Voices: Dr. Michele Carr, McKesson Clinical Support Manager

This article is sponsored by McKesson. In this Voices interview, Home Health Care News sits down with Dr. Michele Carr, McKesson Clinical Support Manager, to talk about how the current staffing challenge is impacting wound care in the home-based care industry. She shares some best practices for building a wound care management program in today’s operating environment, and she also discusses the key ways in which providers can cut costs without sacrificing quality of care.

Home Health Care News: What career experiences do you most draw from, in your role today?

Dr. Michele Carr: My educational background is a bit unique in that I’m a registered dietitian and a podiatrist. I blended those two by becoming nutrition wound care certified. While practicing as a podiatrist, I helped organize a wound program for a smaller HMO, which is really where I grew to love wound care. I learned so much from each of the specialists. Then in 2004, I came to home health and hospice where I developed a wound education and surveillance program.

In 2011, I was offered a clinical educator position with a larger national home health and hospice chain, and I constantly drew on my wound knowledge in that role. One of my first tasks was developing a proprietary wound education course for their clinicians. I was surprised when I received this request because there were so many great wound programs available already — often free of charge.

I thought, why reinvent the wheel? But that’s not what this company wanted. It was a bit overwhelming at first, cramming years of schooling and wound experience into just a couple of days. Then. as I sat with the idea for a bit, I realized it was actually a great opportunity. Here was a chance to build a wound care course from the ground up and incorporate what flowed logically in my head.

So, I started the course from the viewpoint of a new nurse with little to no experience in home health or wound care. Then, I added to the curriculum, piece by piece, until I felt like the same nurse could describe a wound, realize the most likely etiology, understand factors that may be causing the wound to stall and finally, generate some treatment ideas to present to the provider.

Additionally, the course had a hands-on portion to develop basic wound care skills. It was thrilling to see students walk in on day one and say, “I hate wound care”, or “I’m super intimidated by wounds”. Then, by the end of the course, express that they couldn’t wait to see their next wound care patient. Even better were the improved outcomes in our wound care patients.

Another impactful experience was developing a working relationship with our corporate materials manager. In a lot of home health organizations, the clinical and ops teams work in siloes — perhaps they are even antagonistic in nature. But in our situation, we learned how to communicate, coordinate and work together, which helped me understand the need to translate the clinical benefits of treatments into a financial return on investment. This arrangement led to the best of both worlds where an organization could have an excellent formulary promoting the best outcomes, but also keep cost control measures in place.

Can you talk about some of the current staffing challenges you’re seeing in home health and how they’re impacting wound care management?

I attended the NAHC conference in October, and according to Bill Dombi, about 600,000 to 700,000 patients are currently waiting for home health. The patients have orders for home health, they’re appropriate for services and they meet the requirements, but they’re not being admitted because the agencies are short-staffed. In the past, agencies were diligently marketing for each admission but now, intake coordinators are turning them away.

I think since most agencies are short-staffed, they are screening intake calls and deciding which cases can be staffed adequately to meet the patient’s needs. If they can provide the care, then those patients are admitted. However, patients who require higher utilization are probably being turned away. Financially, the reimbursement may be attractive, but the utilization is too costly. I have been hearing the frustration from referral sources because they cannot get their wound patients seen by home health agencies.

What are some best practices you can share for building a wound care management program, particularly with respect to today’s operating environment?

Wound training should be part of orientation. Most nurses entering the home health sector do not have experience treating wounds or more specifically, the chronic wounds seen in home health. Agencies must have some form of wound training that starts with the basics.

Wound education cannot be a one-and-done program. It takes time to learn. Agencies need to invest in their clinicians. Again, assume the clinician is starting with no wound care knowledge.

I like to start by teaching care staff how to describe what they see when they look at a wound. Even a novice clinician needs to be able to do that. Next, I help them put those wound attributes into medical terms that stand up in a chart, then I build off of that.

Teaching also needs to be interactive. Popping in a one or two-hour training video will not be enough to enable inexperienced clinicians to see their first wound patient. Providers need to implement a combined approach with a variety of didactic, hands-on and case-based learning.

Additionally, if agencies want clinicians to know how to use wound care products, they need to get the products in their hands from the start. Clinicians need to touch them, apply them, fill them with water, stretch them, learn about them, wear them — they’ve got to have that tactile experience before they’re in the room with the patient.

Lastly, agencies need to help clinicians learn how to think critically. Often in home health, clinicians must think outside the box.

I would guesstimate that about two-thirds to three-fourths of wound care orders initiated by a provider are very, very generic. A clinician that receives those orders needs to have enough critical thinking skills and wound care knowledge to be able to generate some possible treatment options to present back to that provider.

What are some of the most pressing home care issues outside of staffing today?

This is going to be a tough year with changing regulations around the home health value-based purchasing expansion and Oasis E. There are a lot of changing regulations, and it’s difficult to make progress as a business when you’re spending so much of your resources on retraining and updating your policies and your SOPs. That’s number one for me.

The 4% cut is going to hit a lot of agencies hard, especially on the backside of inflation, higher wage costs and higher fuel costs. I also think we had a bit of a reprieve with respect to surveys during those COVID years, but that is changing now and it’s going to ramp up.

Additionally, there’s a lot of growth when you look at Medicare, but the majority of the growth is in Medicare Advantage. That’s not so great for home health. We need to watch this and make sure their rates stay viable. I would expect an uptick of M&A disruption in the market because of all these factors.

In today’s operating landscape, much of the focus is on cost-cutting. How can care providers rethink their approach to cutting costs with respect to supplies, and how does that lead to better outcomes for patients and staff?

I think agencies tend to look at cost-cutting like they would if they were trimming the family budget. They ask, could we spend less on groceries, less on our home internet, less on gasoline?

They look at similar ways to trim costs in the office.

Before material managers or administrators start exchanging their current wound care formulary for the least expensive products, they need to have a conversation and ask their clinical directors how these alternative products are going to impact our outcomes and utilization.

Those who work in home health know that staffing usually outpaces supply spending by more than three-to-one. Instead of cutting corners with a less expensive product, agencies could spend an extra dollar on a product that could help decrease utilization by one visit per week. There are advanced wound products capable of doing just that, and directors need to look critically at wound care products that do the hard work so their staff does not have to.

In what ways do you see wound care transforming in the next 5 to 10 years?

This is so very exciting. The human body is programmed to heal, and when it doesn’t heal, clinicians need to figure out what’s wrong or missing to resolve that issue. I love helping wounds heal because aside from helping my fellow man, it’s also like solving a puzzle. Today, science is advancing rapidly and we are identifying those missing puzzle pieces like biomarkers and enzymes that have gone awry in chronic wounds.

Manufacturers are beginning to supply those specific treatments — the biomarkers or the products that regulate those enzymes and restore the wound microclimate. Some companies can even take cells from a patient and use those cells to manufacture more of a patient’s own tissue, which can be applied to a prepared wound bed. I know it sounds like science fiction, but it’s happening today. Repeatedly, we talk about patient-centered care, but this is taking patient-centered care to a whole new level.

Finish this sentence: “The home-based care industry in 2023 will be the year of…”

Resilience.

Editor’s note: This interview has been edited for length and clarity.

McKesson works with biopharma companies, care providers, pharmacies, manufacturers, governments, and others to deliver insights, products and services that make quality care more accessible and affordable. To learn more about how McKesson can support your wound care needs, CLICK HERE or speak with your Account Manager.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].

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