A pending decision on whether Medicare will cover skin substitute grafts could put effective wound care tools out of the reach of too many seniors, an expert in wound care and health economics is warning.
Bill Padula, former president of the National Pressure Injury Advisory Panel and an assistant professor with the Department of pharmaceutical and health economics at the school at the University of Southern California, notes the products in the crosshairs are used to treat DFUs and venous leg ulcers, both common in nursing homes patients.
Medicare Administrative Contractors could remove dozens of options from the Centers for Medicare & Medicaid Services coverage list. And without coverage, doctors likely won’t have a full range of products to reach for — or the ability to offer them as frequently as needed.
“Of course, that doesn’t mean that it’s impossible to get these skin substitutes to the patient, but they are expensive,” Padula says in this episode hosted by McKnight’s Long-Term Care News Senior Editor Kimbelry Marselas. “If Medicare is not paying for it — and we all know the story of seniors on fixed incomes that most are unlikely to be able to afford the of-pocket payments for skin substitutes on their own — this could amount to thousands of dollars every visit.”
As a health economist, Padula acknowledges CMS must monitor spending on evolving products to ensure appropriate use. But this is a coverage decision that could well deliver a literal lesson in an ounce of prevention being better than a pound of cure.
Chronic wounds that don’t heal, notes Padula and a wealth of other researchers, often lead to amputations and increased mortality.
Listen in to learn more about the debate fueled by the MACs’ decision and how providers still hope to shape the ultimate call.
