How much do you think that price impacts the way that CTPs (skin subs) are selected in the office setting? One reader sent me this thought – which is testable statistically (although I do not have access to the data to do it):
“Dr. Fife,
I could be wrong, but I think the apparent problem with CTP selection is mostly (though not entirely) with the system that sets prices — not how it is being billed by individual offices.
It would be interesting to see the data, but here is what I would expect to see based on what I hear:
- The products with reported but high ASPs (Average Sales Price) are relatively popular in the office setting everywhere.
- The products with unreported ASPs are popular in the office in those MACs that set reimbursement based on WAC (Wholesale Acquisition Price), not invoice.
- Roughly speaking I think the “WAC MACs” are Novitas, First Coast, Palmetto and WPS.
- Unreported products are not very popular in the office in the MACs that pay only on invoice price, like Noridian.
I know the older data showed a big surge in the unreported products [products without a reported ASP] but that was before CMS started publishing so many ASPs resulting in high priced products being on the ASP list. That changed the game somewhat.”
[Name withheld]
What do you think?
–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
This is why change needs to happen in this product category – 6/27/24 – Justice Department charges nearly 200 for $2.8B healthcare fraud schemes, the charges involved an alleged $900 million fraud scheme related to amniotic wound grafts. AZ mobile wound care company and individuals are all over the news. https://www.azfamily.com/2024/06/27/doj-charges-nearly-200-people-27b-health-care-fraud-crackdown-over-1b-arizona-cases/