NY Times article on skin subs

[heybrother]

Medicare Bleeds Billions on Pricey Bandages, and Doctors Get a Cut

Medicare spending on “skin substitutes” made of dried placenta has soared as doctors pocket lucrative discounts from sellers.

www.nytimes.com

I do not have a times subscription but you can use archive.is to acquire the article if not a subscriber.

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[shadesofgrey]

I generally have a few select wounds per year that have failed everything else and I'll try some type of graft product on with intermittent success. However, it is upsetting to see docs taking advantage of the system, which will inevitably result in patients losing access to grafts eventually. Also there was a not so small part of me that read the article and thought, "my god, if I just put on 2-3 of those a day I could seriously dent my student loans." I mean I could collect a couple hundred thousand in grafts and not even be on their radar compared to the idiots billing for millions.

That was interesting. Thanks for posting.

 

[Homo sapien]

Some people getting millions off of this dog****. It's a scumbags paradise

 

[Homo sapien]

I use skin subs but as last resort. People are out here putting it on everyone

 

[Bored Snorlax]

Pretty wild stuff. The pricing on these "skin substitutes" is insane. Curious if you’ve seen this in your practice or heard others talk about it?

 

[Homo sapien]

I generally have a few select wounds per year that have failed everything else and I'll try some type of graft product on with intermittent success. However, it is upsetting to see docs taking advantage of the system, which will inevitably result in patients losing access to grafts eventually. Also there was a not so small part of me that read the article and thought, "my god, if I just put on 2-3 of those a day I could seriously dent my student loans." I mean I could collect a couple hundred thousand in grafts and not even be on their radar compared to the idiots billing for millions.

That was interesting. Thanks for posting.

These docs don't care if they **** it up for the pts or the rest of us- they just want to scam scam scam

 

[Homo sapien]

Pretty wild stuff. The pricing on these "skin substitutes" is insane. Curious if you’ve seen this in your practice or heard others talk about it?

I've seen some numbers but I don't use them much

 

[pod squad]

Meanwhile, Medicare delaying their skin sub LCD again...

CMS Statement on Local Coverage Determination for Certain Skin Substitute Grafts | CMS

As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin substitute products with high quality evidence of effectiveness. Because of this review, the Skin Substitute...

www.cms.gov

 

[air bud]

Meanwhile, Medicare delaying their skin sub LCD again...

CMS Statement on Local Coverage Determination for Certain Skin Substitute Grafts | CMS

As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin substitute products with high quality evidence of effectiveness. Because of this review, the Skin Substitute...

www.cms.gov

Big Amnio is too powerful

 

[DYK343]

I generally have a few select wounds per year that have failed everything else and I'll try some type of graft product on with intermittent success. However, it is upsetting to see docs taking advantage of the system, which will inevitably result in patients losing access to grafts eventually. Also there was a not so small part of me that read the article and thought, "my god, if I just put on 2-3 of those a day I could seriously dent my student loans." I mean I could collect a couple hundred thousand in grafts and not even be on their radar compared to the idiots billing for millions.

That was interesting. Thanks for posting.

I use skin subs but as last resort. People are out here putting it on everyone

This.

I use some amniotic membranes. SDN likes to crap on these grafts but If you treat enough wounds you will run into wounds that just wont heal. IME its always stasis leg ulcers that wont heal. 6+ months wound not healing and after 2-4 grafts the wound is healed.

I treat about 50 wounds a week. I have my fair share of non healing chronic wounds. These grafts have their place. But obviously abused.

I would wager most RVU based providers are not abusing them. They dont pay that well on a RVU basis. 1.83 RVU to be exact. Less than$100.

 

[air bud]

This.

I use some amniotic membranes. SDN likes to crap on these grafts but If you treat enough wounds you will run into wounds that just wont heal. IME its always stasis leg ulcers that wont heal. 6+ months wound not healing and after 2-4 grafts the wound is healed.

I treat about 50 wounds a week. I have my fair share of non healing chronic wounds. These grafts have their place. But obviously abused.

I would wager most RVU based providers are not abusing them. They dont pay that well on a RVU basis. 1.83 RVU to be exact. Less than$100.

Yeah exactly. And that's what they need to do if they want to cut down all this is take away the ability of a private practice physician to get paid with the discounts. The only reason anybody's putting these graphs on is because of the arbitrage associated with the purchase price and the reimbursement. Not the actual CPT code for the application

 

[Feli]

Love it... NYT ftw.

 

[Boba Foot]

It’s wild that the leading earner, according to the article, is an internal med doctor in CA. Most IM docs won’t touch wounds, someone must’ve shown him his golden ticket. Looking at his Instagram, looks like he’s big into IV hydration, laser stuff and all sorts of scammy crap.

 

[Hybrocure]

It’s wild that the leading earner, according to the article, is an internal med doctor in CA. Most IM docs won’t touch wounds, someone must’ve shown him his golden ticket. Looking at his Instagram, looks like he’s big into IV hydration, laser stuff and all sorts of scammy crap.

A lot of wound care MDs are beating this money pinata for all it’s worth while they can.

 

[DYK343]

I really dont see any use of these grafts for DFUs.
DFUs are really the easiest wounds to heal.
Especially if you think surgical offloading.
A graft cant offload a wound. A graft shouldnt be approved for a DFU IMO.

Ischemic/stasis ulcers they can be helpful.

Kerecis/Integra for deep tissue coverage bone/tendon.
I actually lose money when I put these on in OR because I cant bill debridement with the graft application (Pretty sure debridement is lumped with any graft application - at least according to my billers but im not going to go down that rabbit hole here). A debridement to bone pays more than the graft application but they bill out only graft application. But they work so well for the patient I typically still use them.

The article is a little biased. It said somewhere in the article "there is no evidence these even work" (paraphrasing).
There is robust evidence that these do in fact accelerate skin growth.

 

[DYK343]

I will say we get an occasional email from our wound center management letting us know that grafts exist. Maybe 1-2 times a year.

Doesnt tell us to use more. They are careful about that.

But "just remember these are options for your patients!"

AKA they make $$$ when I put one on. How much I dont know.

 

[Boba Foot]

A lot of wound care MDs are beating this money pinata for all it’s worth while they can.

The wound care center adjacent to me seems to push hyperbaric with every qualified person with a pulse they can find. I’ve had to tell more than a handful of my patients they don’t actually have to spend every day in a tank for 4-6 weeks, and they’ll likely heal up fine without it.

 

[Adam Smasher]

Do I use grafts? yes.
Do I overuse grafts? no (<5 patients per year).
Have my indications always been appropriate? no.
Does profit influence my decision to use them? obviously yes.

When I do a flexor tenotomy and prevent a toe ulcer from turning into a $10k hospitalization, I don't get cut in on the savings. Meanwhile reimbursements continue to decline, while costs continue to rise. Staff want raises, and I need to make it all make sense for them. So if there's a modality out there that will keep my business in the black, so we can continue doing the unrecognized underpaid work that saves Medicare a fortune, yes I'm going to use it. Maybe I'm Robin Hood, maybe I'm just a utilitarian rationalist.

 

[diabeticfootdr]

I use skin substitutes a lot less frequently than I used to in the outpatient setting, but more frequently in the OR and they work great in covering tendon and bone in combination with NPWT. In the OR setting, it's mostly a single application (sometimes two) and then NPWT until granular as a bridge to STSG.

The new LCD draft was full of serious issues that weren't based on science. But I wrote to all 7 MACs with David Armstrong and Larry Lavery and they adopted 90% of our recommended changes. The final LCD (delayed as stated) supported evidence-based, best practices in wound care and wouldn't seriously impact patient access to skin substitutes, but it would have curtailed certain skin substitute companies' access to patients. The delay seems financially and politically motivated and not based on the science.

 

[air bud]

I use skin substitutes a lot less frequently than I used to in the outpatient setting, but more frequently in the OR and they work great in covering tendon and bone in combination with NPWT. In the OR setting, it's mostly a single application (sometimes two) and then NPWT until granular as a bridge to STSG.

The new LCD draft was full of serious issues that weren't based on science. But I wrote to all 7 MACs with David Armstrong and Larry Lavery and they adopted 90% of our recommended changes. The final LCD (delayed as stated) supported evidence-based, best practices in wound care and wouldn't seriously impact patient access to skin substitutes, but it would have curtailed certain skin substitute companies' access to patients. The delay seems financially and politically motivated and not based on the science.

Thank you. OR specific dual layer grafts are awesome, specifically for covering bone/tendon. Need to clarify amnion only vs amnion/chorion.

 

[Bluecollarmed]

I have a few distributors that saw the golden ticket and keep pushing all these grafts that cms is trying to shut down. Every month they send me the adjusted prices on what I can "make" per square cm...some are in the thousands. Now this really only matters if you're billing POS 11 because as others have said above, us RVU boots only get what we get. Reps are starting to pressure and even offer to broach the conversation with hospital admin about adjusting contracts to include some percentage of this honey for the docs actually putting on the grafts. Advice, stay away from anyone leading a conversation of how much you can make. Their bank account won't be at risk if medicare decides to claw some of this back. That being said, use grafts on people that need it. I see wounds one day per week, anywhere from 15-20 patients. Some need it some don't. Time and a place...

 

[heybrother]

Reps are starting to pressure and even offer to broach the conversation with hospital admin about adjusting contracts to include some percentage of this honey for the docs actually putting on the grafts.

Wow. I wonder when VA docs were putting 30 of these on a day if these sort of conversations were ever taking place.

 

[air bud]

Wow. I wonder when VA docs were putting 30 of these on a day if these sort of conversations were ever taking place.

Narrator: They were

 

[Bluecollarmed]

I’ve heard from the same reps trying to push it so take that as you will but they’ve mentioned two hospital pods in the area who have negotiated 25-30% cut of the graft money.

 

[heybrother]

I’ve heard from the same reps trying to push it so take that as you will but they’ve mentioned two hospital pods in the area who have negotiated 25-30% cut of the graft money.

What do you think that looks like on their taxes?

 

[diabeticfootdr]

What do you think that looks like on their taxes?

I think it's reported on the line "Graft graft"

(deleted previous post due to quote gibberish)