Wound Care: Dr. Payam Tehrani on Bringing Expert Wound Care to Nursing Homes | Healthcare Series

Anthony Codispoti: Welcome to another edition of the Inspired Stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Kodespode and today’s guest is Dr. Payam Tarani, CEO of SNF Woundcare, based in Beverly Hills, California. They provide expert bedside surgical wound and skin care for skilled nursing facilities across the country.

They focus on reducing hospital readmissions by offering services like G-tube replacements, wound vacuum applications, and in-service training at no cost to the facilities. Dr. Tarani has been leading SNF Woundcare since 2017 and is a board-certified wound care specialist with training in internal medicine and hyperbaric oxygen therapy. Before starting the company, he served as an attending physician at Long Beach Memorial Medical Center where he worked closely with the renowned Dr. Michael Strauss to develop specialized wound care programs. Under his leadership, SNF Woundcare has grown steadily, earning reputation for outstanding patient support and innovative treatment strategies. Now before we get into all that good stuff, today’s episode is brought to you by my company, Add Back Benefits Agency, where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our innovative programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies, contact us today at addbackbenefitsagency.com. Now back to our guest today, the CEO of SNF Woundcare, Dr. Payam Tarani. I appreciate you making the time to share your story today.

Dr. Payam Tehrani: Thank you, Anthony. I appreciate having me.

Anthony Codispoti: Okay, so how did this all begin? How did you get into the field of specifically wound care?

Dr. Payam Tehrani: So I used to be a hospitalist, which is an internal medicine physician at a facility at Long Beach Memorial Hospital. As a hospitalist, he’d taken a lot of patients, when they go through the ER, they have some issues, the hip fracture, what not, they call you, and they say, hey, a patient’s coming in with a hip fracture, and we have an orthopedic surgeon on call who’s taking the patient’s OR, but we want you to do their medical management. And so I would be the medical management for these patients. And they would always use a specific surgeon, Dr. Michael Strauss, that is extremely helpful.

And I had a close relationship with him. And what would happen is that he would do the surgery, and then I would do their medical management. And then after when all was said and done, they would end up back at his clinic just to make sure the patient’s wound was healing.

So Dr. Michael Strauss would do their surgery, do also the follow-up wound care on these patients. And then after some time, I was told, hey, come to my clinic and see some of these patients for basic wound care who have these wounds, some of them are healing great, some of them are not healing so great. So I went over to his clinic one day, and he kind of taught me how to do wound care. Zero expectations took me like a son and pretty much showed me how to do wound care for all sorts of wounds, not just surgical wounds, but pressure wounds, diabetic foot ulcers, venous ulcers, all sorts of stuff. So I kind of learned it. And that’s kind of how I got into the wound care aspect of life.

Anthony Codispoti: So for the layperson, the outsider, somebody not in the medical profession, wound care to me is, I don’t know, wash it with soap and water, you put a bandage on it, you wrap it up. Clearly, I see you sort of smirking, there’s a lot more to it. Like educate us, why is this sort of a specific area of medical care?

Dr. Payam Tehrani: So there’s a lot more to it, depending on the amount that it drains, the etiology of what caused it, you want to make sure the cause is not there anymore, the amount of drainage, there’s multiple different appointments that we can apply to these, certain ones help it clean it up, certain ones are for moisture, so it’s a little bit more than that. But yeah, we see a lot of improvement with one cream versus another, there’s so many different ways you can treat these wounds. And a lot of it’s trial and error.

Anthony Codispoti: Are there tests that you do on the wound to see, I don’t know, like what the bacterial culture is?

Dr. Payam Tehrani: So there’s a lot of marketing out there for that, like use this test, run this test, but our patient population, because they’re in nursing homes, a lot of them are incontinent. And if they’re incontinent and they’re going, you swab these wounds, you’re going to grow multiple different bacteria, just because they’re soiled and whatnot, and then you don’t know if this bacteria is really causing an infection or if it’s a contaminant. So we really don’t swab them as often, because we’re getting a lot of contaminants, and then we have to treat the contaminant, and then we’re exposing these patients to a lot of antibiotics. So we have more of a clinical judgment, do we think the wound is infected? If we do, then we’ll probably get a, you know, a deep culture and go from there, but just swabbing them, we will grow a lot of resistant bacteria that aren’t necessarily doing anything. They’re just hanging out on the wound, and they just need to be flushed off as opposed to taking antibiotics. Gotcha.

Anthony Codispoti: Okay. So we have neosporin in our house. Is that something we should be using?

Dr. Payam Tehrani: I mean, neosporin is great. It works even in some of these nursing homes we use in neosporin, but there’s a lot of other things that are a lot better.

Anthony Codispoti: But there’s no downside to be using it. Sometimes I see articles online that say, oh, it’s worse for the wound. It slows down the healing.

Dr. Payam Tehrani: I mean, I would, if you’re home and you have a wound, I would put neosporin on it for a few days, and if you see it’s getting better, hey, continue it. If you see it’s getting mass-weighted and getting worse, maybe time to reach out to somebody and be like, hey, applying it, not getting better, I can go from there. But yeah, it would be a good starting point.

Anthony Codispoti: Okay. So, Dr., I understand that you’ve introduced bedside surgical wound care in skilled nursing facilities specifically. Is this a rather unusual approach?

Dr. Payam Tehrani: So I think a lot of these nursing homes have these elderly patients. A lot of these elderly patients on top of their multiple comorbidities, they have a long list of comorbidities. Another one they have is the skin and wound issues on top of it.

As you get older, you become more immobile, more bedbound, and you bump your leg here, you lay in bed for longer, you get all sorts of skin and wound issues. And certain nursing homes that kind of aren’t very rural areas, they are sending these patients out to a, getting an ambulance because these patients are immobile on a gurney bedbound and they’re transferring them out to a wound clinic. And it’s very costly, you know, they have to pay for the ambulance, the whole transportation ride, and who’s paying for this, right? So a lot of these, you know, physicians, we send out the physician to the nursing home, and then on average, I would say there’s about a 15% wound rate.

So if you have a facility that has about 100 patients, about 15 patients will have a wound that we would go out there and we would see pretty much anyone with any sort of skin or wound issue. This way you’re avoiding that transportation cost. It’s easier for the patient, you know, the patient is enough to be transferred out and all that.

Anthony Codispoti: So you said let’s cut out that expensive transportation process, which is probably also relatively unsettling to the patient, and let’s bring the care right to where the patients are, right, the nursing office.

Dr. Payam Tehrani: Right to where the patients are as opposed to transferring patients out, you know, imagine 15 ambulances a week trying to transfer patients to a wound clinic.

Anthony Codispoti: Okay, so okay, so you learned from Dr. Michael Strauss, they kind of got you started in this, and then what was sort of the next leap into actually starting your own practice?

Dr. Payam Tehrani: So started with him, I learned it, and then as a hospitalist, which is just basic internal medicine following up patients at the hospital, I would also go to the nursing home and just see them for primary care management and make sure you know they’re everything’s okay, their blood sugars and whatnot.

And I remember, you know, one of the, you know, the heads of the nursing homes says, hey, we’re using, you know, a certain company, we’re not happy with them. You know, your patients that you have that are under you also have wounds, and we heard that you’re familiar with wound care. Do you want to see a few of these patients yourself so we don’t have to give them to this other company that we’re using?

Sure, I’ll see my own patients myself and I’ll take care of it. So the few patients that I did have in that facility, I saw myself and I did a great job and I became friends with, you know, the nursing home people. And then they’re like, hey, do you want a couple more patients? And I thought about it and said, sure, I’ll take a couple more, you know, patients that have wound care, but the problem was it was a weekly thing, I’d have to go there weekly to see these patients. So I ended up going there weekly to see these residents and they did well. And then the nursing home was like, hey, like we plan on cutting our contract with this company and going with another company.

But if you want the contract, we’d be happy to give it to you. So I took one facility. That was my first one that was in Long Beach, I don’t know, 2017. And yeah, that was the first one. And then the company had multiple nursing homes, seven or eight. And then they kind of put me into the different ones as well.

They said, hey, come to this one, come to this one, come to this one. And at that time, you know, my full-time job was to work in the hospital. It wasn’t really these nursing homes stuff. So once these nursing homes became, you know, seven, eight, nine nursing homes, I’m like, do I leave my full-time job at the hospital and do, you know, full-time nursing homes? So what I was doing was like, wake up at three in the morning, go to the hospital, see my 25 patients at the hospital, leave at like 8am, you know, from three to five, three to seven, eight, see those patients, take all the calls that come in for them, and then also go to these nursing homes in the, you know, late morning.

Yeah, so it was a lot. And I was doing that for about a good year. And until these nursing homes became excessive, and I couldn’t do the hospital work anymore, I’m like, okay, I’m gonna stop my own business doing nursing home, moon care. So I just ended up, you know, cutting the hospital work off, going to these nursing homes and seeing these moon patients. And then I just got called for more and more and more nursing homes. And then some of these nursing home, like the heads would leave and go to another city, another state, they would call me and say, hey, can you come to Phoenix? Can you come here? I mean, now I’m in Alaska, Florida, Maine, all over the place.

And then, you know, it just keeps growing. As long as you’re, you know, you offer a good service, you’re honest, and you knew what’s right. You know, if they see you’re doing what’s right, and you’re not just there billing and doing it for the money, they honestly bring you in. And I think that’s kind of where I grew was because we don’t always do what’s profitable, we do what’s right.

Anthony Codispoti: Payam, what was it that you were doing that was so different slash better than the companies that they were already using to where they they approached you, you’re not knocking on their doors, you’re not marketing, say, hey, doctor, we love what you’re doing. What were you doing? It was so much better.

Dr. Payam Tehrani: So initially, I was knocking on doors, but I was picking up my phone on them. You know, how many times do you have direct access to a physician who’s going to pick up his phone at two in the morning, and get the job done, get your notes for you show up at two in the morning for something urgent? Other people don’t pick up their phone, or when you’re dealing with them, they don’t pick up their phone.

So I was actually picking up the phone, getting all the work done, showing up when they needed me, you know, getting them out of problems, you know, doing the documentation correctly, getting it done promptly, all these things. Not a lot of other people are doing it.

Anthony Codispoti: You know, a lot of facilities site cost is a barrier to this kind of advanced wound care that you provide. But if I’m understanding this correctly, you offer your specialized services at no direct expense to them.

Dr. Payam Tehrani: Correct. So what we do is these patients, so these nursing homes are, you know, that’s a business, they take in these patients, and they, you know, build their health plan, right? So when you go there, you know, they build whatever health plan the patient has for the stay and for the rehab and for everything. So we also build the patient’s health plan as well. So when we see the patient on a visit for, you know, whatever issue they have, we don’t build the facility, we build the patient’s health plan.

So it’s free for the facility more or less, because we’re not building the facility. And then we also see all patients, we don’t discriminate, oh, this one has, you know, their insurance isn’t very good, we’re not going to see them. No, we just, you know, everybody’s got to be seen, whoever has an issue has to be seen. I remember when we first came from, you know, my parents came from Iran, they didn’t have the best insurance, they probably had no insurance. And I remember one doctor saying, oh, I can’t see them because they don’t have an insurance. And that’s the last thing I want to do is say, no, I’m not giving care, because your insurance isn’t the best. So that’s, you know, something we don’t do is we just see everybody with the same standard. And, you know, if we get paid, great, if we don’t get paid, you know, we just write it off.

Anthony Codispoti: Oh, wow. I’m going to guess that most of the patients have some kind of insurance, because if you’re in nursing homes, at least they’ve got Medicare, right? Correct.

Dr. Payam Tehrani: Most of the patients have almost all have some insurance, but they don’t all have decent insurance. Some of them have very bad insurance. Some of them, their insurance doesn’t pay us. They make an excuse not to pay us. I would say about 70% we get paid, the other 30% we just eat it.

Anthony Codispoti: Is that typical in medical field?

Dr. Payam Tehrani: Based on what I’m here, well, I mean, some providers are just like, no, we’re only going to see patients that insurance is actually pay us and they want, you know, a preauthorization that they are going to get paid. But I mean, by the time we sit there and wait for preauthorization, we could just saw the patient got it over with.

Anthony Codispoti: So it’s interesting your background, your parents coming from Iran and saying, oh, hey, we can’t see those folks. Their insurance isn’t very good. Yeah. Like that’s stuck with you. That’s imprinted on you. Yeah. That’s not a situation that you want to put somebody else in.

Dr. Payam Tehrani: Especially when you’re elderly, you know, a lot of these patients that are confused or prevented, you know, and to say no to one of these patients that can’t see them, can’t care for them, especially when they can’t even make decisions. Their health plan is telling you what to do. It’s the last position I want to be in if I’m in that case.

Anthony Codispoti: We need more doctors like you. So let’s talk about treating tough wounds like venous stasis ulcers and pressure ulcers. Why are these challenging and how do you deal with them?

Dr. Payam Tehrani: So pressure is very challenging. Pressure wounds develop because the patient is immobile. Usually these are, you know, as you get older, you become less mobile and you’re not going to become more mobile with time. You’re just going to become more immobile with time or if you’re, you know, paraplegic, you’re immobile and it’s not going to change. And when you’re immobile, you’re prone to pressure injury, pressure wound, that sort. So the problem is these wounds are developing because you’re immobile and you’re not going to get better.

You’re likely only going to get worse. So it’s very hard to treat these patients if the underlying problem of immobility is not, you know, it doesn’t get better. So pressure wounds are very hard to treat because the patient’s immobile and the weight continues to put pressure on the site, for example, the heel.

And, you know, and when you have that pressure on the heel, the blood supply or whatever tissue is underneath that heel is compressed because of the weight of the foot and then there’s poor blood supply. So it’s just not going to heal regardless of how much we care for these wounds because of that, you know, their immobility remains. But if you can remove the inciting agent, it gets better. But when we can’t get these patients, you know, more mobile, they can’t turn and reposition them, you know, we’re supposed to reposition these patients every two hours, almost all nursing homes do a great job at doing this.

But, you know, they go for four hours without being repositioned. It causes a problem. A lot of these patients are non-compliant. They don’t want to wake up at, you know, three in the morning to be turned.

You know, it’s hard to wake them up three in the morning, five in the morning, turn them, they want to sleep. But then on the other hand, their wounds are getting worse. And because they’re paraplegic or you know, they’re not feeling the wound either. So they’re like, well, don’t wake me up and then their wound gets worse.

Anthony Codispoti: Dr. I think you’ve got email or an instant message or kind of open in the background that’s a ding it, but that’s something that you’re able to close. Yeah. But while you’re looking at that, I’d like to understand what hyperbaric oxygen therapy is. Can you talk about that?

Dr. Payam Tehrani: So now when I was in the hospital, we did some hyperbaric oxygen therapy. This was more for acute stuff when they had patients had like a surgical flap that failed.

There’s not enough blood flow to it. We would have them go under a hyperbaric chamber. I think it was like close to 30 different sessions of hyperbaric. But we don’t do it for the nursing home population. The nursing home populations wounds are chronic. And these chronic, I’m sorry, I don’t know how to turn off the sound for that thing.

So then the emails that come in are yeah. So you know, the patients at nursing homes, the their wounds are chronic and hyperbaric is more for more acute stuff or flap, you know, flap issues that are not getting enough blood flow. So we want to increase the oxygen in the blood to get it to these acute stuff. But for these chronic wounds, these patients have had it for four years, 10 years, 20 years. So giving them hyperbaric is not necessarily going to help them much.

We’ve tried it. We didn’t see much improvement with the chronic wounds. And then also it’s very hard to put these patients in a chamber, especially if they’re confused, put them in a chamber, you know, the public, why am I in a chamber? So it’s hard to put this population in a chamber.

Anthony Codispoti: And so what happens when somebody’s in the chamber?

Dr. Payam Tehrani: It’s yeah, they put them in a hyperbaric chamber, it’s like a tube. And they’re there for 90 minutes. And then they, you know, increase the oxygen to that chamber. And as you inhale higher levels of oxygen, it goes into your lungs, it goes into your circulation system. And they think with hyperbaric oxygen, you know, these wounds are supposed to be healing better. I’ve seen it for acute wounds. I’ve seen acute wounds do better with it.

You can see it’s more, you know, more red, more pink, the acute wound. But does it always work? No, some insurances cover it, some insurances don’t cover it. But it doesn’t always work. And sometimes it does work. But heck, you know, if it’s your last resort, you might as well try it and see if you get better.

Anthony Codispoti: Yeah. So it doesn’t work so well in the nursing home environment to where you’re dealing with some of these, a lot more of these chronic wounds. Given what I’ve already heard from you, hey, we want to take care of the patients, you know, we’re not going to argue that they don’t have coverage. I have to imagine that you’ve probably got a collection of stories like specific stories of like success, you know, you go in with a patient and here’s a problem that they had and here’s what you guys did to kind of help them recover. And I’m wondering if maybe you can pull one from your memory banks, that would be fun to share.

Dr. Payam Tehrani: Yeah, we’ve got a few of these where, you know, there was one gentleman, he had, he was very immobile, a fairly young guy, fairly immobile. And we were hopeful that he’s going to be a backup and walk. I think it was a motorcycle accident. We were hopeful that he’s going to get up and walking again. But, you know, he had a couple of pressure wounds and fairly large, I would say the size of like a grapefruit. And, you know, he was getting extensive rehab, trying to get him back up. And we were doing the wound care on him.

Initially, it got a little bit worse. And with time, you know, he wanted to heal. He, you know, he was on a feeding tube at that time, couldn’t even swallow. But we changed his feeding, you know, sources, we gave him additional rehab therapies and he was being seen for his wounds on a regular basis, cleaning it out. And, you know, he stood out, he stood out and he eventually all of his wounds healed.

He had a sacrocoxics wound, which is the very common wound on the bottom when these patients are immobile. He finally did better. And he was, you know, and he reached out to me down the line and said, Hey, I’m finally healed. And he’s that’s going to be very rewarding, very rewarding. Yeah. You know, every so often he gives me a call now, I’m well okay.

Anthony Codispoti: That’s nice. Said you had Christmas card maybe. So as you were growing and more of these facilities were contacting you to do for them, what you’d been doing, you know, for a lot of other nursing homes, obviously, you, Pym, can’t be everywhere all at once. So you had to start hiring people and training them in, in the way that you do things, the folks that you’re training, are they other doctors? Are they licensed nurses?

Dr. Payam Tehrani: Like what level of a little bit of everything, a little bit of physician surgeon, nurse practitioner, physician assistant. So we’re about 40 total now as a group of 40 NPPAs physicians who go across the country and seeing these residents. And there’s a whole team that trains them.

There’s a whole, you know, there’s teams of nurses that train them on how do you measure a wound? How do you document it? How do you treat it?

What ointment do you apply? And once they’re ready, we give them an exam to take and make sure they’re ready. And then also we have another team of nurses that once they do start seeing patients, they start reviewing all of their notes to make sure all of their notes are perfected as well. So quite a bit of, you know, training is going in it and then ongoing training as well. You’re documenting this, but you’re applying this cream.

What is your reasoning behind it? So all of this is in there as well, you know, to make sure we’re, you know, since it’s fairly big, you know, we want to make sure all of the providers are on top of it.

Anthony Codispoti: So you said they travel around. So it’s not like when you’ve got, you know, clients in Alaska, you don’t have a team there in Alaska? You have folks that are moving. It’s all mobile.

Dr. Payam Tehrani: Like so the facility is in Alaska. There’s one provider who lives in Alaska, and he sees those patients who are in Alaska. But when he uploads his notes, those notes are all remote. And then we audit them remotely to make sure that what he’s documenting is, you know, correct and accurate and whatnot. So he uploads his notes. And then we, you know, team of nurses review those notes. Okay. And then there’s one group of, you know, provider in Louisiana, another one in, you know, Florida or whatnot, and everybody just uploads their note to the hub and then everybody take, you know, then they review it and then they email and say, hey, you’ve documented this, but maybe it should have been this and whatnot.

Anthony Codispoti: Gotcha. Okay. So you mentioned Dr. Strauss before, who was a bit of a mentor to you. What practical insights or techniques did you learn from him and how have they shaped the way that you do wound care?

Dr. Payam Tehrani: So he was a little bit older and he was, you know, he liked the old school stuff. There’s so many new products that come out. But he liked the old school stuff. And that’s what kind of what I was taught from, you know, these are the old school stuff.

And the nursing homes like these old school stuff as well. So, you know, he showed me how to do a debridement, which is cleaning the wound. You take a little small surgical knife, it’s a disposable knife, and you cut out the dead tissue. If you leave the dead tissue in there, it’s, you know, a high risk for, you know, not healing, possibly getting infected, but the wound will not close and heal over a dead tissue. So the dead tissue has to be removed. And that’s done through debridement and different creams that we apply to get rid of the dead tissue and, you know, keep the blood flow there.

Anthony Codispoti: You apply a cream to get rid of the dead tissue instead of like physically cutting it out.

Dr. Payam Tehrani: You do both. So you first, you know, cut it out. And then of course, you can’t cut everything out. You know, it’s kind of hard. It could be painful for the patient, even though we apply numbing, you know, sprays and injections, but you can’t get rid of all of it. And it can be, it can be bleeding a lot and whatnot. So therefore, you know, at the end, we also apply a cream that will remove some of the dead tissue if the dead tissue remains. So he kind of taught me how to do all that, how to clean the wound, how to debrid the wound, which ointments go on while, you know, and it worked, you know, how to flush your wound out, you know, sometimes people are just cleaning the surface of the wound, but sometimes the wound is deep. So how to irrigate them and all this sorts of stuff.

Anthony Codispoti: And you mentioned that there’s a lot of new products that have come out. Are they mostly just like other ointments that have different substances in them that sort of affect the healing in a different way?

Dr. Payam Tehrani: There’s all sorts of stuff, ointments, patches, cleansers, you name it, they have new products that come out every day that, you know, and a lot of it’s the same stuff just rebranded differently, to be honest.

Anthony Codispoti: Is there, is there something that you want to see come out that doesn’t exist yet?

Dr. Payam Tehrani: I don’t think there’s any, you know, magical cream or ointment. A lot of it’s, you know, getting rid of the inciting agent, what caused the problem first, you know, get rid of that problem, and then just making sure the moisture, it’s not too dry and it’s not too wet to cause maceration. I think these are the two main, you know, and keeping the wound clean, you know, keeping the wound clean and making sure it’s not too dry or too wet.

Anthony Codispoti: Dr, what advice would you have for folks listening that are interested in advancing their own career in this field?

Dr. Payam Tehrani: Work hard, show up and don’t, you know, work hard, show up, be there on time, be punctual, you know, don’t show up late, and, you know, give it a chance, you know, I think marketing is important. You have to have a good marketing team as well, otherwise nobody’s going to hear about you.

Word of mouth, you know, goes far, but it doesn’t go, you know, you can’t become nationwide with word of mouth. And yeah, work hard and do what’s right. Don’t always go after and chase the money. If you do what’s right, you know, if there’s a need for something and you can sell it, you know, go after it and don’t just always look at the money.

Anthony Codispoti: Do you feel like that’s been the biggest key to your growth and your success? Are there other sort of creative levers that you’ve pulled that have allowed you to grow?

Dr. Payam Tehrani: I hope people help me a lot. You know, make systems for me that run well. You know, computer systems for marketing that has done quite well. I have online courses for nurses to renew their license. We offer these to a lot of facilities and also the general population for all health care professionals to take these courses. But you got to get your name out there. You got to get your name out there and be responsive to them.

Anthony Codispoti: What does your marketing look like? You’re talking about the courses and that’s probably great. It’s probably another kind of revenue generator, but it’s also a way to kind of build your name and your brand. What do the ads look like that you’re running? Is this like Facebook, LinkedIn kind of stuff?

Dr. Payam Tehrani: All of them Facebook, Google, running for the course, running for the services. You just have to keep running it. Yes, so much you see nothing, but the course does pretty well. The courses are at an all-time high this month.

Anthony Codispoti: Why do you think that is? Here we are, very end of January 2025. What’s the time?

Dr. Payam Tehrani: The word gets out there and you have to price it fairly, competitively compared to others. You have to give them what they need. If they need X amount of hours to renew their license, I try to give them what they know, fulfill their all their hours, give them exactly what they need and market it fairly. How would somebody find your course? I think I’m on like the number one or two spots. If you check for wound care certification or wound care courses, I come up on Google as like the number one.

Anthony Codispoti: Would they also find it on your main website, snfwoundcare.com?

Dr. Payam Tehrani: Correct, they could find it on snfwoundcare.com or on Google, we come up pretty immediately.

Anthony Codispoti: We’ll include those links in the show notes for folks. Thank you. Let’s see. A book, a course or a podcast, something like that that’s been particularly helpful for you that you might recommend to somebody else?

Dr. Payam Tehrani: Honestly, a lot of my stuff has been trial and error on my own. Finding a problem and looking for a solution to get it going. A lot of these needing supplies from places. I would ask people, where can I go to get this? I ended up on Alibaba finding something, ordering it. Now pretty much all of my stuff is ordered via that. But honestly, you have a problem and you figure out a way to solve it yourself.

Anthony Codispoti: Let’s see, where do we want to go here? Everything is sort of self-taught. Is there a particular philosophy that guides you in your daily work and your business?

Dr. Payam Tehrani: Yeah, be available and do what’s right, honestly, is the philosophy that has worked. That is our main goal is care for these residents. Don’t look at what it’s going to bring in, value eyes. See the patient and take care of them and eventually everything falls into place. We get called out to go do things 30, 40 miles away and the patient has no insurance. We still go.

Anthony Codispoti: You know that in advance. You know going there, they’ve got no insurance.

Dr. Payam Tehrani: It happens all the time where I just tell the office, just have somebody take care of it, it doesn’t matter. I know in advance we’re not going to get paid, but it is what it is. Somebody gets sent out and I still have to pay the provider who’s going out there. They’re not going to do per-free, but they still go out there to take care of it. You look at the big picture, it’s very profitable what we’re doing. So you keep some costs.

Anthony Codispoti: I wonder where this comes from. You mentioned sort of early your parents coming to this country from Iran and that experience of going to the doctor and saying, hey, we’re not going to see you because you don’t have good insurance. Is there more to sort of this? Because I mean, I agree with you and I love what you’re doing. Just sort of do the right thing and everything else takes care of itself, but not everybody’s wired that way. Is that something that was taught to you from a very early age? Were there any other formative experiences that sort of shaped that in you?

Dr. Payam Tehrani: I’ve had quite a few mentors. One of my other, when I was in residency, there was another gentleman, Dr. Scott Ravlin, Alan Scott Ravlin. He was the same way. He would just say, you know, don’t look at the money.

You don’t look at it that way. Just do what’s right for the patient. And I remember when we were walking down the hallway and he had a cup of coffee in his hand, he would always slam it down and say, do what’s right. And these things just stick with you. We’re in this field to help. And honestly, there are some physicians out there who, I don’t think they’re always doing the best and whatnot, but if you are actually out there caring, people will notice it. People will tell that, you know, that you know you’re not going to get anything out of this, but you’re still doing it. And they will call you out and say, hey, like this guy goes and does these things regardless. He won’t even ask the patient’s insurance. It’s so go and he’ll take care of it. You’re likely to use him.

Anthony Codispoti: Signals that you’re a good human being. And that’s who we want to work with. So as you’ve grown, Payam, I’m wondering how much time you actually get to still practice and see patients versus, you know, kind of running this business.

Dr. Payam Tehrani: I don’t see patients anymore unless something urgent comes up or it’s like a, you know, please go and see my loved one. You know, I’ll go and take a look. But it’s just all administrative work now. But I have a lot of time to myself. You know, it’s quite nice.

I, just as long as I have my phone on me, I pretty much, you know, get to go to the gym at 10am and enjoy life and, you know, I walk around and people think I don’t have a job.

Anthony Codispoti: Do you miss any of that direct patient contact or like, it’s, you know, I assume it’s got to be pretty stressful, especially to see people in, you know, conditions that aren’t always great.

Dr. Payam Tehrani: I do miss it. I mean, it’s nice, but I like what I do better. I do, you know, I mean, waking up at four in the morning, going into work, seeing these patients was nice, but it was tolling. It’s not easy, you know, be up and then go to bed at seven to wake up at three, four.

But, you know, I do miss it, but I love what I do now, you know, running a company, you know, it’s very stressful, you know, what I do currently. Since we have so many facilities, I always get called with complaints. Nobody calls to say how wonderful we are. But even though, you know, you get three or four complaints a day, it’s pretty good when you have, you know, 300 facilities, if you get three or four complaints, it’s not bad.

Anthony Codispoti: Yeah, that’s a pretty good ratio. Especially when it comes to medical care, because there’s all kinds of things that are outside your control.

Dr. Payam Tehrani: And honestly, a lot of it’s like their problem, because they procrastinate or they don’t do things well, and then they’re calling me asking me like, well, how I can help. And I’m like, God, I don’t even know how to get out of this one. But I try to always figure it out.

Anthony Codispoti: What’s it like there in the nursing homes for the patients themselves?

Dr. Payam Tehrani: You know, I always thought about this. I think it’s, you know, a lot of these patients, I go in the morning when I was going. So maybe that’s why I don’t, a lot of these patients, nobody comes and visits them. There’s not a lot of family or their family’s out of the state.

They’re alone in there. Some of these nursing homes have a, you know, unfortunately have a turnover that can be higher than normal. So then if they’re using an agency to staff, it could be a problem. They don’t care as much. But some of the nursing homes are amazing that are well run. And some of them you see like the high turnover, the staff don’t care.

Then the patients suffer. So, you know, but it is what it is, what happened. You know, getting old is not, it’s very tough. Yeah, it’s very tough. And we’re all heading, you know, we’re headed that way.

Anthony Codispoti: You talk about a lot of these nursing homes that have a fair bit of employee turnover. How do you approach your team building, recruiting, retaining good folks? What’s your approach there?

Dr. Payam Tehrani: I give them a lot of, you know, they’re their own boss. They go out there and they see these patients. I don’t like, you know, micro manage any of them. They do their own thing. They get paid pretty well. And do we have a high turnover? The only time I see turnover is when the provider is going to like one building and they’re like not happy just servicing one facility. They want like a full time gig. So that’s when we’ll see like, you know, I have high turnover in these facilities is when I can’t give them enough work.

Anthony Codispoti: But usually the people that we are servicing more than three or four facilities don’t need us to stay with us for quite a while. You know, Dr. growth often comes from some of the biggest challenges that we face in our lives. I’d be curious to hear about a serious challenge that you’ve had to overcome, whether it’s personal or professional or maybe both, what that was like, how you got through it and some lessons that you learned.

Dr. Payam Tehrani: Yeah, so I would say being my competitors coming after me when I first started out, when I first started out, honestly, I was seeing two or three patients. And I get a lot I get a like a cease and desist letter from a competitor.

That’s all you need to pull back off. And I was just so confused. You know, and at that time, I didn’t have, you know, I was a tiny little, you know, I wasn’t even a company then it was just me solo trying to see patients and getting a cease and desist letter from a, you know, decent sized company was kind of scary, you know, like how am I going to pay for this?

What am I going to do? And I remember like their attorney calling me and I’m like, what do you even want? But, you know, you just know that what you’re doing is you’re not doing anything wrong. So they can, you know, and I pretty much told their attorney, I didn’t have even have my own attorney. I was like, no, I’m not doing anything wrong. You could do whatever you want. Send me as many letters.

Anthony Codispoti: What were they trying to say that you were doing wrong?

Dr. Payam Tehrani: Kind of push me out, trying to monopolize the, you know, do whatever kind of work they do, good or bad, you know, and then just don’t let anybody else in the field, right? Because if you get into the same business and you do more than them, you do better services than them, then you’re going to get more of the clients and then they’re going to be pushed out. So the less competition that, you know, they have the better it is.

So just trying to push people out. So I just stood my ground and then they kept coming after me for other stuff and other bogus, you know, and you just stand your ground and then the latest one was another, you know, lawsuit. But this time I got my own attorney and we won the case.

So, you know, but they keep coming, you know, competitors can be, I’ve never sued anybody in my life, but competitors come after me, but I stand my ground at this point, I don’t back off because I know what I’m doing is not wrong. What are they trying to say? Pretty much just push you out, trying to say you’re taking over these contracts for, you know, the latest one is like my phone number, like get rid of your phone number. I’m like, I’ve had this phone number for seven years.

Anthony Codispoti: Something illegal about the sequence of digits in your phone number?

Dr. Payam Tehrani: My phone number is 833 Dr. Woon, DR Woon. So remove Dr. Woon from your number. My license plate says Dr. Woon Donate. So they call me to tell me to remove these things because they’re using it in a different state. And I’m like, oh man, you know, I’m like, I don’t even know how this even affects your business.

But, you know, I have my own trademark attorney and I just sent him a letter, I just forwarded him and he sends the guy a letter within a day and we’re going to hear what the results are. But, you know, but I try not to back down anymore and just, you know, as long as I’m doing what’s right, we go forward, we push strong.

Anthony Codispoti: Clearly people are threatened by you.

Dr. Payam Tehrani: Yeah, they’re threatened by me. But, you know, get your act together and, you know, provide more services.

Anthony Codispoti: Level up your game. Yeah, that’s the way to compete, not with these goofy lawsuits. Correct.

Dr. Payam Tehrani: Provide more services, you know. Yeah. Don’t complain and, you know, don’t complain when they call you at two in the morning. Take care of the job. They won’t switch out.

Anthony Codispoti: So what do growth plans look like for SNF-1 care? Is this more territories, more services?

Dr. Payam Tehrani: More services? Yeah, I don’t know if I could do more services. I pretty much do all of them that you can imagine. But more territories. You know, a lot of these nursing homes are very scared to switch. They’re like, oh, we’re going to switch to you. We’re scared and whatnot.

And I’m just like, you have to try and use things. So, you know, I’m like, even in our agreement when we sign them up, it says you can cancel the same day. You don’t even need to give us a one-day notice. If you don’t like us, we leave. We’re not coming back. You know, so just to make sure they’re not threatened that like we’re going to want to come there and stay around. Like, you don’t like our services.

We leave the same day. So, but yeah, look to expand, get more territories, get the name out there and, you know, have a great team in the back that runs all of these, you know, facilities. And we have a great team.

Anthony Codispoti: And, you know, I love what you guys do with the contract there. And obviously there are some businesses where, you know, the service provider has got a lot of upfront fixed costs. And so they want to be able to make sure that, you know, they can recruit that over time. And so I understand the, you know, kind of the purpose and the value of having contracts with terms in them. But yeah, and a service like yours, like, what you’re doing is providing people with the ultimate level of comfort, saying that I’m so confident in what we do and the way that we do it and that you’ll be happy with it, that, you know, right in the middle of the service. If you don’t like it, you can tell me to leave. And that’s it. There’s no, I think that’s great.

Dr. Payam Tehrani: Some of these facilities, some of these other companies have like a 90 day, you know, six months termination notice. I’m like, you could sign the contract now and cancel it in 10 minutes and tell me you don’t want me to come back. But yeah, so I don’t want, you know, if they’re unhappy, I don’t want to go there. We don’t want to go there, right? We want you to be happy with our services. Yeah.

Anthony Codispoti: Payam, any daily practices that kind of help you through your day and make sure that you’re ready for everything?

Dr. Payam Tehrani: Yeah, wake up early in the morning, go to the gym. And I think that’s a nice way to de-stress, you know, get to the gym every day and get my cup of coffee and pretty much get the day going.

Anthony Codispoti: Did you hit the gym this morning before our interview?

Dr. Payam Tehrani: After this, I’ll be heading to this still pretty early here.

Anthony Codispoti: Yeah, I was going to say, I mean, you’re a pretty early riser.

Dr. Payam Tehrani: Yeah, go to the gym and just enjoy the day, go to lunch, but you know, always be ready because you never know, right? Somebody might call out sick and I have to go somewhere, fly out somewhere. So, you know, be ready to go. No.

Anthony Codispoti: Sometimes in my experience, our mistakes end up becoming our greatest teachers. Is there an early career moment that’s seen like a setback to you at the time that actually helped to propel you forward looking back now?

Dr. Payam Tehrani: Yeah, there’s actually a malpractice lawsuit that was very unfortunate but pretty bogus that happened, you know, while I was in, right when I got out of training. And even though I had nothing to do with the case, they sued everybody in that case. And it kind of, you know, I’m like, I don’t want to be doing this hospital work forever. This is high risk stuff.

You know, even though I had zero involvement, zero exposure, they still sue you and they still, you know, try to go after you. So that was like a turning moment. And I learned a lot about, you know, the legal aspects of things that we know, how these, you know, malpractice lawsuits work, how to document appropriately and how to save yourself. Otherwise, that would have been a disaster. It was a disaster case that happened. But, you know, even though you have no involvement, no exposure, they still come after you and you learn the whole legal system of these malpractice cases. And at that point, I’m like, I want to get out of this, you know, hospital work. It can be very problematic.

Anthony Codispoti: Which is terrible, right? Because we need more doctors and medical professionals. We don’t need to be scaring them off with these kinds of things.

Dr. Payam Tehrani: They scare you off, correct. It’s so wrong, but they scare you off and it’s all about, you know, making a buck. But yeah, they scare you off.

Anthony Codispoti: What’s a specific thing that you learned about how to protect yourself, be sort of proactive?

Dr. Payam Tehrani: Oh, just document appropriately. Document, you know, what you saw, who you spoke with, your treatment plan. And, you know, the hospital is very helpful with these things. The hospital has so many different layers of protection that help protect physicians as well. But when a case goes wrong, you know, you have 10,000 cases, all of them go, well, one goes wrong, you know, it bites you.

You know, it bites you. But, and there’s multiple, you know, and when you have, you know, when a patient’s hospitalized, there’s not just one physician. There’s usually 10, you know, this is ICU case patient. There was about 15 physicians on the case. And everybody got sued from the residents to the ICU, to the ER doctor, to everybody. So we pretty much learned from that case of what can go wrong.

Anthony Codispoti: You know, it’s put the legal stuff aside. And obviously, like we sort of touched on this before, you know, in medical care, things are going to go wrong. Not everything is within your control.

You are not a God, like you can’t heal everybody. And so when you are, again, legal stuff aside, just on the personal side, like how does it affect you? How do you work through when there’s an outcome that’s less than favorable?

Dr. Payam Tehrani: You know, I’m in a lot of these physician group chats on Facebook and whatnot. And I mean, you can’t sleep for many, many nights. You can’t sleep. You’re worried. And you know, you know, you tried your best or something went wrong, you know, without your control.

But night sweats, you don’t sleep well, you’re worried, you’re bothered, you don’t go out, you become depressed. It was pretty bad. You know, I’m like one month out of my residency, and I’m getting sued, am I going to lose my license for this?

But luckily, you know, absolutely nothing happened. But I can see, you know, other physicians going through the same thing, and they might have other issues going on at the same time, you know, it’s very haunting.

Anthony Codispoti: But, you know, is it helpful to be able to talk with other physicians and sort of have a little support group there?

Dr. Payam Tehrani: When you talk to other physicians, they’ll tell you they’ve had the same thing happen to them. And you know, there’s a light at the end of the tunnel, just wait it through the medical board is fair. They look at the case, they review it, and you know, and they understand, you know, and it’s happened so many times before.

So and they understand, you know, we’re trying to do our best and things go wrong, you know, or, you know, a lot of I would say most of the cases of these law, you know, medical malpractice lawsuits tend to be frivolous, they just, you know, send out letters trying to see what they can do.

Anthony Codispoti: What’s the best decision you ever made for your business, doctor?

Dr. Payam Tehrani: The best decision, honestly, so one was leaving the hospital and starting my own business. That was the best decision. And from there, honestly, it was just I had a big vision when I started like when I went to go pick my mailbox, I didn’t get a small mailbox to be like, oh, I’m going to get like, you know, 10 pieces of mail. I got the largest mailbox at the post office literally was like one of those massive ones.

And now that mailbox gets full to the brim every few days. So I had this vision where like, I’m going to grow nationwide from the day I started, it wasn’t, you know, I’m going to go little and something and just service some there. I had this vision that I’m going to be huge like my competitors that and I got the biggest mailboxes.

I got everything like nationwide stuff. So I don’t just market locally and it grew into that. It grew into that. So I had these big visions of what I wanted to be. Nice. And people would look at me like, what are you doing with this big mailbox with four pieces of mail? And I’m just like, it’ll come.

Anthony Codispoti: You had faith in yourself.

Dr. Payam Tehrani: I knew I can’t go wrong. I knew it’s only like room for growth and expansion.

Anthony Codispoti: You know, I’m a son of an immigrant. My father came to this country when he was young with his parents and his brothers. And, you know, it was very challenging for them to make that move. You know, they didn’t know the language, they had to learn the culture, find jobs.

You know, lots of challenges there that I think built a sturdiness and a robustness in them that propelled them to be very successful in what they were doing. I’m curious if you think that there’s some of that going on in you as well.

Dr. Payam Tehrani: You know, to be honest, I don’t know how my dad and mom moved from Iran, not knowing, you know, more than a couple words to America with three kids and raising us.

It’s like us moving to another country like the China. I have nobody, I’m alone. You know, I’m single. I could do it maybe for myself as it being difficult. But I can’t imagine how my dad did it with, you know, my mom knowing English with three kids moving to another country and starting a family, you know, kind of mind boggling. I don’t think I would be able to do it.

But they did it. And, you know, and I saw their struggles, you know, I saw my parents’ struggles and, you know, we didn’t have anything. We were very simple and barely making it day by day, going to public school and, you know, I had great parents, you know, they were all people loving, caring and you get that love, you know, from them, you learn from them, you see how hard working they are and you become the same. You know, I see my dad is silly, my dad is 84 and he’s still hardworking, more hardworking than me.

Anthony Codispoti: Well, the apple doesn’t fall far from the tree there. So innovation requires courage, right? Tell us about a time that you tried something completely different in your business, whether it worked or it didn’t. What did you learn from that?

Dr. Payam Tehrani: So what have I tried differently? Honestly, the marketing, it was totally different. Like out of my, you know, I just listened to some person, they said, Hey, let’s try to put you on these, you know, email and stuff and platforms and I had no idea what I’m signing up for. But this person just, you know, I paid her and she pretty much just did everything. And then the next after a while, I realized what she had made. Only to realize like that is the reason why it grew to as much as it did is, you know, became so big outside of the local areas because of this platform that she made. And I’m very thankful for her, but I didn’t want to do it initially because I’m like, you know, it’s going to be like, what are you even making me? And it was this whole marketing platform that’s amazing. And we use it pretty much all day, every day.

Anthony Codispoti: Now, what was it that she said that convinced you?

Dr. Payam Tehrani: Well, she’s just like, you need a way to reach out to people, you know, you can’t go to every nursing home yourself, you need a way to reach out to people and, you know, you’ve got to do it through either phone call or email or something. And I’m like, yeah, she’s right. But I don’t understand the nature of what she’s going to build me. And she built me like this beast program where people get nonstop, you know, notifications, you know, from us. And even though you don’t sign up now, you’ve seen my logo, you’ve seen my picture, you’ve seen my name. So you’re going to remember if you need a wound care doctor, you know, that phone number is going to stick out, that, you know, something is going to stick out and you’ll reach out to us. Give us the phone number again. A 3 3 Dr. Wound.

Anthony Codispoti: I can just one more question for you, Pym. But before I ask it, I want to do a couple of things. First of all, for those listening today, I know that you love today’s content. Dr. Tarani has been a wonderful guest sharing all kinds of interesting stories. Make sure that you don’t miss out on future content like this, hit the like, share, subscribe, follow button on your favorite podcast app. I also want to let people know the best way to follow you or to get in touch with you. Pym, what would that be?

Dr. Payam Tehrani: Just on our Instagram page, follow us on SNFwoundCare.com. And I’d be happy to, you know, get back to you guys or email us info at SNFwoundCare.com. I N F O at SNFwoundCare.com.

Honestly, there’s even a lot of people who send me a picture of their foot or their back or their wound and you know, somebody replies to them and helps them out. Okay. Regardless. What does SNF stand for? Skilled nursing facility. So it’s like in a skilled nursing facility where we work at these are called nursing homes, skilled nursing facilities. So it’s SNF wound care. Gotcha.

Anthony Codispoti: So last question, as we look to the future, Dr, whether thinking specifically about your business or the larger industry in general, what are some of the changes that you’re most excited about?

Dr. Payam Tehrani: What are the changes I’m most excited about? Well, I’m looking to expand honestly, I don’t know if there’s any changes that are coming about based on, you know, what we provide. It was pretty much your stable, but I’m just looking to grow, get out there and yeah,

Anthony Codispoti: are there any parts of the country where you would not operate or is it pretty much everywhere? I mean, we just, Alaska, right?

Dr. Payam Tehrani: So yeah, Alaska, Maine, pretty much anywhere. I mean, because these patients are everywhere, right?

Anthony Codispoti: Yeah. And is there, what’s the chicken or egg? Like, I would guess like you’re looking for the facility first. And then once you’ve got an agreement or pending agreement, you know, it’s going to happen. Then you go and you try to build a team there. Correct.

Dr. Payam Tehrani: Yeah. So first is the facility. Once you get the facility, then you can figure out how to get things started out there. Yeah.

Anthony Codispoti: And does that generally involve sending one of your established people there to kind of do some recruiting in person? Or you just look to hire somebody brand new in the area to kind of be your coordinator?

Dr. Payam Tehrani: We usually send somebody out there to meet with them, tell them the services that we offer after that. And if they’re agreeable, then we get somebody out there to service them.

Anthony Codispoti: Gotcha. Well, I want to be the first one to thank you for sharing both your time and your story with us today. I really appreciate it.

Dr. Payam Tehrani: Thank you for having me. I appreciate it.

Anthony Codispoti: Folks, that’s a wrap on another episode of the Inspired Stories podcast. Thanks for learning with us today. Thanks.