TWC News Update

California Wound Center Earns Warriner Excellence Award

  Sonora (CA) Regional Medical Center has received the Robert A. Warriner III, MD Center of Excellence award for wound healing. According to facility officials, the center earned the award by surpassing rigorous quality standards for two consecutive years. Festivities included a gathering for staff and an award presentation by Healogics Inc., Jacksonville, FL. In 2012, the center achieved a healing rate of 96% in 23 median days for chronic wounds, exceeding the quality standard of 91% in at least 30 median days. In addition, 93.4% of patients rated their overall experience at the center as “excellent,” also exceeding the quality standard of 90%.   The Center of Excellence award is named for Warriner, a pioneer in wound care and the former chief medical officer of Healogics.    “We’re honored,” said Eden Smith, MD, medical director at the Sonora Center for Wound Care. “It’s a privilege to be part of a great collaborative effort between the hospital and Healogics. Together, we are able to heal patients in our community and get them get back to living happy, healthy lives.”

MGH, City of Boston Offer Donation Opportunities for Marathon Funds

  In the aftermath of the terroristic events that unfolded at the Boston Marathon April 15, city officials and administration at Massachusetts General Hospital (MGH) have created support opportunities for those seeking to make donations to the local area.   One Fund Boston Inc. has been established by Massachusetts Gov. Deval Patrick and Boston Mayor Thomas Menino to help those most affected by the tragedy. Donations can be made online by visiting https://secure.onefundboston.org.   The MGH Emergency Response Fund helps support the hospital’s emergency response by providing social services support for victims and families, and will support emergency care, disaster relief, and disaster-preparedness training. Donations can be made online by visiting https://give.massgeneral.org/boston-marathon-donate. Any questions can be addressed by emailing mghcommunityfundraising@partners.org.   Local residents are also encouraged to help by donating blood. To schedule an appointment, call 617-726-8177.

Alliance of Wound Care Stakeholders Officially Adopts “Cellular and/or Tissue-Based Products”

  The Alliance of Wound Care Stakeholders have voted to update the term “skin substitutes” with “cellular and/or tissue-based products for wounds” (CTPs). The adoption culminates the Alliance’s yearlong effort of its working group to determine a term that would be broad and inclusive to include both present and future technology.   Use of the term “skin substitute” was recognized to be clinically inaccurate by representatives from clinical specialty organizations who work on CPT coding issues. They also determined that if an accurate terminology and appropriate classification system for these biological materials was not created, CMS would be unable to craft proper coverage policy, clinicians would not be paid for using these materials, and patients would not have access to them.   Thus, Alliance members decided to update the term since the Agency for Healthcare Research and Quality, in its draft technology assessment on skin substitutes, stated these products were not “skin substitutes” and the Centers for Medicare & Medicaid Services abandoned the term in code descriptors for these products in 2010, when “Q” codes for each individual product were issued by its brand name. In order to achieve a fair, inclusive process for determining this new term, a workgroup of scientists, clinical organizations, and business entities was created from the Alliance to address this issue spearheaded by its chair Charles Drueck, MD. It held many conference calls in 2012 in working toward development of the new term, determined by the following criteria:     • be based on science     • be inclusive of all products in the marketplace today with an eye towards what is in the “pipeline”     • be neutral in regards to FDA (nothing that would be offensive and not allow manufacturers to get their products approved in the future, if needed)     • ensure that all products are eligible for Medicare coverage as drugs and biologicals consistent with their US Pharmacopeial Convention monographs     • easily understood by clinicians     • easily linked to the existing Current Procedural Terminology codes for the application of the products.   The Alliance held a decisive call in October with more than 25 scientists, clinicians, and manufacturers who reviewed the historical perspective of the 18 names the workgroup suggested over the past few years and to determine a final term. The group determined that the modified term “CTP” was the most appropriate term to put forward for these products. In discussing this term at a November meeting of the ASTM, an FDA representative had concerns with the term “derived.” Since the FDA does use the term “based” in its regulations regarding “Human Cells, Tissues, and Cellular and Tissue-Based Products,” the Alliance decided to use “based” to be consistent. Therefore, the final term became “Cellular and/or Tissue Based Products for Wounds.”

Ask the Board

In this exclusive column, TWC offers readers the chance to ask industry-related questions to our expert editorial board members. This month’s question comes from Orlando, FL. Q: Do you agree or disagree with some insurance companies not covering any skin substitutes – and why? A: By Donna J. Cartwright, MPA, RHA, CCS, RAC, FAHIMA   The Today’s Wound Clinic board is not in a position to agree or disagree with the medical directors of insurance companies. Therefore, following is a quick review of how qualified healthcare professionals should educate payers about products with published clinical evidence:   Medical directors of the Medicare Administrative Contractors (MACs) do provide coverage for cellular and/or tissue-based products for wounds that have published evidence such as meta-analysis, randomized clinical trials, etc. If a particular product has published evidence and is not covered by the MAC that processes your claims, you should educate the MAC medical director through the Local Coverage Determination Reconsideration Process. This process is clearly outlined on the website of each MAC. Medical directors of private payers also provide coverage for cellular and/or tissue-based products for wounds that have published evidence. Sometimes coverage criteria are more lenient, the same as, or less lenient than the MAC medical directors’ coverage criteria. If a particular product has published evidence and is not covered by the particular private payer for a specific plan, you should educate the private-payer medical director through the prior authorization or pre-determination process. Donna J. Cartwright is senior director of strategic reimbursement services with Integra LifeSciences Corp., Plainsboro, NJ.