Integrating PT Services With Your Wound Care Program

I was assigned to write a column on how wound care clinics can successfully integrate physical therapy into their new and established programs based on responses that Today’s Wound Clinic (TWC) received through its most recent Reader’s Choice survey. In my opinion, this is a somewhat misunderstood topic, but one that I nonetheless want to tackle because I have plenty of experience dealing with this issue. To serve our readers justice, I will introduce this topic here by acknowledging that I’d like to receive further input from you through an additional survey dedicated to the role of physical therapy. You can expect an email to be sent to your inbox containing the survey in the near future (if you haven’t already received it). The survey will attempt to better understand how physical therapists (PTs) in this industry are currently being utilized in wound care clinics, since various model types exist. In preparation for the eventual article, which we hope to bring to you in TWC some time this coming winter or spring, I’ve begun to reach out to clinicians across the country to find examples of effective inclusion of PTs on their respective wound care teams. Although patient care outcomes appear to be favorable when PTs are included in wound care programs, according to the research I’ve conducted, barriers such as salary discrepancies, lack of facility reimbursement for services provided, lack of general understanding of the PT’s available skills among professionals in the healthcare industry, and a similar uncertainty on how to document a proper plan of care involving physical therapy seem to be keeping PTs from joining more wound care clinics than they currently occupy. 

If you are reading this article, whether you are a fellow PT, someone who works with a PT, or someone who does not work with a PT, please be on the lookout for the survey and participate in it if you have the time. Regardless of your answers, your participation will help immensely. If you would like to take the survey but do not recall receiving an email, please contact me at the email address listed at the end of this article and I will be sure to get the survey into your hands. You can access the survey here. 

Thanks in advance!

THE VARIED ROLE OF THE PT

Before bringing this installment of Let’s Be Frank to a close, let me ask you, as a reader of TWC and from what you’ve been able to learn about me based on the topics I’ve written about in this column space since 2016: Would you hire me if I applied to work in your facility? Before you decide “yes” or “no” too quickly, allow me to provide some background info. First, I’m going to assume that it would be agreeable to all reading this article that there’s an increasing number of chronic wounds being cared for in outpatient clinics nationwide, in addition to an increase in their complexity. The World Health Organization argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes, and strengthening the health system.¹ One of the biggest challenges in wound care delivery today is the lack of united services aimed at addressing all of the healthcare needs of individuals who are living with wounds.² Lindholm et al have warned that a lack of integrated wound care services compounds the suffering of those living with chronic wounds, which, in turn, substantially increases associated costs.³ 

Today’s wound care clinics often tout their having a multidisciplinary team on staff, but barriers tend to exist between the various disciplines truly working collaboratively, in my experience. Additionally, many clinics do not implement PTs because they may not understand the appropriate billing practices. That said, at the same time there is proof of various models being used in wound clinics across the country in which PTs are employed as part of wound care teams. Some clinics may refer patients to their hospital’s therapy staff for gait training, lymphedema treatment, adjunct modalities, and/or therapeutic exercise. Other models may include PTs serving as wound care “navigators” or, to use myself as an example, a wound care service line director. My role is multifaceted and is rooted in my desire to be a patient advocate throughout the continuum of care and to help my fellow clinicians ensure optimal outcomes, as well as to help with overall health system changes (as appropriate). My role continues to evolve as others see more clearly the value of what physical therapy brings to inpatient and outpatient teams. Over time, I have been added to my system’s product committee, been put in charge of the hospital-acquired-injury committee, and been invited to attend daily case management meetings and meetings at various wound care departments throughout the continuum. I’m also among those who attend meetings regarding hospital policy and procedure, and I’m involved with our community outreach programs, staff education programs, and consultative sessions with physicians. I am employed in a system where a true team effort has been accomplished and has had a significant impact on patient outcomes, length of stay, and cost savings. When empowered and utilized appropriately, PTs are involved in preventative measures as well as in treating patients living with various diagnoses. The goal of coordinated care is to ensure that patients, especially the chronically ill, receive the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.⁴ 

If I can make one more request, please be sure that when completing the aforementioned survey that you make note of the various models that exist for PTs who are utilized as part of your wound care team (if applicable). Let’s take the opportunity to learn from one another, which is the driving force behind the existence of this column. Happy holidays, and Happy New Year! 

Frank Aviles Jr. is wound care service line director at Natchitoches (LA) Regional Medical Center; wound care and lymphedema instructor at the Academy of Lymphatic Studies, Sebastian, FL; physical therapist/wound care consultant at Louisiana Extended Care Hospital, Lafayette; and physical therapist/wound care consultant at Cane River Therapy Services LLC, Natchitoches.

References

1. Moore Z, Butcher G, Corbett LQ, McGuiness W, Snyder RJ, van Acker K. AAWC, AWMA, EWMA position paper: managing wounds as a team. J Wound Care. 2014; 23(5 Suppl):S1-S38.

2. Lazzarini P, Gurr JM, Rogers JR, Schox A, Bergin SM. Diabetes foot disease: the cinderella of australian diabetes management? J Foot Ankle Res. 2012;5(24)1-9.

3. Lindholm C, Bergsten A, Berglund E. Chronic wounds and nursing care. J Wound Care. 1999; 8(1):5-10.  

4. Accountable Care Organizations. CMS. Accessed online: www.cms.gov/medicare/medicare-fee-for-service-payment/aco