From the Wound Center to the Home: Breaking Down Barriers for Advanced Wound Care

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Lee George: How did you get into nursing and wound care?
 
Maureen Vantine, NP: I have always taken an interest in health and wellness and had a desire to serve others. Early in my career working in primary and urgent care, I saw the barriers patients faced trying to access care. During this time, I focused my attention on community health and how we create more equitable access to the care people need. That led me to join a company that provided mobile primary and urgent care.
 
I had never planned on getting into mobile care, but once I witnessed the difficulty my patients had trying to access care, I knew it was something I wanted to pursue. Most of us in the health care space understand there is a massive logistical hardship and inconvenience of going into a clinic for an appointment. Transportation alone is a huge barrier to accessing health care in the traditional brick and mortar setting. It is often cited as one of the leading causes of people missing appointments, delayed care, and missed medication use. I learned a lot about providing in-home care during this time and it was also where I met the other co-founders of Mendota Health.
 
Lee George: Why wound care? How did you move from mobile primary care to starting a mobile wound care company?
 
Maureen Vantine, NP: Conservative estimates say there are 8.2 million people with Medicare who are impacted by wounds, and this was before the pandemic.¹ During the COVID pandemic a survey noted that 43% of wound clinics were closed, and those that were open saw a 60% reduction in visits.² Addressing wounds is a serious issue in the United States, one that got worse over the pandemic and is exacerbated by a system that is ill equipped to meet the challenge. So, for the other co-founders and me, it was a no-brainer that we needed to leverage our experience in mobile care and focus it on mobile wound care.

Mendota Health emerged out of the pandemic in response to a healthcare system that did not have the capacity to treat the increasing number of people with chronic and non-healing wounds. Quality care hinges on access to care. Through a mobile advanced wound care clinic, Mendota Health is able to provide access to high quality expert advanced wound care at home. This model quickly and efficiently deploys wound care interventions to reduce the incidence of death, severe infections, amputations, and hospital admissions from chronic and non-healing wounds. We are providing advanced wound care treatments in the home that were only available in a clinic or hospital setting pre-pandemic.

It might be shocking to know that frequently when new patients come to us, they have had severe wounds for months, years, and even a decade. The lack of access to wound care pre-pandemic because of transportation, cost, stable housing, or other factors has meant our patients have not received the proper care to heal their wounds and thus have not been able to fully live the life they want.
 
Lee George: What services do you provide and how are you able to provide them in the home?
 
Maureen Vantine, NP: Changes to Medicare billing allowed us to bring advanced wound care into the home. The Centers for Medicare and Medicaid Services (CMS) changed reimbursement guidelines for treatments in the home setting to allow more interventions to be covered. Without these changes we would not be able to do what we do.
 
Once CMS changed what could be reimbursed in the home, we launched Mendota Health. When we began, wound care was being performed by home health nurses and in brick and mortar wound care clinics. Home health nurses are equipped to provide conservative wound care in the home. When a wound becomes complex or chronic, they typically refer the patient to a wound clinic. This means organizing transportation for the individual on a weekly basis, having to reschedule appointments if the patient is sick, and dealing with other barriers. As I noted earlier, transportation is a huge issue and frequently these patients miss appointments. The provider in the traditional wound clinic has limited insight into the patient’s home life and may recommend treatments that the patient can’t follow. This leads to a distrust of the provider, which is another barrier to being able to execute a care plan. The result is wounds that don't heal, get worse, patients being readmitted to the hospital, amputated limbs, and death.
 
We knew there was an opportunity to bring the advanced treatments provided by hospital-based wound clinics to the patient’s home. Our focus is patients who have complex and chronic wounds and had difficulty accessing advanced wound care in the traditional setting. Studies show that patients with complex wounds have better outcomes when they are seen on a frequent basis. Because we bring the care to the patients, missed appointments are practically nonexistent and the frequency of care is not disrupted. Patients are receiving provider-level care and expertise within the comfort of their home.
 
Our nurse practitioner–led model allows us to use advanced treatments like surgical sharp debridement and cellular and tissue-based products which supplement the conservative treatments provided by home health nurses. Our nurse practitioners oversee the complete care of the wound, create a comprehensive treatment plan, and collaborate with other members of the healthcare team to execute it. Nurse practitioners have the knowledge of a provider and the skill set of a nurse, which gives them the unique ability to direct the care plan, while also performing the nursing care like dressing changes, prepping, and positioning the patient for the procedure, performing the advanced wound treatments, and completing the dressing change. Since our providers are in the patient's home, they have a relationship with the patient. And because they have a heart to serve, they will often end up helping with non-wound related things like taking out the garbage or doing a couple of dishes in the sink.
 
Lee George: Where did Mendota Health start?
 
Maureen Vantine, NP: We started in Minnesota in 2021. At the time I was the only provider and was seeing all our patients. I still remember that first patient visit and it was a bit anticlimactic, to be honest. When I arrived at the home, I found out the patient did not have an insurance we were credentialed with, so unfortunately, I was not able to see her. For a health care startup it was a great learning experience—it lit a fire under us to get credentialed with more insurance payers so we could provide services to more patients. Navigating the credentialing process can be lengthy and extremely difficult to understand which treatments a particular insurance will cover. We expanded rapidly over the last two years and are now in 12 markets across the United States, have seen over 2,000 patients, and completed over 14,000 visits. 
 
Lee George: Do you compete with traditional wound care clinics?
 
Maureen Vantine, NP: Absolutely not. In fact, wound clinics refer patients to us. We are all working in the same health care ecosystem where there is an endless queue of patients and there are too few providers. So, the fact is traditional wound care clinics are under immense pressure to address the wound care epidemic in the U.S. If they have patients who have transportation issues, have missed multiple appointments, or are not a good fit for their clinic for other reasons, they refer those patients to us. Conversely, some patients are better served in a hospital-based wound clinic, especially if they have needs like hyperbaric oxygen, which we are unable to offer at home.
 
There is a lot of research stating that wounds heal better when there is a multidisciplinary team involved, and our patients are best served if we collaborate with other clinicians, including wound care clinics. So, we work with lots of partners such as vascular surgeons when there is a vascular issue preventing the wound from healing and home health nurses and other caregivers to make sure the patient gets the frequency of wound care they need.
 
Lee George: How do you measure your success?
 
Maureen Vantine, NP: The greatest success is when we heal a wound and the patient tells us all the things they get to do again.
 
When we start seeing patients, they are pretty debilitated. Their wounds might be painful, which inhibits them from taking part in the activities that bring them joy and fulfillment. Or their wounds might be draining a lot, and so they might feel embarrassed about leaving the home. Or they have logistical concerns of being out and having to care for their wound. Their wounds keep them at home.
 
Our providers spend a lot of time with patients, they go into their homes as much as once a week and stay for a long time. Typically, our appointments take about an hour. Contrast that with a typical clinic appointment where the patient gets a very short amount of time with the provider, and the provider feels like a hamster on a wheel just trying to get in and get out to see as many patients as they can in a day. We're able to allow our providers to really spend some time with the patient and build a relationship. Our providers end up knowing a lot about the individual, their life, and even getting to meet their family members. Our model of care creates a great environment for healing.
 
It is very common for patients to engage in life again as they move toward healing, and their wounds get smaller and easier to manage. Patients will go outside and work in their garden, or will go play bridge with their friends, go on walks, or back to church. They get to reengage in the things that make life worth living. You can see their entire demeanor change. You can see these people emerge from the depression they were battling. Seeing this and being a part of this is the most rewarding thing.
 
Nurse practitioners excel at healing wounds. Nurse practitioners who specialize in wound care outperform even physicians when it comes to healing wounds. According to a study in the Journal for Nurse Practitioners, nurse practitioners who specialize in wound care had a healing rate of 93% compared to 67% for physicians.³ We also measure our wound healing in other ways. Wounds are a major cause for readmission to the hospital. Our hospitalization rate because of wound complication is just 3.2% according to a data set of patients from one of our national partners. And our providers heal wounds 13% quicker compared to other wound care providers. Mendota Health is keeping patients in their homes and increasing their quality of life.
 
Lee George: What else do you want people to know about Mendota Health?
 
Maureen Vantine, NP: I would like people to know just how rewarding it is for providers to take care of people and their families in their home and how beneficial it is for patients. Our providers truly love what they do and feel a strong connection and sense of responsibility for the people in their care. We have the greatest positive responses from our patients who have told us numerous times their lives have been completely changed because of our work. Many of our patients have had wounds for many years and have not had success in healing their wounds until they had in-home advanced wound care provided by Mendota Health. Reimagining care that works for the patient is the key to healing wounds and healing people.
 
Maureen Vantine is an adult and family nurse practitioner with a background in primary care, urgent care, care in the home, and healthcare innovation. She is Co-founder and Chief Nursing Officer at Mendota Health, a company that provides advanced wound care in the home for patients with chronic wounds. She is passionate about innovation within the health care space to improve access to health care for those patients who are underserved.

Lee George is the Director of Marketing and Communication for Mendota Health.

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References
1. Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. Am J Manage Care. Published Sept. 21, 2021.
2. Cole W. A look at the impact of the COVID-19 pandemic on wound care practices one year later. Today’s Wound Clinic. 2021; 15(3).
3. Gonzalez A, Delgado V, Buscemi CP. Wound closure rates: a comparison between advanced practice registered nurse and primary care physician treatment. J Nurse Practitioners. 2019; 15(9):e173-6.