Industry Insider News

Noridian Healthcare Solutions Clarifies LCD for Surgical Dressings

Noridian Healthcare Solutions has made several clarifications related to its local coverage determination (LCD) for surgical dressings, including that the three types of wounds covered are independent of each other, according to a report by the American Association for Homecare. Noridian officials have also clarified that collagen dressings can be used for a maximum of seven days and can be changed daily, depending on the wound. Additionally, hydrogel dressings are covered when the wound is not a pressure ulcer and “the LCD’s characterization of a wound as ‘full thickness’ or ‘partial thickness’ applies for purposes of coverage, rather than the [National Pressure Ulcer Advisory Panel] wound staging definitions that apply only to pressure injuries.” 

Docs Prescribe More (And More Expensive) Drugs Based on Gifts, Study Claims 

A new study has found that physicians prescribe more (and more expensive) drugs when companies provide gifts to those physicians (and more lavish gifts). According to researchers claiming to have used data from the Centers for Medicare & Medicaid Services on prescriptions written by doctors in Washington, DC, and information from the district’s department of health on gifts from pharmaceutical and medical device companies given to providers in 2013, healthcare providers given gifts wrote an average of 892 prescriptions compared with 389 for those who accepted none. Additionally, according to the study, which is published in PLOS One, the average cost of a prescription was $135 for gift recipients and $85 for others. Gift recipients chose the brand-name drug one-third of the time, compared with 25% of the time for non-recipients. The study also found that 39.1 % of prescribers received gifts ranging in value from $7-$200,000, while the rest received none. In total, any gift was associated with higher-cost prescriptions, but the larger gifts had an even greater effect, researchers said. Those who received gifts worth more than $500 during the year averaged $189 per prescription. 

Alliance of Wound Care Stakeholders Documents Imperative for Quality Measures, Reimbursement  

With quality measure-based payment models now driving Medicare reimbursement under the Medicare Access and CHIP Reauthorization Act (MACRA), wound care providers are left with few quality measures to report that are relevant to the care they give. In response to this reality, the Alliance of Wound Care Stakeholders recently funded research to calculate the total cost of chronic, nonhealing wounds to Medicare as part of advocacy efforts to bring improved data to the Centers for Medicare & Medicaid Services (CMS) as the agency evolves MACRA quality measures and reimbursement models. Key findings of the study “An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds” include:

• Chronic wounds impact nearly 15% of Medicare beneficiaries (8.2 million).
• A conservative estimate of the annual cost is $28 billion when the wound is the primary diagnosis on the claim. When the analysis included wounds as secondary diagnosis, the cost is conservatively estimated at $31.7 billion.
• In regard to site of service, hospital outpatient settings drove the greatest proportion of costs ($9.9-$11.4 billion) — demonstrating a major shift in costs from hospital inpatient to outpatient settings.
• Including cost of infections, surgical wounds ($11.7-$13 billion) and diabetic foot ulcers ($6.2-$6.9 billion) drove the highest total costs.
• On an individual wound basis, mean Medicare spending per wound per beneficiary was $3,415-$3,859. The most expensive wounds were arterial ulcers ($9,105-$9,418), followed by pressure ulcers ($3,696-$4,436).
• Surgical infections were the largest prevalence category (4%), followed by diabetic wound infections (3.4%).

According to Alliance officials, the study’s uniquely comprehensive analysis of the economic costs can have important implications for federal research and CMS policies. The documentation of the specific, significant burden of chronic wounds in the Medicare population illustrates the need for CMS and health policy makers to include wound-relevant quality measures in all care settings and to develop episode-of-care measures, chronic care models, and reimbursement models to drive better health outcomes and smarter spending in the wound care space, officials said. 

The full study can be viewed online at www.valueinhealthjournal.com. 

Organogenesis Inc., Advanced Medical Solutions Enter Into Patent Out-Licensing Agreement

Advanced Medical Solutions Group (AMS), Winsford, UK, a surgical and advanced wound care specialist company, and Organogenesis Inc., Canton, MA, a commercial leader in regenerative medicine focused on advanced wound care and surgical biologics, have announced a joint out-licensing agreement on a United States patent for a collagen-based wound dressing containing polyhexamethylene biguanide (PHMB). Under the terms of the agreement, Organogenesis has been granted an exclusive license in the U.S. to the patent, according to company officials. In exchange, AMS will receive a minimum payment of $2.5 million, which will be recognized in 2017, and a minimum royalty revenue of $1 million for each of the financial years ending Dec. 31 in 2018 and 2019, as part of an ongoing royalty that will be payable to AMS on the net sales of the licensed product for the life of the patent. The patent is due to expire in October 2026. “We are delighted to sign this agreement with Organogenesis, a commercial leader in regenerative medicine focused in the areas of bioactive wound healing and soft tissue regeneration,” said Chris Meredith, chief executive officer (CEO) of AMS. “The group’s ability to out-license our patent technologies is another endorsement of the quality of our innovation, and we are confident that our partner will be able to use the AMS patent in order to help patients across the U.S.,” he said. PHMB is an antimicrobial that is effective against several bacteria. AMS’ PHMB foam was approved for marketing in Europe in 2016 and subsequently this year in the U.S., according to company officials. “We are very pleased to secure an exclusive license to this patent in the United States,” said Gary S. Gillheeney, Sr., president and CEO of Organogenesis. “This is an important agreement for Organogenesis that underscores our commitment to offering a comprehensive portfolio of products that addresses patient needs across the continuum of care.”