Check out the entire series here.
I know this story qualifies as hearsay. I could provide the names of the companies involved, but I can’t afford the legal bills. Since I can’t provide the details, you don’t know whether to believe me, but here goes:
- A doctor called me who does case reviews for private insurance companies who provide Medicare secondary policies. He’s been getting asked to review claims for the in-home application of CTPs/Skin subs.
- To set the stage, all these patients have Medicare as the primary, but their Medicare benefits have run out, and now the bills have been submitted to the secondary (private payer).
- I won’t tell you what companies are providing the secondary insurance in these cases, but they are big ones.
- The doctor described one of several cases he has been asked to review — not revealing patient names or dates. One case he described was a patient with a “superficial pressure ulcer” on the buttock.
- A Physician’s Assistant came to the home and performed a superficial debridement and cleansing and applied a CTP/Skin sub (I am not going to say the product name) at the cost of $18,000 for one piece. The ulcer was 2.5 cm x 3 cm.
- The CTP was applied 10 times on 10 separate visits by this PA, and the total bill to the private payer was $180,000.
- No information was available to the case reviewer as to whether the patient was on an off-loading mattress or had any type of nutritional evaluation.
- The company that sent the Physician’s Assistant to do the applications provides these services, focused on “wound care”, in several different states.
- This is only one case of many that the doctor has been asked to review for medical necessity.
- The doctor who called me said he had another case with a bill in excess of $500,000. None of the claims were for less than $100,000.
Let me recap what I now understand. There are companies that exist (perhaps solely) to provide the in-home application of specific CTPs/skin subs at the cost of thousands of dollars each. The charges can add up to six figures for each patient. The CTPs/skin subs are not always applied by a physician. This is happening in many different states to many patients.
I have officially run out of words.
Caroline
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
