The Rising Costs of Wound Care: Finding Solutions Without Sacrificing Access

By now, it is obvious to even the most profit-driven participants in the wound care market that the systemic explosion of skin substitute prices is posing an existential threat to what has otherwise been a significant advancement in expanding access to quality wound care. Under a system previously reliant solely on hospital outpatient departments, many patients—especially the elderly in care facilities, the poor, the homebound, the rural, and the otherwise disenfranchised—never enjoyed equitable access. Today, however, more patients than ever are receiving wound care as providers are motivated to bring advanced modalities directly to them.

Unfortunately, as with all trends, especially those influenced by government-imposed market distortions, this balloon has overheated, soaring recklessly like Icarus racing skyward. Soon, the upward surge will likely transform into a downward spiral as aggregate spending on wound care escalates from concerning to potentially destructive. Those of us who have been committed to chronic wound care long enough to remember when porcine submucosa was seen as revolutionary are eagerly anticipating a future where conversations with providers return to a focus on clinical data and how to heal better, faster, more efficiently, and sustainably. Together, many of us have been working collaboratively to see if we can land this balloon without harming the people in the basket: the patients, the practitioners, and, of course, the industry responsible for innovation.

Initially, we were navigating this balloon alone, but now we find ourselves in a vast regatta of balloons, much like the annual Albuquerque Balloon Fiesta. If we collide or descend too abruptly, a lot of people stand to get hurt. I'll drop the analogies and return to a more direct approach. Something must be done, even if it impacts industry and provider profits. That’s why the proposed LCD blunt instrument continues to find its way into the hands of the imperfect regulators of last resort: the insurance-affiliated MACs. While the LCD is like a shotgun aimed at mosquitoes, far worse are the numerous inappropriate, unfounded, and nonsensical payment denials, even where medical necessity and outcomes are clearly proven by the providers under scrutiny. You've heard this before, but what you may not know is that some individuals in positions of influence are designing solutions that may benefit no one more than themselves.

Several months ago, Venture and Biostem collaborated with the MASS coalition to launch a website (fairwoundcare.org) where the disaffected can easily send public comments or letters to their Representatives and Senators. Since then, we have engaged with many members of Congress who acknowledge the urgency of the issue. Members from the Doctor’s Caucus, Ways and Means, and the Subcommittee on Health Services are all involved.

In recent trips to DC, we have taken this further by clearly outlining to those best positioned to effect change the various crosscurrents causing confusion around solutions. Large transnational companies with legacy products and extensive lobbies seem to have different goals than smaller, more innovative companies motivated to demonstrate better approaches. This should not be surprising. Neither should the fact that the contracted reimbursement agents, often affiliated with or even owned by Big Insurance, have draconian visions of severe restrictions. In America, their views are as valid as anyone else's, and they are adept at communicating with policymakers. Thus, unless we want an endless war of lobbyists, a middle-ground solution must be devised and tested. Nothing can be perfect for everyone, and aiming for a solution perfect for anyone has become the enemy of good for everyone as we remain entangled in this three-year proposal cycle.

So, without invitation or permission—just as we launched the website and raised awareness—we are now raising our hands and putting forth ideas. These ideas are not grounded solely in self-interest, and they will reduce spending. They do not disproportionately favor those who contribute most to any associations, nor do they favor specific physicians, manufacturers, or product types. We are prepared to equally irritate everyone, and that’s just fine with us.

In follow-up meetings with policymakers and physician thought leaders, whom we deeply value and thank, we are proposing a common-sense restructuring that rewards innovation when it translates to improved outcomes while preserving reasonable coverage for more than just the handful of oldest products marketed by the largest companies. No doubt, our proposals will seem innovative and intelligent to some, while to others, they may appear self-serving or even self-destructive. The author hopes that with a little creativity, accountability, and compromise, we can achieve a solution that, while not perfect for everyone, does not cause the entire industry to crash. After all, the passengers in the little wicker baskets are the patients who will be most harmed if we cannot safely deflate the market and land it somewhere secure.

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