Upperline Health

Michael King

So, do you think you want to get into the wound care management space, either clinically or business-wise? Wound care is a complex field not easily navigated for several reasons both on the clinical side and on the business side of the equation. Not everyone is cracked up (or trained properly) to be a wound care “expert,” but many call themselves such. The apparent lucrative field of wound care from the business perspective may seem appealing but can be fraught with huge costs and complications galore if one is not a true expert in such care, both clinically and as a business provider.

First, wound care is not just a service one provides to a patient, it is often a limb-saving proposition, which can quickly lead to a limb loss issue. Dealing with the multiple morbidities that co-exist with these problems often escalates to a much more serious issue. Five-year mortality rates in the ambulatory post-amputation population were found to be 30 percent vs 69 percent in the non-ambulatory amputation cohort.

(1). Are you prepared to keep them ambulatory and get that higher survival rate? Do you understand the off-loading principles necessary to keep them ambulatory, and the costs that go with that?

Many think that wound care management is simply the application of fancy, high-priced products such as cellular tissue products and hoping it heals. If not, well…we can amputate. Not a good option in most cases. Yes, sometimes amputation is the best and most prudent course but not one any good clinician desires to see occur.

Most of these begin with simple ulceration. Currently, ulceration and amputation are associated with increased mortality. Five-year mortality following first-time ulceration is approximately 40 percent in patients with diabetes and ranges from 52 to 80 percent after major amputation

"The keynote to be taken here is that this is not a field to be taken lightly or simply for the gainful economic appearance of selling products. One must approach the patient from a total health perspective, and be willing to sacrifice a great amount of effort and quite frankly stress in managing these conditions"

(2). One of the first things a good clinician learns is when debriding (cleaning up the bad stuff) ulceration, DO NOT create a new one! The novice can easily escalate a grade one ulceration into a grade two or worse. Taking into account the co-morbidities, the vascular status, the neurological status and even the ambulatory needs of the patient are paramount in one’s approach.

Wound care products for good healing are not cheap; for the patient, the provider, or the healthcare system. It cannot be advocated, in good conscience, for just the old-fashioned cheap “saline wet-to-dry” dressing approach or just slapping on some iodine for healing. Those are not the state of the art and often inadequate approaches. One must understand the underlying reasons for the ulceration, and manage those effectively and simultaneously with the attempt to heal the lesion in question.

As a provider who did this for over 30 years, I have seen both sides of the equation, good and bad. Had successes and failures and learned from both. The keynote to be taken here is that this is not a field to be taken lightly or simply for the gainful economic appearance of selling products. One must approach the patient from a total health perspective, and be willing to sacrifice a great amount of effort and quite frankly stress in managing these conditions. Wound care is not simply a money maker; it can be quite costly. One must be an expert to proceed. Learn from the best, learn mental and hands-on skills, and be assessed by experts so you can become one too.