By Michel H.E. Hermans, MD
In the June 2015 issue of the Journal of Ostomy Wound Management, Bell et al. published an article in which they reacted to the recent decision by CMS (January 22, 2015) to change its HCPCS code for a Manuka honey dressing for Medicare Part B patients to a non-covered code. Apparently, this ruling was based on the fact that the dressing is impregnated with more than 50% (by weight) honey. The authors, rightly so, stated that this would be a major loss for a significant number of patients who, under the previous ruling, would have been able to use the dressing as a reimbursed material. Indeed, this specific dressing is one of the materials with a good record with regard to clinical proof.
Changes in Reimbursement for Surgical Dressings with Honey
On June 17th of this year the "honey company" for which the CMS announcement was most important mentioned in a press conference that the previous code had been rescinded effective June 12, 2015 and that a new code, HCPCS A4649, (surgical supplies, miscellaneous) has been issued. An amended policy article, adopted by all four DME four Medicare Administrative Contractors (MACs) MACs is effective on October 1, 2015.
This event triggers some thoughts. How is it that the percentage by weight of an active dressing component suddenly drives a CMS decision? Why specifically for this particular product which, in several trials, has been shown to have good properties for a series of different wounds and ulcers? Why don't we have an institution in the US that, similar to NICE in the UK, drives decisions on medical grounds, not for seemingly irrelevant reasons?
The Big Picture of Treatment Costs
A movement amongst oncologists exists to start taking a look at pricing for some of the newer anti-cancer drugs: indeed, some of them are said to cost $10,000 per month while "only" offering a relatively short extension of life. I am no expert at reimbursement at all, so I do not know if (and if so to what extent) these anti-cancer drugs are reimbursed, but whoever pays for them, these are very serious numbers. Of course, I do not want to trivialize the seriousness and suffering of cancer patients for one single moment but compared to the price of good dressings, these amounts of money are insane.
It might be time for CMS and other reimbursement authorities to take a look at what good dressings offer from a clinical point of view for patients suffering from wounds. Even when one is purely looking at costs, if a dressing (obviously as part of an overall treatment regimen) helps prevent an amputation in a patient with a diabetic foot ulcer, about $80,000 has been saved. This is the context in which performance of dressings and their costs have to be analyzed and not by how much the active ingredient in a dressing weighs.
Full disclosure: a couple of years ago I have done some consulting for the affected company.
About the Author
Michel H.E. Hermans, MD, is an expert in wound care and related topics, trained in general surgery, trauma care and burn care in the Netherlands. He has more than 25 years of senior management experience in the wound care industry. He has conducted a large number of clinical trials relating to devices and drugs aimed at wound care and related indications and diseases. Dr. Hermans speaks internationally and has authored many published works relating to wound management.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.