Will Reimbursement Changes Adversely Affect Preventative Wound Care?
- Volume 24 - Issue 2 - February 2011
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The skin substitute policy has also undergone drastic changes. Both Apligraf (15340) and Dermagraft (15365) were replaced by a CMS G code (G0440). The service was also revalued. In 2010, Apligraf had an RVU of 7.00 and Dermagraft had a RVU of 7.72. In 2011, G0440 is valued at 3.51. While the products are still reimbursed, the reimbursement for the physician service dropped by more than $150 in all scenarios.
Understanding The Impact Of The CMS Changes On Wound Care Clinics
To determine how this will affect physician revenue in the clinic, we sampled two consecutive days of patients (55) and calculated the reimbursement for the services delivered under the 2010 guidelines compared with the 2011 guidelines. The 55 patients in 2010 would have generated $5,643.87 and now the same services coded in 2011 would generate $4,419.61, a reduction of 22 percent.
Our calculations were based on a doctor delivering services in a facility with the 2010 and 2011 fee schedules from CMS Palmetto, Los Angeles County.
Every year in the United States, there are nearly 100,000 amputations, a majority of which are on those with diabetes.1 There are 25.8 million people in the U.S. with diabetes and 79 million adults over age 20 with pre-diabetes.2 Amputations are a dreaded complication of diabetes. A chronic wound is present on nearly 85 percent of limbs that are amputated, making it the one of most common reasons for amputation.3
During the 2008 presidential election, many candidates campaigned on increasing revenue and access to preventative services, and used the “diabetes-related amputation” as an example to illustrate their point.4 This update in the CMS fee schedule for wound care is the antithesis of that ideology. The substantial reduction creates a disincentive for physicians to treat patients with chronic wounds. As a result, this may leave Medicare patients experiencing delays in treatment or cause them to seek treatment by non-specialists. Just as the epidemic of diabetes continues to get worse, we may see an increase in the rate of amputations.
Dr. Rogers is the Associate Medical Director for the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles. He is the Medical Director for the Amputation Prevention Centers of America, a national network of wound centers and limb salvage centers.
1.Centers for Disease Control and Prevention. Hospital discharge rates for nontraumatic lower extremity amputations by diabetes status - United States, 1997. MMWR Morb Mortal Wkly Rep. 2001;50(43):954–958.
2. Centers for Disease Control and Prevention. National Diabetes Fact Sheet 2011. http://www.cdc.gov/diabetes/pubs/factsheet11.htm .
3. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care. 1990;13(5):513–521.
4. American Podiatric Medical Association. Presidential candidates stump podiatry reimbursement plight to make a case for health reform. Available at: http://bit.ly/h7tZvx .