinary means we're still in our silos and we're still not talking. We might be looking at each other's notes, but we're not talking. That's not true interdisciplinary. So collaboration means you talk to each other, you know the skillsets and what each and every health professional brings to the table for whatever your team is doing, be it cardiac rehab, sports medicine, doesn't matter.
wound care. What does the rest of the team know how to do? What does their license let them do? And not to be left out, what can we get reimbursed for by these other professionals?
Catherine Milne:
Right. So I find a lot of C-suite people say, "My physical therapist only gets paid when they see a patient and when they talk with people, they're not getting paid." Or these modalities that we use, they're too expensive. I know how I would respond to that. How would you respond to something like that?
Pamela Scarborough:
Leaving that wound open is more expensive, but more expensive, not to use that electrical stimulation, not to use that negative pressure, not to ... It's going to be more expensive in the long run. We are having shortsightedness when we talk about, well, we can't do that because it's expensive. Well, continuing that wound being open, potentially going to infection, potentially going to sepsis and death is going to be way more expensive, that negative pressure wound therapy or that mattress or whatever it is that we're being denied that that person needs.
Catherine Milne:
And also, I think now that reimbursement is now focusing on that return to the acute care facility, because these settings get penalized financially for those returns back to the acute care setting. So using the therapist to their utmost scope of practice is, why wouldn't you? So I think we have a lot of things that we need to work on in that area. So I want to get into the unique aspects that mobile wound management can provide from a clinical perspective. You kind of touched on a little, which is the e-stim and diathermy and a few other things. Anything else?
Pamela Scarborough:
Well, when we're looking at all of mobile, so are we looking at the whole team? Is that what we're talking about right now?
Catherine Milne:
Well, I think all of mobile because we are interdisciplinary.
Pamela Scarborough:
Okay. As we look at the whole ... And not all of the whole team is engaged simultaneously. You mentioned dieticians who are critical, of course. And one of the most important people on the team when it comes to wound prevention and even management, one of the most important people on that team is a CNA. And every time I teach a course, I say, "Do we have any CNAs here?" Sometimes I get one hand and I'm so grateful that we have a CNA because most of the tasks for preventing wounds is on the shoulders of the CNA and they get the least amount of education for continuing education than anybody else. So that is a whole. When we look at educating people, educating the CNA, of course, our dieticians are important with the nutrition component and our speech language pathologists are important…
Are we looking at this whole team or are we doing provider and nursing only? If we're doing provider and nursing only, you're leaving out considerable components, facets that can help us to reach the goals that we're trying to reach. Now, there are some holes in accessing certain specialties, and that is a problem in post-acute care, Kathy, be it home health, be it long-term care, be it assisted living. It doesn't matter. We have some holes and sometimes being in a hospital, those holes are plugged. For instance, I need vascular now.
There are certain states that we work in in the Northwest. We can't get vascular now like you could at a hospital. So that becomes a problem. Oftentimes, I tell my providers, dermatology and wound management are sister professions. We get so much stuff that has a dermatological component to it, but it becomes a wound. And so we need to be able to do both. So we don't have all the knowledge even with wound management. Some of us don't have the dermatology background. That's another hole. So we do have holes. There are other team members we do have to bring in from the outside and you have to make up your list for that, Kathy.
Catherine Milne:
Yeah. And those are wonderful challenges that really stand out in mobile wound care. And when you do identify somebody, and those people most likely will not do mobile. So you have to convince the patient that they need to go to that person's office or clinic or wherever. But sometimes the wait times are so long for some of these special providers. And I find that that's a huge challenge for me in my practice. And I think it's a practice issue that we see across the country. So are there any operational or business related components that you think are either unique and/or challenging or both?
Pamela Scarborough:
Both. Yes. So Cathy, how do you set your car up when you go to do your work? Is that a challenge?
Catherine Milne:
Yes. And you know what else is a challenge? And I think any home health provider would agree with this one is it may be 60 in the morning, it may be 100 by 12 noon. And what's happening to the equipment in my car that I didn't bring in?
Pamela Scarborough:
That's right. Absolutely. So again, these are challenges. And if you have to keep things cool, there's sometimes you have products you have to keep cool. Are you putting refrigerators in your car? Little refrigerators you can plug in. Some people are and some people aren't. When we talk about challenges from operational perspective, getting your car set up, getting all of your things organized, you have to organize yourself to be able to do this in a timely, efficient way. And you have to organize it the night before so you can go out the morning of. So that's a challenge. And when we get there, do we have all the things we need? Do we have whatever we're going to use to decrease their pain when we do either the dressing change or debridement? Do you have whatever you're going to need to do to take care of the ... Do you have your antimicrobials and do you have the right antimicrobials that you're going to want to use?
Do you have the right dressings? Do you have the methodology you're going to have it to be attached to the skin? So there are some things that we need to think about. So that's the car. And then as we're talking about challenges, either clinical or operational, I just want to bring up, if you're doing long-term care, which we do a lot of long-term care, a lot of nursing homework, if you don't understand the regulations, it's going to eat your lunch and you are going to work yourself out of mobile wound care practice and long-term care. If you set the buildings up for F-tags, for federal tags, because you are as a business and your clinicians, as the wound care providers do not understand the regulations which frame up our clinical practice in long-term care, you're going to get fired. You get the building's F-tags, they're going to have to fire you.
They have no choice.
Catherine Milne:
So for those listeners today who don't understand what an F-tag is, can you quickly explain what that is?
Pamela Scarborough:
Yes. And the F, it doesn't mean failure. F means federal, federal tag. And F686 is the integumentary tag for long-term care. This tag, this was set up so that the surveyors, they're called surveyors and they come in and they look at your practices and wound care is only one thing. They look at everything that's going on with that patient or resident. And these tags are the minimum. They frame up the minimum of what you should be doing from a clinical and our emotional supports perspective for these people. And if you do not do some of these things, for instance, if they get a pressure injury because you didn't have a turning schedule in place, you're going to get an F686 tag. And when that building gets that tag, they have to put in a plan of correction. They have to put in education. They have a time limit to get this done.
They are also at risk for fines, for sometimes very hefty fines if there was harm to the patient. So F tags are a big deal and actually drive clinical practice in long-term care also. So if you're going to go into long-term care, get you a good person that understands the regulations because it'll eat your lunch otherwise.
Catherine Milne:
Yeah. And I think when people who have never practiced in long-term care go into long-term care, they're shocked about all the regulations and how you have to word things so they meet the regulations. And it actually can be so daunting people leave practice and it is one of the most rewarding places to actually give care. So it's a challenge. The other thing about FTAGs is that they are published. These surveys must be available to anybody who asks for them at each facility. And when that happens, so if you're a family member, you're coming in to take a look at the facility and for a loved one, you might pick up this manual of what the surveyor said and read that somebody didn't have incontinence care and eventually developed a horrible wound. So you're not going to put your loved one there or that the mobile wound care provider didn't wash their scissors in between patients.
I mean, and that's what gets mobile wound care providers fired.
Pamela Scarborough:
There you go. Back to infection control practices.
Catherine Milne:
Infection control, right? And that's a different type of tag number. That's what people will look at and the community can look at. And it's a transparent process, which it should be. So mobile providers actually provide a lot more than just the wound care piece. So when we talked about at the last episode, what a employer in mobile wound care looks for in a potential employee. Let's kind of look at the potential employee. What should they be looking for or asking about when they're exploring the possibility of entering the wound care healing profession?
Pamela Scarborough:
I think one of the most important things that people need to be asking for is, do I get education? What kind of education do I get to be able to do this if I've never done this before, this specifically? Knowing whether or not they're going to have the education that they need to be successful, they should be asking about it. Probably they don't, but that's one of the things I want to know. Not only where do I get the education for what I'm going to be doing, but where will I be doing the work? Because some mobile wound care practices are doing ... Stay started out in home health. So their practice is mostly home health. Others are long-term care. Others are a hybrid of the two. Some of them may even support acute care or outpatient wound care. Not as many mobile wound care groups do that, but some of them do.
I will do acute and outpatient also. So another question you want to know is where am I going to be working? What type of setting am I going to be working in? What type of support do I get from the perspective? I'm going to be using my car. I'm going to be using some of my resources. How do I get reimbursed for using my resources? So there are a lot of questions that the provider will have also, who's going to be my upline? How am I going to communicate with them when I'm always out in the field? So these are some of the things that providers might want to know.
Catherine Milne:
I know we're almost done here. And so as this episode comes to a close, we always ask our guests again to share a wound to the whys. You so kindly did this very nicely last time you joined us. So I'm going to amend the request just a little bit. Pamela, for your wound to the whys, looking at mobile wound management, what tip or pearl do you wish you knew when you first stepped into mobile wound care?
Pamela Scarborough:
Oh my. I wish I'd understood how important the regulations were for my clinical practice, Kathy. Word to the wise for mobile wound care people, get that regulatory component under your belt.
Catherine Milne:
Yes. And one of the things that you're going to be covering this in your wound management series, I can't wait to listen to that. I'm sure I'm going to learn a lot too, but unfortunately we have to end today's session. So we greatly appreciate your time and your patience and your wealth of knowledge and sharing it with us.
Pamela Scarborough:
Thank you, Cathy, for that.
Catherine Milne:
I'm sure our audience also has appreciated this. We do have more to come in future episodes, so stay tuned on woundsource.com, SoundCloud, Spotify, and Apple Podcasts. Until then, make sure you browse the content available on woundsource.com and the accredited education opportunities available for WoundCpm. As you remember, HMP Global is hosting a virtual mobile wound management series. Pamela is involved in that, and it's going to go real deep into some of the things we talked about today. So the next installment will be taking place on May 15th and again on June 10th. Please register for that series. You can do so by going to httbs: T-I-N-Y-U-R-L, tiny url.com/4N as in Nancy, U as in under Z as in zebra, 85X4. It's free to register and it offers continuing education credits, which we all need. So please go ahead and sign up. Thank you again for joining us as we listen today and apply tomorrow.