Wound & Ostomy Care Gaps | With Joe Ebberwein

Jason Crosby

Hey, everyone. I’m Jason Crosby with Strategic Healthcare Partners and your host for Beyond the Stethoscope: Vital Conversations with SHP. Today we are joined by Joe Ebberwein, who is cofounder and CFO for Corstrata, a tech enabled solution provider for the wound and ostomy care markets. Joe, thanks for joining us today and welcome to the podcast.

Joe Ebberwein

Yeah, great to be with you today.

Jason Crosby

We look forward to it. Well, we’ve got some questions lined up for you. But first, let’s start with just some background information on yourself and kind of your journey to healthcare industry.

Joe Ebberwein

Absolutely. Yeah. So my background is actually accounting and finance, got an undergraduate in accounting and the CPA route and worked for both and this’ll age me, but both Arthur Anderson and Price Waterhouse. And started working in healthcare in early in that career at doing CPA work auditing and what’s in Atlanta for a little while, and then moved back to Savannah and actually began work with Memorial Medical Center, now part of HCA, but worked primarily on the post-acute side and the for-profit entities, which back then were the area ambulance and MedStar the ground ambulance, and then all of the other ancillary in home services such as home health, DME, et cetera.

So I’ve really spent most of my career in that space just about anything that could be done in the home from nursing traditional home health, Hospice, private duty care. And then as the years went on back in the early 2000s, the agency that I was involved with, we got into telehealth in a big way. And the use of vital signs monitoring in the home. So we were one of the early adopters, really nationally, and kind of became known as national thought leaders around implementing that, that use of technology in the home health space.

And we saw some pretty amazing results. We saw improvement in clinical outcomes and improvement in financial outcomes. So we were much more equipped to manage patients with chronic conditions like CHF, COPD etcetera in the home using this equipment again back in the early 2000s, clunky, expensive equipment that, fast forward, that was really kind of the initial groundwork for what my business partner Kathy, paid and I ended up doing at Corstrata about seven years ago. And really what we did is we took that concept of how can you apply technology to a healthcare problem. And we had experienced a big problem in managing chronic wounds for patients that were in from health. So similar to the teleradiology model.

We thought kind of came up with a thesis that we could move images similar to radio graphic images to a distributed workforce and that that workforce happened to be board certified wound and ostomy nurses. So we started doing a lot of R&D into research around how could we come up with a technology solution to that problem. So that’s really kind of how Corstrata was born seven years ago, but that’s my background.

You know, finance, accounting, but a whole lot of other hats along the way in early-stage companies.

Jason Crosby

Yeah, sounds like a natural evolution from the early 2000s. You know, you got see telehealth early on and home health. And now that’s kind of all you’re hearing about, right? So kind of makes sense now that you as you mentioned with Corstrata. So tell us, let’s dive into that. You you’ve touched on it; tell us a little bit more about the operations of Corstrata and the problems you’re trying to solve, who and who you’re trying to solve them for, right. Which who’s your typical client? What type of provider setting? Dive into that a little bit for us.

Joe Ebberwein

Sure. Yeah. You know, wounds are an interesting problem because no one really owns wound outcomes. You know, you’ve got cardiologists that are dealing with cardiovascular issues or endocrinologists dealing with kidney and diabetes function and that kind of thing. But nobody really owns wounds because they cross multiple comorbidities. You might have wounds related to vascular issues, lower extremity wounds.

Huge prevalence of diabetic foot ulcers in the diabetes population. One in four diabetics will get a diabetic foot ulcer in their lifetime and one in four of those will have an amputation. And then the five-year mortality rates are off the chart. Crazy for people that are that recover from an amputation. So those are the kind of wounds. Additionally, you have a multitude of other words related to different conditions.

Whether it be pressure injuries from immobility, or you know a lot of times you hear them referred to as bed sores and unfortunately that’s highly prevalent in skilled nursing facilities and a lot of them can be prevented with the right with the right education, with the right techniques, the right surfaces, et cetera. So it’s a $96 billion problem, 15% of all Medicare patients members have a wound and the real problem that we’re trying to solve.

And chipping away at it is that there are only 15,000 board certified when nurses in the country and that equates to about one nurse for every 600 patients. It’s not sustainable. The number of diabetics obviously we know that that’s growing. We’ve got about 37 million diabetics and another 96 million pre diabetics.

So it’s a really, you know it’s like a freight train going down the track and it’s it doesn’t have a good ending. There’s a big wall at the end of it and it’s all-around access to these specialists. So as I said, no one knows wounds across multiple specialties, multiple provider settings, whether it’s home health, skilled nursing facilities, we’re about 1/3 of the patients have a wound, L tags.

Rural hospitals, all of these different care settings have patients that present with wounds and yet we don’t have the expertise to really manage them and get evidence-based care.

One out of 10 nurses that are certified in wound and ostomy care practice in the post-acute space, so in that includes home health Hospice sniffs rural hospitals.

90% are practicing in the hospital settings and outpatient wound centers. So I mean you, you can see there’s such a disparity with where the experts are. We’re solving that problem with technology in a number of different ways. And I can go into that if you want or…yeah.

Jason Crosby

So with that the key obviously being technology adoption.

Joe Ebberwein

Right.

Jason Crosby

I on the on the provider side and some are a little bit more accustomed to that adoption. Some aren’t with that and with the gap in in qualify nurse on the, on the outpatient side as you just mentioned.

What are you seeing those as your key barriers or what other barriers are you seeing? To that to entry into those spaces.

Joe Ebberwein

There are a number of barriers, one of them that’s really interesting is some providers don’t want to take wound images of their patients wounds and you can kind of see that right because of litigation discoverable in the chart, et cetera. But what’s interesting is most of those patients say with a pressure injury or pressure ulcer, if it gets bad enough somebody is probably photographing that wound and what we tried to get across our client says do you want, you know, a qualified professional taking photographs of the wind over time to show the progression and have the medical records support that decline or hopefully improvement or do you want you know, the patient’s nephew to have the photograph in a in a court of law. So a lot of times we can get over that barrier pretty quickly the other.

The other barrier is we’re really a value add to our customers, so whether it’s home health or Hospice or skilled nursing facilities because we are nursing model, we’re not billing any Part B, we’re not billing any commercial Medicaid. We bill our clients and our clients to get a return on investment from having access to experts. So we can reduce nursing time, home health visits, we can reduce. So we can reduce their spend on advanced wound dressings and also really to be honest help them with coding and reimbursement as well because a lot of times they’re misidentifying wounds and they’re leaving dollars precious dollars on the table from a reimbursement standpoint.

Jason Crosby

Sure, that sounds like if if 15% of the Medicare population have wounds and there’s obviously a growing number there. I would just imagine there’s greater demand for that type of service. Where are you starting to see some of those trends knowing that you’ve got the aging population, you’ve got hospital closures, not only rural hospitals, but you’ve got WellStar for goodness sake?

Joe Ebberwein

In Atlanta, yeah.

At the hospital, large hospital in Ohio. And that’s only gonna continue, right? So, go down that path a little bit. Are you are you gonna, do you envision continued demand for such a service or is that just going to become a barrier for you as well?

Joe Ebberwein

Umm, I think it’s gonna become quite an opportunity for further penetration in multiple markets. And I’ll tell you just a couple of examples. We are we’re working with some large hospital systems and on the West Coast and these are these are big hospital systems in urban settings and because of lack of staffing, they’re closing their ostomy clinics so.

Literally, we’re getting that business to our virtual consultations. We are able to do a 30 minute live video with the patient in their home, troubleshoot the appliance, save a ER visit and assist these hospital systems that are desperate for staffing of these nurses on indeed.com. I went on there today, there are 4001 Open wound nurse positions across the US.

Well, if they’re only 15,000 certified period, you can see there’s such a disparity with COVID kind of the great resignation of a large number of nurses who are considering leaving the profession. It’s a big and growing problem. So hospital systems, as you mentioned in rural facilities. Really just about anybody that in the post-acute space. Also that is dealing with the wound, a wound patient.

Jason Crosby

So what? What do you what do you say to those? Then there’s obviously the appetite that the man for the service that you guys are providing.

But many reasons, as we you just laid out there still slow adoption to that whether you’re still nursing facility, rural hospital provided a large health system. You know practice setting across the board, there’s not provider that can’t utilize the service. What do you tell those that are just hesitant to look in that direction and starting investigating you know a service like yours, what do you say to them to get them across the line?

Joe Ebberwein

Great question. And I do think that COVID and the adoption of telehealth broke down a lot of those barriers for us because a lot of facilities had to move to virtual care, they had to, you know, put the systems in place, not only from a technology standpoint, but also all the infrastructure. And so that has actually helped us in that in telling that story, but.

You know, for instance, when we talked to, say, rural hospitals that now are either not able to admit a wound patient or they’re having to transport them to a higher acuity system because of lack of expertise, it becomes really an amazing impetus to start considering using virtual care.

Jason Crosby

So, in the markets, almost telling them itself, “hey, this is why you need to look into it.” They don’t necessarily need the sales pitch. I mean, just listen to the market.

Joe Ebberwein

Right.

Jason Crosby

And let the market tell you need to look into. No, that that makes sense. What? Continue going down that path. Let’s pivot somewhat into that, you know, to me that virtual health, Telehealth is kind of the A disruptor that we need. So continue looking at that and let’s also look into your crystal ball, right. What are some innovations that you’re seeing in these service areas that you’re you know, what are you seeing coming down the horizon there?

Joe Ebberwein

Yes. So interestingly, we have and this is one example, but we have a diabetic foot ulcer prevention program. So obviously diabetic foot ulcers don’t just occur in the Medicare population. These are people that are working, they’re 40s, fifties, some even younger that have severe diabetes, they develop neuropathy and they end up with a diabetic foot ulcer and it’s just an incredible kind of cycle. It can spiral down well.

We have working with companies that have electronic sensors for measuring temperature and pressure in the soles of shoes. A lot of technology is moving toward prevention, and most diabetic foot ulcers are preventable. If you have the right early detection. So that’s one example. There are sensors built into orthotics for measuring compliance; and you know what ends up happening is that data, that sensor data that tells that someone’s getting into trouble, that comes to an entity like Corstrata, and then we’re able to intervene. We had a really interesting this is just an anecdotal story, but we had an interesting encounter with a gentleman who was using one of these monitoring systems.

And every weekend he would alert. And so we knew something was going on the weekend where he was getting elevated temperatures, which is a precursor to ulceration. And so, one of our nurses said, OK, let’s dig into this, let’s do a video call. I want you to show me every shoe you have. I want you to tell me what you’re doing on the weekend. We’ll turns out he had a part time job and a Funeral Home, and he had to wear a certain kind of black shoe. And it was not the proper shoe to relieve that pressure. So, we got him in the right shoe. The alert stopped coming in. But that’s the that’s the illustration of you got all this great sensor data, but what do you do with it? And then that human intervention, that biofeedback and coming up with a plan to to really prevent that ulceration.

Jason Crosby

Wow, that’s a great, applicable story that anybody listening can certainly resonate with right? I mean that’s great. Appreciate you saying that. So what’s now in the strategic road map for Corstrata? What are you guys working on today and over these next couple of years?

Joe Ebberwein

Yeah. So it’s been interesting over this last year where we had predominantly really been working mostly in the post-acute space like Home health, Hospice, skilled nursing facilities. What we’re starting to see are some of the emerging models for really acute care services in the home hospital at home, if you will.

And we’re working with a number of those who organizations that really help facilitate a hospital building a hospital at home program.

What where that becomes really interesting is, and this was really accentuated during the pandemic, you’ve got these acute patients; Who really, when there weren’t enough beds in the hospital, could be managed in the home with the right equipment. And when I say hospital at home, I’m talking there is hospital grade equipment, hospital bed, vital signs monitoring, all going back to kind of a Star Trek central station constantly monitored, daily nursing visits, nurse practitioner visits, etcetera. So you know, imagine that they’re really setting up a command center in the home that is, you know, transmitting data so hospital at home is an emerging market and a lot of those patients have wounds and ostomies. And so they’re engaging with us to do virtual consults for the people that maybe do not have experience with wounds, other innovative type things that we’re seeing are mobile physician groups that are doing primary care. Obviously the proliferation of ACOs and the whole value-based care bundles. You know we are in discussions with some payers that also have mobile clinical teams. So yeah, it’s really kind of been an interesting year and it’s a shift in who’s approaching us for those kinds of consults. Ostomy is a big deal as well, even though it’s not a big number like the wound population, it’s a really high 30-day readmission rate into the hospital. And so ostomies kind of go hand in hand with wounds because of the certification of their nurses.

Jason Crosby

Interesting that you know here you just talked about what, 20 years ago the focus was all in the skilled nursing facility if that and now you can span across any provider setting a CEO’s practice setting, it doesn’t matter come a long ways and there’s just the last 20 years. So another exciting few years ahead, I’m sure.

Joe Ebberwein

We’re seeing such incredible stories, both with individuals living with ostomies that literally were driving to an ostomy clinic 4 hours away. That can now do this in the privacy of their home to people with long term chronic wounds that just never had the right evidence based treatment plan. And we’re getting those wounds closed, obviously saving a lot of money for the providers. But the human impact Is amazing as well.

Jason Crosby

Well finally, Joe if our audience supposed to learn more, how do they go about doing so?

Joe Ebberwein

Sure. So lots of ways to contact us. Obviously our our website Corstrata.com, we’re on LinkedIn and Twitter and Facebook and just about any social media. So very easy to get us.

Jason Crosby

With some great information and even better conversation there lots of lots of data to support. You know what you guys are doing is a great thing. It’s a service that’s needed out there in the marketplace. So really appreciate that. And I’m sure the listeners will, will find it. This is useful as I did. You definitely opened my eyes to a lot of things there. I appreciate that and the we really appreciate your time and joining us today.

And I wanna thank our listeners for your time. We look forward to our next podcast and until then everybody have a great rest of your day.

Joe Ebberwein

Thanks for having me.