On the Front Lines of Care

All American Podiatry & Wound Care, Tidewater, Virginia

Today’s Wound Clinic recently had the opportunity to interview Joseph G. Smith, DPM, CEO of All American Podiatry & Wound Care (Tidewater, VA). Dr. Smith reflects on the events and opportunities that prepared him to serve in his career in healing. Caring for numerous patients, each with their own individual needs, propelled Smith’s involvement in the fields of wound care and podiatry. This edition of Front Lines offers an exclusive look at the techniques and operational procedures Smith relies upon and adheres to for daily success. Smith reveals what products, services, and technologies best accommodate his patients and ultimately result in a successful track record of healing.

Today's Wound Clinic (TWC): What is the name of your business and where is it located?
Joseph Smith (JS): I operate and oversee All American Podiatry & Wound Care located in Tidewater Virginia.

TWC: Who or what first introduced you to wound care?
JS: Like all podiatrists, I had extensive training in diabetic and vascular ulcers as well as burn injuries throughout medical school.

TWC: How did you get involved with wound care?
JS: During my residency at the Coatesville, Pennsylvania VAMC, I had the opportunity (or misfortune!) of entering a program that was intended for four residents, yet during this transitional year there was only one — me. So I had the opportunity to treat a very large number of wound cases being the only resident, particularly pressure related wounds, which I did not have much experience with at school. I later went on to lead the Wound Care Advisory panel at this hospital during my tenure there. When I returned home to the Tidewater area, most of the folks involved with wound care were doing things from decades past, and were not really up to date with what was happening in the exciting world of wound care. So I kind of blazed a path for myself in that arena from the start, not to mention ruffled a few feathers along the way.

TWC:What is your position in your facility, and how long have you held this position?
JS: I am the CEO of All American Podiatry & Wound Care; I have held this position for 10 years now.

TWC: What are some of the unique characteristics of your wound care facility?
JS: The most unique and exciting aspect of my wound care facility is that it is 100% mobile. I travel throughout the dozen or so cities, towns, and counties that make up the greater Tidewater area. By going to nursing homes and assisted living homes I perform over a thousand house calls a year. The homebound patients really appreciate the effort my team makes and it affords me the opportunity to see a wide variety of wounds in a multitude of settings.

TWC: Can you describe the types of positions your employees hold that work in your clinic and the important rolls each plays?
JS: My head nurse, receptionist, scheduler, QuickBooks keeper, etc is my lovely wife Sondra Smith, LPN. She used to go on a lot of house calls with me too but once we started our family she preferred to stay at home. We really have no other employees. I have however, established a network of companies that provide services to homebound patients and are mobile like All American. I use a billing company, Advanced Medical Services that handles our friends at the insurance company. Miss Brenda Lyle from this company has been priceless. I outsource all products so I use Lawson Medical for diabetic shoes, AFO's, CROW boots, etc. I depend on Tycon medical for my beds, walkers, and wheelchairs. They both come to the patient’s home and are excellent at what they do. Mr. Duane Cook of Heritage Mobile X-ray has been very valuable as well by providing me with same day mobile x-rays. Numerous home health companies in the area have been a tremendous help and have been a symbiotic referral service for all involved. Dr. Abiola Opeitum and Dr. John Patterson have been great referrals as house call primary care MD's and have alleviated much suffering due to their tireless efforts. Of all the staff at the various nursing homes I attend, Liz Williams is especially attentive to the needs of both doctors and patients.

TWC: Approximately how many patients do you see per year? Is this up or down from last year?
JS: I see several thousand patients throughout the year. This amount is slightly higher and it has increased every year that I have been in practice.

TWC: Do you expect to see more patients in 2010? If so, why?
JS: Yes, it seems to be the trend in my business as I am the only mobile podiatry/wound care doctor in town. Each year more people grow older and more people are keeping their parents or grandparents in a renovated room at their house instead of putting them in nursing homes. Because of this, I am seeing an increase every year in the house call arena and therefore the wound care arena as well. The competition for nursing homes is pretty high throughout this area here so that number is staying the same.

TWC: What is an interesting trend or frightening statistic that you are noticing in wound care?
JS: Both an interesting trend and frightening statistic is the number of people involved in wound care. It has really increased in the last decade and I have been really excited to attend many of the SAWC and Wound Care Congress seminars that are offered. It concerns me that suddenly everyone is calling themselves "wound care specialists" or "wound certified" when maybe all they do is change the bandages at a nursing home, or maybe they went to some diploma-mill weekend wound care certification. Very little knowledge can be dangerous. Several years back I remember an old primary care provider prescribing Regranex™ for a Stage III dry eschar, like he wanted to grow more of it. Some people get stuck on a particular protocol or formulary and really deprive themselves and their patients of optimum treatment modalities.

TWC: Is your wound care operation independently managed or overseen by a management company and if so, which company?
JS: My wife and I run it with help from our trusty accountant, Nicholas L. Potocska.

TWC: How long has your facility been in business?
JS: We have been in business for nearly 10 years.

TWC: What were the business’s initial challenges from the start?
JS: Biggest challenges were trying to keep up with all of the phone calls, prioritize patients, and organize routes accordingly. Tidewater is a very large area and some days our phone rings off the hook— non-stop.

TWC: What efforts have proven successful for you in the areas of marketing and advertising?
JS: Word-of-mouth referrals and an earned reputation seem to be the only thing that is working. We tried the yellow book and yellowbook.com this year and we are currently weighing out the amount of response it yields.

TWC: What efforts are you hoping to include in the future concerning the company’s marketing and advertising?
JC: I’m thinking of going on our local news channel with a television ad. Seeing that I really have sort of a niche practice, I am trying to find something that will appeal to the 70 years and older demographic throughout Tidewater.

TWC: Do you have a website for your business? If so, what role does it play for your business?
JS: Unfortunately, we do not have a company website. We had one with Yellow book, and supposedly had tens of thousands of hits, but no one ever said they found us online. Since none of our clientele referenced the web as their source of information, we decided to get rid of it.

TWC: How is your business incorporating technology into your center’s workflow?
JS: I’m always open to learning about and using new products. Unfortunately many of the new wound care gadgets are for hospital or office use only and are not fit for a mobile practice. I am however always trying out new topical gels and bandages.

TWC: What wound care products and companies do you highly recommend and use often?
JS: I recommend Johnson and Johnson because of their historic dedication to the advancement in bandage and wound care technology. Smith & Nephew also make some reputable bandages and they are committed to the ongoing pursuit of wound technology. KCI impressed me from the moment I read their mission statement. As far as products, I really miss Panafil and Accuzyme. They were like the “miracle-gro” of wound care products for me and worked wonders for my patients.

TWC: What do you feel are some of the largest operational challenges for your business today, and do you have any advice for other professionals struggling in these areas?
JS: Keeping up with the coding changes and keeping documentation accurate poses an ongoing challenge. The best advice I can offer to other professionals is to attend the SAWC and attend the pre and post conferences also. Talk and network with other people in your arena as often as possible. Many pearls can be gained in this fashion of communication. Its best to know your industry and your product as competition continually increases.

TWC: Do you have advice for clinic directors who are looking to improve their facility?
JS: I would suggest they make sure to stay well informed about the advances in wound care, keep all staff informed, and stay open to new ideas and concepts. Directors should teach their staff some of what they know; it will pay them back tenfold.

TWC: What advice do you have for clinicians that are interested in entering this segment of wound care?
JS: Attend seminars, read, and find an area with a particular need. As far as house calls, there is going to be a switch back to this type of medicine in the coming years as the population ages. The demand will be great.

TWC: What would you identify as your favorite aspect of being a Podiatrist?
JS: As a DPM in general, I would say a favorite aspect of my work is the ability to have a patient suffering in pain at the presentation yet being able to dance when they leave the office. Injections are good for that so are the removal of ingrown nails. With regard to mobile wound care, my favorite aspect of this sector is the genuine love that I feel radiating from the patients and their families when I come to see them. The fact that we can go from a painful Stage III heel wound to a foot that is able to bear weight with intact skin, speaks volumes.

TWC: Please give us a wound percentage breakdown regarding the patients that you treat:
JS: The percentage breakdown is as follows:

Diabetic = 15%
Venous= 25%
Pressure= 50%
Arterial= 5%
Traumatic= 3%
Surgical= 1%
Burns= 1%