Wounds are a significant clinical challenge among older adults and medically complex patients, particularly in post acute and long term care.
In 2019, an estimated 10.5 million Medicare beneficiaries had a wound, representing approximately 16% of the Medicare population. Using the study’s most conservative method, Medicare expenditures associated with wounds as a primary diagnosis were approximately $22.5 billion that year.[1]
Medicare beneficiaries had a wound in 2019
Medicare expenditures for wounds as a primary diagnosis
mean time to healing, specialized bedside wound teams vs usual care
For Skilled Nursing Facilities, however, the challenge is not simply how many wounds are present. It is managing them consistently over time while considering the resident’s overall health, mobility, nutrition, circulation, comorbidities, and goals of care.
That is where consistent physician involvement can be valuable.
A Wound Is Rarely Just a Wound
Good wound care involves more than choosing a dressing.
The clinical team may need to consider pressure and offloading, perfusion, nutrition, infection, diabetes, medications, mobility, moisture, pain, and other conditions that can affect healing.
The Wound Healing Society’s pressure ulcer guidelines emphasize evaluating the patient as a whole, including systemic disease, nutritional status, tissue perfusion, and oxygenation. The guidelines also support appropriate debridement of devitalized tissue when clinically indicated, while recognizing situations in which debridement may not be appropriate.[2]
Direct physician evaluation at the bedside allows the wound to be considered within the context of the resident’s broader clinical condition.
Consistency Matters in Physician Led Wound Care
Many wounds require follow up over weeks or months.
Regular rounds make it possible to monitor progression, recognize when a wound is not responding as expected, adjust the treatment plan, and identify when additional evaluation or a higher level of care may be necessary.
One large retrospective study compared pressure ulcers in long term care facilities managed through weekly specialized surgeon led bedside wound teams with those receiving usual care.
Mean time to healing was 47.5 days in the specialized team group compared with 69 days with usual care. The specialized teams included a wound care surgeon working with facility nurses and, in some cases, physician assistants or nurse practitioners.[3]
Because this was an observational retrospective study, it does not prove that the care model itself caused the difference. The authors described the findings as hypothesis generating and called for additional research.
What it does suggest is that structured, consistent, guideline based wound care with regular specialized clinical involvement may improve continuity and wound management in long term care.
Bringing Appropriate Wound Care to the Bedside
For residents of Skilled Nursing Facilities, leaving the facility for every wound related issue can mean transportation, additional appointments, new clinical handoffs, and disruption in continuity of care.
When appropriate, many elements of wound management can be provided at the bedside.
A retrospective nursing home study evaluated 190 pressure injuries that underwent serial bedside sharp debridement. 73% of those wounds decreased in surface area during the study period.[4]
That result should not be interpreted to mean that every wound requires debridement or that debridement alone produced the improvement.
The decision to debride depends on the wound, tissue perfusion, signs of infection, bleeding risk, patient condition, goals of care, and other clinical factors. Current wound care guidelines specifically recognize circumstances where debridement should be delayed or avoided.[2]
The objective is not to perform more procedures.
It is to make appropriate care available where the resident already receives care whenever it can be provided safely.
Communication Is Part of Wound Care
The physician’s visit is only one part of the resident’s wound care.
Treatment nurses and facility staff continue the plan between visits, monitor the resident, manage dressings and offloading, identify changes, and communicate concerns.
That makes coordination between the physician and the facility team essential.
A well organized wound care program should provide:
- A clear treatment plan
- Consistent follow up
- Timely clinical documentation
- Communication with the facility team
- A process for reporting changes between rounds
- Appropriate escalation when the resident’s condition changes
Documentation Matters in Wound Care Outcomes
Clear documentation helps everyone involved understand what was found, what treatment was recommended, what procedures were performed, whether the wound is improving, and what should happen next.
Pressure injuries and changes in skin integrity are also included within the Centers for Medicare and Medicaid Services’ Skilled Nursing Facility Quality Reporting Program. CMS currently reports a Changes in Skin Integrity Post Acute Care: Pressure Ulcer/Injury quality measure for SNFs.[5]
For that reason, consistent wound assessment and documentation are important parts of both clinical care and the facility’s overall wound management process.
What Direct Physician Involvement Means at Crescent
At Crescent Wound Care, wound care rounds are performed by physicians.
Our physicians evaluate residents in person, develop and adjust treatment plans, perform appropriate bedside procedures, communicate with facility nursing teams, and follow wounds over time.
This physician model is an intentional part of how Crescent practices.
It does not mean wound care happens through the physician alone. Treatment nurses, nursing staff, dietitians, rehabilitation teams, primary care providers, specialists, and facility leadership may all have important roles depending on the resident’s needs.
Our goal is to provide consistent physician involvement within that broader care team.
The Bottom Line
Effective wound care is not defined by a particular dressing, device, or number of procedures.
It requires appropriate assessment, consistent follow up, communication, documentation, evidence based treatment, and the clinical judgment to recognize when the plan needs to change.
For Skilled Nursing Facilities, having a physician regularly at the bedside can provide consistent clinical oversight while allowing appropriate wound care to remain within the facility.
That is the model Crescent Wound Care was built around.
Physician care at the bedside. Consistent follow up. Treatment based on what the resident actually needs.
See the model in practice
References
- Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE. Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: changes between 2014 and 2019. Journal of Medical Economics. 2023;26(1), pages 894 to 901.
- Gould LJ, et al. WHS Guidelines for the Treatment of Pressure Ulcers: 2023 Update. Wound Repair and Regeneration. 2024;32(1), pages 6 to 33.
- Levinson AW, Lavery HJ, Santos AP, Ciminello FS, Marriott RJ. Effect of Weekly Specialized Surgeon Led Bedside Wound Care Teams on Pressure Ulcer Time to Heal Outcomes: Results From a National Dataset of Long Term Care Facilities. Wounds. 2019;31(10), pages 257 to 261.
- Anvar B, Okonkwo H. Serial Surgical Debridement of Common Pressure Injuries in the Nursing Home Setting: Outcomes and Findings. Wounds. 2017;29(7), pages 215 to 221.
- Centers for Medicare and Medicaid Services. Skilled Nursing Facility Quality Reporting Program Measures and Technical Information. Accessed 2026.