Board Member Spotlight: Mikhail Novikov, MD, CWSP

At 16, you began volunteering at a hospital in Russia. What motivated you at such a young age to do so, and what did your volunteer work include?

Initially, I wanted to explore my interest in biology and expose myself to medicine. Volunteering at the hospital was an interesting experience. It gave me the opportunity to observe and help while working basic jobs but feel like I positively contributed to those around me.

You attended IM Sechenov Moscow Medical Academy, where you obtained your medical degree. Why did you choose a career path in surgery?

I decided to pursue a career in surgery after observing surgeons and witnessing the immediate impact they have on a patient’s condition, while using their hands and skills to do it. 

At what point did the overlap of surgery and wound care lead to your specialty in outpatient/post acute care?

I was fortunate to have surgical experience at well-known medical centers in the former Soviet Union/Eastern Europe and Harvard teaching hospitals here in the United States. What I missed was the local impact and opportunity to build long-term relationships with patients, both of which is often missing in a larger hospital setting. Opening my own practice allowed me to use my expertise in an environment that benefits the patient as well as honor what is important to me as a provider.

My dream was to reside in a town and treat residents of the town. 

Prior to the launch of your practice in 2015, you were the medical director of the New England Region of Vohra Wound Physicians. During this time, you provided care to more than 20 rehabilitation centers and nursing homes. Additionally, you worked at Baystate Medical Center, a 700+ bed medical facility and training site associated with University of Massachusetts Medical School – Baystate. Did you see a broad range of wound types and etiologies as a result of providing care to this region, or did you see repetitions of specific types of wounds? 

A variety of wound cases were treated; all were slightly different caseloads. Each patient helped to broaden my clinical experience of treating different patient populations. My approach to treating wounds is an individual approach. All factors that led to the wound, such as other medical problems and conditions, are considered. Teamwork with other professionals is important to solve any underlying issues that may be contributing to the patient’s non-healing wound.

Of all the mainstay treatments in wound care, which have proved to be most successful in your treatment protocols for patients?

My team and I are well aware of modern wound care treatment protocols. We regularly attend national and international conferences. Virtual attendance to many conferences during COVID times made this easier while saving travel time and expenses.

Our holistic approach for each patient addresses many factors that may have led to the wound and may impact healing.

We bring expertise, leadership, communication skills, and education to the bedside. It is an exciting opportunity to create a health care team in each healthcare facility. Without teamwork, it is difficult to get good outcomes. Each team member helps us on a day-to-day basis to heal our patients.

What was one of the biggest difficulties in managing the care of patients across so many facilities? Did insurance coverage impact the treatments patients could receive across those facilities?

Insurance reimbursement is a challenge. Insurance rates are tailored to major health care centers, who are reimbursed 7 times higher than a small practice for comparable services. I would like to see insurance companies invest more in smaller practices. It is unfortunate that we are not seen as valuable as we are.

Our expertise and model of care prevent costly hospitalizations and high health care costs. The savings should be passed back to the providers with increased support so these practices can be sustained.

Your practice, Dr. Novikov Wellness and Skin Care, does not focus on day-to-day revenue but rather the quality of care for each and every patient. What was the motivation behind focusing on the optimal outcome of the patient rather than meeting financial goals? 

Our model is different, with a focus on quality vs day-to-day revenue, and we have seen since 2015 that this model is viable. Patient satisfaction is high, and comparable or better healing outcomes are seen when the focus is on the individual patient’s needs. 

Oftentimes, revenue-based enterprises end up healing patients in the most expensive way, sometimes offering unnecessary services to keep their bottom line.

In partnering with rehabilitation and long-term care facilities in both New Hampshire and Massachusetts, patients receive weekly care in their rooms. How is bedside care beneficial to wound care patients, especially those who have a disability or are elderly?

In this model, providing wound care at the bedside makes a difference to the patients and families. We save patients time, money, and stress, and in some cases, we save them from additional deterioration of their conditions. 

On average, patients who travel from long-term care facilities to conventional health care delivery facilities, such as hospitals, spend a half-day outside of the facility. That translates to patients missing other beneficial services, such as physical therapy or participation in dementia programs, and results in delays in their overall recovery. 

Moving patients with severe dementia to an unfamiliar environment can cause them unnecessary confusion and stress. Bedside treatment and care can help to prevent this from happening.

On the financial side, transportation of patients from the facility can be costly. Providing bedside care eliminates the need for transportation and provides huge savings for the health care system.

Patients who are bedbound and may need to be treated for skin ulcers risk developing additional ulcers by lying on a stretcher for an extended period while being transported to a wound care center. Bedside care reduces this risk.

Long term facilities love us; patients and relatives love us. Bedside care is a better delivery system for patients in a facility.

The healing rates at your practice are approximately 50% better than the national average.¹ Why is that the case? 

First, we determine what caused the wound and whether we realistically can heal it. A small percentage of patients are appropriately referred to a different specialist if we are not the best provider for them. For example, a patient may need a vascular surgeon to restore blood flow first and then we are happy to restart the wound treatment process with them.

For some patients, the reasonable goal of care is to prevent infection and related hospitalization and not to offer aggressive treatments to heal the wound.

We also invest time in education. During our visits, patients receive continuing education about their condition, thus achieving great adherence with treatment recommendations. We involve the caregivers of the patients and other team members in the treatment plan. Printed reference materials given to patients and the caregiving team help to reinforce information discussed.

Overall, early diagnosis and a definitive treatment plan with a holistic approach to the issue heals wounds faster. We are interested in the ultimate outcome for patients, even if it is not with us.  

What would you recommend wound care clinicians incorporate into their treatment plans and approaches in an effort to see higher healing rates?

Wound care outcomes are directly correlated to how invested the clinician is in wound care.  They should truly be excited about the ultimate outcome, which sometimes takes as long as 3 to 4 months. It is very satisfying to see the reduction of the wound size at every visit. The approach may need to be adjusted if we are not meeting our goals.

We are fortunate to have very dedicated providers on our team. We are thrilled to see the nurses and other caregivers enjoying our educational wound rounds and be as excited as we are about the healing process. 

Acknowledgments

Ms Taft-Lockard is Associate Editor of Wounds. 

This article was not subject to the Wounds peer-review process.

References

1. Dr. Novikov Wellness and Skin Center focuses on healing one patient at a time. Community Advocate. June 24, 2021. Accessed July 9, 2021. https://www.communityadvocate.com/2021/06/24/dr-novikov-wellness-and-skin-center-focuses-on-healing-one-patient-at-a-time/