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If you are at SAWC Spring this week and you missed the email blast below, it may not be too late to have dinner on the Cellular Tissue Product (CTP) company circulating the invitation. Per their email (forwarded to me by several irate physicians), you can get a 40% discount on the product priced at $3,300/cm2. This means you can make a profit of $1,980 per cm2 on that product. And according to the manufacturer, you can bill up to 300 cm2 at a single application before you hit the MUE (Medically Unlikely Edits),  which might kick out the claim.

Just to be clear, that means you can bill up to 300 cm of a $3,300/cm2 product at a single application, which is a total of $990,000. A 40% discount means that you would pocket $594,000 per application, should you by some accident, neglect to provide Medicare the invoice showing the discount. Here’s a heavily redacted version of the email, but the prices are quoted accurately:

Hello [redacted],

We’re excited to let you know that we’ll be attending SAWC and would love to catch up over dinner…

 Here are our signature grafts for Q2 with the following CMS reimbursements:

  1.  [name redacted] (QXXXX): ASP of $1,749/cm², MUE 300.
  2. [name redacted] (QXXXX): $2,008/cm², MUE 180
  3. [name redacted] (QXXXX): Fee Schedule of $2,214/cm², MUE 180.
  4. [name redacted] (QXXXX): Fee Schedule of $3,300/cm², MUE 300.

 To help you get started, we’re offering a 40% discount on (#4) and a 50% discount on all other products. If you are available for dinner during SAWC, please RSVP.

 Best regards,
[name withheld]

In case you think these numbers are made up, the Medical Director of a healthcare plan sent me an email last month stating that in one state, over $7 million had been spent on care of 4 patients with wounds, largely due to CTPs provided in the home setting. In fact, over $4M in CTPs had been applied to a single sacral ulcer, and the problem was growing across many states.

Thanks to the shenanigans in the CTP industry, some practitioner is driving a Ferrari on our tax dollars, Someone has a second home in the Caymans or maybe Martha’s Vineyard, paid for with our money. Someone took a fabulous vacation, paid for with our money.

Lots of people are upset about the proposed LCDs limiting CTP coverage to four applications of a handful of products. I don’t like their arbitrary decision about what constitutes “evidence.” We must insist that the MACs have transparent and fair evidence standards. However, the MACs are using the only tool they’ve got slow down the pillaging of the Medicare trust fund. How would you suggest that the MACs or CMS stop this?

And if you go to dinner with these folks, make them buy you a 300cl Jeroboam of Cristal. That’s about the same price per cc as their CTP, and they can afford it.

–Caroline