Some days ago, I asked if it was legal for practitioners to make large profits off the cost of CTPs/skin subs – and the answer seems to be “yes”. Of course, I knew that no reputable attorney was going to send me a considered legal opinion on social media. I am still worried that some of these incentives and discounts can or will be construed as kickbacks, but for now, let’s assume that it’s all totally fine. At a recent meeting, a physician who seemed very caring talked about the excellent medical care and ancillary services that he and his team offer in the home setting. Although I don’t know him personally, I was impressed with his presentation. He made the off-hand comment, “With the money we are making, we can afford to help these patients.” That comment deserves some discussion.

I am going to call this, “Robin Hood” wound care. The profits made from the use of CTPs/skin subs are not being “stolen” from Medicare – but it is true that the money is being made because of a loophole in coverage policy. Whether it is ethical is an interesting and separate question from whether it is legal. One commenter on my blog informed me how stupid I was since I clearly did not understand that the patients had “paid into Medicare” and it was not my tax dollars that were funding his profits. Another told me that since the Medicare copays were “waived,” no patients were financially hurt. I won’t even try to deal with the issues of draining the Medicare trust fund with services of unclear benefit, which ultimately means restricting other types of care because the Medicare coffers are empty – or the specter of raising taxes or insurance premiums to cover the deficits created.

Many practitioners who offer mobile wound care services drive long distances to remote settings. Caring for patients in rural and isolated settings is highly “inefficient,” not to mention that it’s often difficult and perhaps even dangerous. They frankly admit to me that were it not for the profits they make from the use of CTPs/skin subs, they could not offer wound care to those patients. Because of these CTP profits, patients who have been forgotten now have access to care. I know that many practitioners going into the home setting for wound care services are doing far more than wound care. They are helping with nutritional needs, health care education, social isolation and no doubt, many other services for which there are no billing codes – meaning, for which Medicare and other payers do not pay.

The now infamous APEX scandal shocks us in part because the DOJ describes charges in excess of $1.5 million per patient. Revenue like that could fund a new house for a patient. How much of those revenues were used to fund otherwise uncovered services for patients? I have no idea. I do know that I have concerns about Robin Hood wound care. Firstly, it’s up to the moral compass of the individual providers to decide how much of their profits will be “given to the poor,” (meaning, to fund needed but otherwise uncovered services). It’ also worries me because when Medicare closes the loopholes that allow these profits (as CMS will certainly have to do), those patients will be back where they started – without access to care.

How do I feel about using the money that falls out of the Brinks van to fund unmet healthcare services? Truthfully, I feel uncomfortable. Fundamentally, we have a problem with healthcare policy.  And I don’t have an answer for that.

What do you think about Robin Hood wound care services?

–Caroline

Caroline Fife, M.D.

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.