Price & Size Limits to Cellular Tissue Product (CTP) Use in the HOPD vs the Office (This is All So Messed Up)

I  am trying to find ways to visually depict our current situation with regard to Cellular and/or Tissue-based  products (CTPs). Several things can be true at once:

• Package pricing in the hospital-based outpatient department (HOPD) limits the cost per PIECE that a hospital can afford.
• Pricing limits the size of the CTP that can be used in the HOPD; the higher the price per cm2, the smaller the piece that can be used in the HOPD before the hospital starts to lose money.
• Package pricing thus limits the size of the wounds that can be treated with a CTP in the HOPD.
• In the office-based setting, there is no limit to the cost of a CTP since costs are passed on to Medicare and the patient.
• In the office-based setting, there is no limit to the size of the wound that can be treated with a CTP.

I have tried to depict this visually. This is a table of 4 actual CTPs (names redacted) in price per cm2. Three of these will be used in the HOPD, and the 4^th in the doctor’s office.

The red line is the threshold that an HOPD can pay and not lose money on the 3 products used in the HOPD. Using only 3 product examples, the largest piece that is affordable under a package price rate ~$1700 is 16 cm2. This represents the maximum size of a wound that can be treated in the HOPD. Using these 3 products as examples, the price per cm2 ranges from $50 -255/cm2 in the HOPD.

Product #4 is $602/cm2. It can only be used in the office-based setting because there are no affordable pieces for the HOPD. In the office-based setting there is no limit to the size of the pieces that can be purchased, and thus the size of the wounds that can be treated. There is also no limit to the COST of care in the office-based setting.

We took a stab at depicting this issue like this. The blue lines show the “affordable” products based on price per cm2 and total cm2. The yellow line is the price that can be paid in the office-based setting. It’s clear to me that there are problems in both sites of care. Let’s also remember that in the HOPD, the patient copay at least has a limit. In the office setting, the patient copay increases in proportion to that yellow line.

This is one messed up system.

Thank you to Ben LeBoutillier at Intellicure, LLC for the graphic.