Brian Wallace

I’ve been professionally on social media for over a decade now, building relationships with industry experts across essentially every sector of the economy. Having done so gives me the advantage of seeing trends before they actually turn into trends. That way my team and I can further research and dissect the matter. 

Recently, I’ve caught wind of the availability issues surrounding wound care in the age of the coronavirus, and how expanding telehealth can lend a hand. Due to the scarcity of specialized wound care clinicians, members of the post-acute community are at a disadvantage — causing many to suffer from wounds while waiting for care.

Although telehealth may provide solutions to some pandemic-induced healthcare challenges, due to wound care’s complexities, the solution is not that easy. For this reason, we have been commissioned by Swift Medical (a leader in Digital Wound Care Management Technology) which prefers data to tell their story. However, at NowSourcing, we understand lengthy data makes for a tiresome read — so we’ve compiled our findings into a visual performance. You can find our finalized infographic outlining wound care amidst the pandemic here.

How has the pandemic affected wound care in senior living?

The Life Care Center nursing facility in Kirkland, WA, is widely considered ground zero for the COVID-19 pandemic in the US. In a matter of weeks, the virus ripped through the facility and killed at least 35 residents. By the end of March, more than 400 skilled nursing facilities across the country had at least one positive case of COVID-19, nearly doubling from the week before. 

The high density and vulnerability of residents living in skilled nursing facilities amplifies both the spread and consequence of COVID-19. To protect their residents, many skilled nursing facilities have begun to bar non-essential staff from entering their facilities. While these policies help to curb the transmission of the virus, they can increase health risks for residents that require complex care, such as those with chronic wounds.

Today, 8.1 million Americans require some form of long-term care, and a huge percentage of these patients suffer wounds while in care. Here’s a specific look at which patients will suffer from untreated wounds the most:

  • Up to 36% of home health patients (1.6 million people)
  • Up to 35% of hospice patients (500,000 people)
  • Up to 35% of skilled nursing patients (300,000 people)
  • Up to 27% of long-term acute care patients (219,000 people)

However, things don’t stop here. Elderly patients aged 65 and up also need post-operative wound monitoring due to posing a higher risk of non-healing wounds and infections that require rehospitalization. Today, elderly patients account for 33% of ambulatory surgeries, contributing to the 9.4 million people that may require postoperative surgical wound care during the pandemic.

All in all, up to 2.5 million seniors in care may require chronic wound care during the pandemic. These wounds often require daily or weekly treatment, which is typically supported by external care providers. These wounds, if untreated, can rapidly lead to infection, hospitalization, amputation, and death.

The need for wound care in the senior living and post acute care population

The hardest part of the pandemic is that it’s almost the exact same population that are most vulnerable to complications from COVID-19 that are in most need of wound care. What’s been happening because of this, is that caregivers have to make an extremely difficult choice. Do they take the risk of exposing their patients to the virus, or do they continue with the much needed wound care?

The population that is most impacted by this pandemic is also the same population in most need of wound care.

Can telehealth come to the rescue?

Medicare estimates the cost of acute and chronic wound treatment to range from $28.1 billion to $96.8 billion each year. Surgical wounds account for up to $13 billion of that ration, and diabetic foot ulcers account for up to $6.9 billion.

Furthermore, chronic, non-healing wounds impact nearly 15% of Medicare beneficiaries each year — or 8.2 million seniors. In other words, wound care costs around $3,000 to $4,000 per incident, per patient. In fact, treating the most expensive wounds can cost nearly $10,000 per incident. As a result, expanding telehealth may be able to not only combat the effects of the coronavirus, but also reduce costs across the entire healthcare system.

In March 2020, the Centers for Medicare and Medicaid Services expanded telehealth coverage to allow more patients to obtain virtual care services. The Department of Health and Human Services even announced HIPAA enforcement discretion for telehealth during the COVID-19 pandemic to remove any barriers to quick adoption. This way, nursing facilities and long-term care centers can implement practices to assist their patients.

With that being said, providers will be able to communicate with patients using any non-public facing remote communication product including FaceTime, Messenger, Google Hangouts, Skype, Zoom, GoToMeeting, and Webex throughout the duration of the pandemic. Engaging in telehealth, or telewound, helps reduce visits to clinics and emergency rooms, manage increased demand for acute care by determining each patient’s need while they remain safe at home, and minimizes the risk of spreading the virus — for both patients and providers.

“Telehealth capabilities are essential to meeting the challenges of COVID-19,” states Richard Feifer, the chief medical officer of Genesis HealthCare. “This model helps limit the risk of exposure to the virus and promotes the safety and wellbeing of our patients/residents, center staff, medical providers, and consultants. This is especially important as we have limited all outside medical appointments across our network of skilled nursing facilities, except for those which are medically necessary and time sensitive such as dialysis and chemotherapy.”

However, suspending HIPAA compliance for telehealth can pose risks. For example, using everyday communication tolls could leave private medical information vulnerable to data breaches and misuse. In other words, after the crisis, doctors and nurses will only have to re-learn HIPAA-compliant procedures. When enforcement resumes, a single HIPAA violation could garner a fine of $100 to $50,000, and multiple violations could cost up to $1.5 million per year. It’s therefore extremely important that, even if facilities choose a tool to get up and running quickly, they should be considering a longer-term solution that will meet not only HIPAA requirements, but also the complex needs of delivering wound care remotely.

“Skilled nursing facilities have experienced the very worst of the virus and they need support,” says Carlo Perez, the founder and CEO of Swift Medical. “The innovative solutions we create today will not only ensure continuous and compassionate care now, but will also permanently shape the future of care delivery.”

Precision in vision: Why standard telehealth doesn’t work for wound care

Most telehealth solutions offer simple two-way video sessions where a clinician will diagnose patients based on them describing their symptoms. 

However, wound care is a visually demanding specialty and video alone cannot meet the clinical requirements. Video fails to color correct, it fails at enlargement for details, it pixelates, and lacks the basic requirements of “store and forward” which is essential for cross consultation, communication and coordination. Finally, video cannot provide discrete comparison of the wound bed over time.  Specifically, how does the wound bed compare to a week ago, a month ago?

The visual nature of wound care requires a visually precise method for imaging and measurement, which only specialized wound care software can provide. Reducing patient exposure to outside visiting specialists and eliminating the need to transport to external wound care clinics is crucial during this pandemic, and a lack of trained wound care professionals in various settings especially in rural areas who are looking for referral guidance / consultation just adds to the challenge. Patients with chronic wounds often transition through multiple sites of care (e.g., inpatient hospital, outpatient wound center, home health care, or nursing home), making continuity of care extremely challenging. Again, an accurate visual record and consistent, complete documentation is essential.

“To respond to the demand for beds for COVID-19 patients, hospitals are rapidly moving patients from higher levels of acute care to the home and other care settings. Netsmart clients are at the forefront of post-acute care where there has never been greater adoption of virtual patient care,” says Dawn Iddings, senior vice president and general manager of post-acute care with Netsmart. “Netsmart care providers across home health, hospice, private duty, assisted/independent living and skilled nursing are requesting help and the Swift wound care solution gives our clients what they need at this time.”

Brian Wallace is the founder and president of NowSourcing, an industry leading infographic design agency based in Louisville, KY, and Cincinnati, which works with companies that range from startups to Fortune 500s. He also runs #LinkedInLocal events nationwide, and hosts the Next Action Podcast. He has been named a Google Small Business Advisor for 2016-present and joined the SXSW Advisory Board in 2019.