ARLINGTON, VA., FEBRUARY 06, 2020
The wound care market is a battle between the drive for innovation and the desire to cut costs, as healthcare market researcher Kalorama Information notes in a new report. While wound care products themselves benefit from the cost cutting trend, as they reduce hospital stays, new reimbursement schemes can impact the $22.3 billion market. Kalorama, part of Science and Medicine Group, made its prediction in its Worldwide Wound Care Market Summary.
A lack of effective treatment options, adding to the increased costs for wound care has contributed to the growing frustration in the industry. It is the goal of new and existing product manufacturers to capitalize on these concerns by offering products designed to improve healing rates and prevent wound formation. Industry participants have attempted to diversify their offerings by acquiring smaller companies with new and innovative technology. This move has created more competition among large wound care companies, driving prices down.
The Quality Payment Incentive that is part of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models was implemented by the U.S. Centers for Medicare and Medicaid Services (CMS). Clinicians are included in MIPS if they are an eligible clinician type and meet the low-volume threshold. Beginning in payment year 2019, the low-volume threshold encompassed allowed charges, the number of beneficiaries who receive services, and the number of services provided. Clinicians must participate in MIPS (unless otherwise exempt) if, in the determination period, they bill more than $90,000 for Part B-covered professional services, see more than 200 Part B patients, and provide 200 or more covered professional services to Part B patients.
Changes in 2019 included an expanded list of clinicians who must report, including physical therapists, audiologists, registered dietitians, occupational therapists, clinical psychologists, speech pathologists, and nutrition specialists.
Other changes include expanded codes for deep-tissue pressure injury, effective October 2019.
For home care, starting January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) will offer top reimbursement for the care provided to patients in the Patient-Driven Groupings Model (PDGM), including the assessment, treatment, and evaluation of surgical wounds, nonsurgical wounds, ulcers, burns, and other lesions. Per CMS data, the wound clinical grouping is one of the clinical groupings with the highest reimbursement potential.
Wound care patients have never been easy to manage, and now the industry must work to achieve success with this difficult population within the limitations of the PDGM payment cycle. Not only are wounds painful and stressful for the patient, but time and money also can be wasted when the wrong treatment is provided or even if the same treatment is carried out for too long without success.
Due to delay in the next round of competitive bidding, the program has temporarily ended last year – The gap in competitive bidding contracts is expected to last throughout 2020. What this means for participants is that any Medicare-enrolled durable medical equipment, prosthetics, orthotics, and suppliers (DMEPOS) supplier may furnish DMEPOS items and services to people with Medicare in the former competitive bidding areas (CBAs). Medicare patients can switch their DMEPOS supplier if they wish