If you run a Medicare-certified home health agency, you already know wound care is one of the most demanding services you provide.
- Pressure injuries
- Diabetic ulcers
- Post-surgical wounds
- Venous stasis wounds
…are complex and time-consuming. It’s no wonder many agencies choose to partner with mobile wound care groups to bring specialized expertise to the home.
While many of these partnerships are beneficial, others create hidden challenges that can quietly hurt your outcomes and compliance.
In some cases, agencies find that wounds aren’t improving as expected, patients lose trust, or billing issues arise months later, triggering ADR letters and denials they didn’t anticipate.
*This article was written in consultation with Mariam Treystman & Dr. Robert Goldberg.
At The Home Health Consultant, we’ve helped hundreds of agencies investigate these issues through QAPI reviews, survey prep, and ADR responses. That’s why we sat down with Dr. Robert Goldberg, a highly trained Cardiothoracic Surgeon who has transitioned his expertise into advanced wound care. He’s seen firsthand how gaps in oversight, communication, and clinical skill can affect healing, and what agencies can do to protect themselves.
Who Is Dr. Robert Goldberg & What’s His Specialty in Wound Care?
Dr. Robert Goldberg is a thoracic surgeon who transitioned into wound care after seeing too many patients sent home with unhealed wounds and little follow-up.
“What I saw were patients with wounds that could have healed in a few months, but they were lingering for years because no one was doing proper debridement,” Dr. Goldberg shared.
Today, he leads a mobile wound care practice in Los Angeles that partners directly with home health agencies to treat complex wounds. Dr. Goldberg treats everything from diabetic ulcers to surgical sites. He helps agencies rebuild wound programs that actually heal.
“We’re not there to maintain wounds,” he said. “We’re there to heal them. That’s the difference.”
Dr. Goldberg joined The Home Health Consultant Podcast to discuss:
- what’s broken in home health wound care
- how to tell if your partnership with a mobile wound care group is working
- how to avoid compliance traps that come with outsourcing
Why Is Wound Care So Challenging in Home Health?
Wound care in the home health setting is complex because patients often have multiple chronic conditions. This could be anything from heart failure, diabetes, vascular disease, or mobility limitations, all of which slow wound healing.
And because all your patients are homebound, they rely entirely on your agency’s clinicians and any contracted wound care providers for treatment.
What’s the Hidden Problem With Outsourced Wound Care Groups?
Large wound care companies promise convenience and quick coverage. However, in Dr. Goldberg’s experience, their model often prioritizes volume over outcomes.
Dr. Goldberg shared one of the most important (and often missed) steps in home-based wound care is debridement. Debridement is the removal of dead or infected tissue so the wound can heal. Not every clinician can safely perform it. When this is skipped or delayed, even high-quality nursing care can’t make progress.
“Some of these providers are documenting and photographing wounds,” Dr. Goldberg said, “but they’re not actually debriding. You can’t heal what you don’t clean. Other times they clean inappropriately and cause severe bleeding and hospital readmissions”
These groups frequently send nurse practitioners (NPs) or physician assistants (PAs) with limited or no surgical training.
The result? Surface-level wound maintenance and not true healing.
And the danger doesn’t stop at patient outcomes. Many agencies also get caught in billing overlap. For example, after working with home health agencies Dr. Goldberg has seen:
- NPs who also hold RN licenses may bill under both roles
- This creates duplicate billing, leading to ADRs and payment recoupments
- Agencies often don’t realize it until months later, after CMS flags their claims, and are caught completely off-guard
How Can You Tell If Your Wound Care Partner Is Actually Helping?
If you’re not sure whether your wound care vendor is delivering results, start by looking at the data.
According to Dr. Goldberg, a properly managed wound should show visible healing (be about 50% smaller) within 30 days.
The above is the easiest way to recognize whether a wound is being treated correctly. But there are other red flags that your provider isn’t effective:
- Wound size unchanged or worsening
- No documentation of debridement
- No communication between the wound group and your clinicians or case managers
- Staff can’t explain the plan of care
“If you’re not seeing measurable improvement and no one can explain the plan of care,” Dr. Goldberg said, “That’s not a healing relationship—it’s a billing relationship.”
What Makes a True Wound Care Specialist Different?
A true wound care specialist is usually an MD or DO with surgical experience who focuses on healing, not maintenance.
They approach the wound holistically:
- Treat the cause, not just the symptom (e.g., manage edema, circulation, off-loading, and nutrition)
- Perform safe, thorough excisional debridement when necessary
- Reinforce patient education every visit (more on this below)
- Communicate directly with your home health team.
This partnership-driven model doesn’t just heal wounds. It restores trust between your clinicians, your patients, and your agency.
Why Does Patient Education Matter So Much in Wound Healing?
Even the most skilled provider can’t heal a wound if the patient doesn’t follow through. Many chronic wounds stall because patients forget, or don’t understand why certain actions matter.
“Wound care is 50% medicine, 50% education,” Dr. Goldberg said.
“If the patient doesn’t understand why something matters, they won’t do it.”
Dr. Goldberg shared that reinforcing education at every visit:
- Builds accountability
- Decreases the risk of compliance lapses
- Shortens healing time dramatically
How Can Home Health Agencies Choose the Right Wound Care Partner?
When evaluating a wound care partner, don’t just ask about availability. Ask about results.
Key questions to ask:
- “Who performs your debridements: MDs or NPs?”
- “What’s your average healing rate?”
- “Do you provide progress notes and orders after each visit in a timely manner?”
The best wound partners are transparent, outcome-driven, and collaborative.
“If a wound care group can’t show you their results,” Dr. Goldberg said, “that’s your first red flag.”
How Can Home Health Agencies Fix the Wound Care Problem?
Too many home health agencies rely on wound care groups that maintain wounds instead of healing them. This creates compliance risks, delays in patient care, and patient dissatisfaction.
Healing wounds requires the right combination of expertise, documentation, and education. The difference between a healed wound and a stagnant one often comes down to whether your specialist truly partners with your agency—or just bills it.
Work only with credentialed wound care specialists who:
- Document thoroughly
- Share progress openly
- Focus on measurable outcomes.
Build communication and billing checks into your QAPI programs to catch issues early.
To learn more about Dr. Goldberg’s practice and reach out, visit his practice’s website at https://www.goldbro.md/.
Want to dive deeper into wound care? Read our companion article: Pressure Wound Staging Explained by a Professional.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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