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How a Medicare MAC Views the Role of Real World Evidence in Coverage Policy

How a Medicare MAC Views the Role of Real World Evidence in Coverage Policy

by Caroline Fife, M.D. | May 28, 2025 | Fight the Good Fight, SAWC

At the recent SAWC, the Alliance of Wound Care Stakeholders hosted Dr. Anitra Graves, the Medical Director for First Coast. Dr. Graves gave a fantastic presentation on the use of real-world data in Medicare coverage policy. I thought I’d provide some of the notes that...
If I Were Queen I Would Fix These Six Stupid Things in Wound Care

If I Were Queen I Would Fix These Six Stupid Things in Wound Care

by Caroline Fife, M.D. | May 21, 2025 | Fight the Good Fight, If I Were Queen

In the 30+ years I’ve been taking care of patients with chronic wounds, I’ve given a lot of thought to the things that are covered by Medicare and other payers (some of which, frankly, don’t work very well) vs. the things that are NOT covered,  but work...
Why Patients with Vasculitis and Pyoderma Gangrenosum Don’t Get Pain Management and the MATE Act

Why Patients with Vasculitis and Pyoderma Gangrenosum Don’t Get Pain Management and the MATE Act

by Caroline Fife, M.D. | May 19, 2025 | Pyoderma Gangrenosum

I felt guilty the day I decided I could no longer prescribe opioid pain medications to patients with severely painful wounds. I didn’t prescribe narcotics very often since that’s a bad way to treat any chronic pain, but it is sometimes necessary in acute vasculitis...
DOJ Unveils a New Corporate Enforcement & Voluntary Self-Disclosure Policy (CEP)

DOJ Unveils a New Corporate Enforcement & Voluntary Self-Disclosure Policy (CEP)

by Caroline Fife, M.D. | May 16, 2025 | Fight the Good Fight

This week, the Head of the Justice Department’s Criminal Division, Matthew R. Galeotti, delivered remarks at an Anti-Money Laundering and Financial Crimes Conference, announcing that the DOJ’s Criminal Division was “turning a new page on white-collar and corporate...
Dr. Lisa Gould: Combining Classical Guitar & Wound Care

Dr. Lisa Gould: Combining Classical Guitar & Wound Care

by Caroline Fife, M.D. | May 12, 2025 | Miscellaneous Musings

Most of us know Dr. Lisa Gould as a skilled plastic surgeon and prolific wound care researcher and lecturer. However, I learned something else about her recently. Dr. Gould is also a classical guitarist, and she combines her skill as a musician with her skill as a...
Tell Me Your Story – The Undaunted Spirit of Patients with Chronic Wounds

Tell Me Your Story – The Undaunted Spirit of Patients with Chronic Wounds

by Caroline Fife, M.D. | May 9, 2025 | The Patient's Voice

Patients have humbled and inspired me for decades. There’s a story that I have told few people, but more than 25 years ago, my daughter had a serious health crisis that shook my world. After taking 3 months off trying to find a way forward for her and our family, on...
CMS Launches the Fraud Detection Operation Center (FDOC)

CMS Launches the Fraud Detection Operation Center (FDOC)

by Caroline Fife, M.D. | May 7, 2025 | Healthcare Payment Policy

Fierce Healthcare has reported that The Centers for Medicare & Medicaid Services (CMS) launched the Fraud Detection Operation Center (FDOC) to fight waste, fraud, and abuse. The “fraud War Room” is a real-time operations center which leverages the Fraud Prevention...
Letter about Cellular Tissue Products / Skin Substitutes Used on Pressure Ulcers

Letter about Cellular Tissue Products / Skin Substitutes Used on Pressure Ulcers

by Caroline Fife, M.D. | Apr 28, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, The Patient's Voice

I just got this letter by email from a physician emphasizing (in addition to the ethical issues) the need for clinical studies of Cellular Tissue Products / Skin Substitutes on pressure ulcers. Thoughts anyone? –Caroline Dear Dr. Fife, I am writing to express a...
CMS Needs to Fix the Root Cause – the CTP/CAMP Payment Structure

CMS Needs to Fix the Root Cause – the CTP/CAMP Payment Structure

by Caroline Fife, M.D. | Apr 23, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes

Hi Dr. Fife, Here’s my two cents as someone who has lived this mess for a long time now. The root cause of this issue is the CMS payment structure. CMS has known about this problem this for years.  Every year they talked about fixing it and every year they chose...
Why Heart Failure Gets Attention and Chronic Ulcers Don’t: Cardiologists Tell the Truth About Outcomes

Why Heart Failure Gets Attention and Chronic Ulcers Don’t: Cardiologists Tell the Truth About Outcomes

by Caroline Fife, M.D. | Apr 21, 2025 | Fight the Good Fight

The March issue of JAMA has an article about the “mode of death” in patients with heart failure.  Yes, Cardiologists lead with “here’s how our patients die.” And yet, no one reads that and thinks, “Wow, cardiologists are terrible at their job.” To put this in...
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Wound Care Reimbursements

Recent Articles

  • Skin Substitute Payment Reform: Some “Thankfuls” Around the New Payment Structure December 10, 2025
  • Vohra Wound Physicians and Owner Agree to Pay $45 Million to Settle Fraud Allegations Around Overbilling December 2, 2025
  • The Incredible Journey: Lessons Learned from a Skin Substitute Graft Audit (Part Three) November 20, 2025
  • Here Comes the Judge! Part 2 of the Incredible Journey of a Skin Substitute Audit – Guest Blog by Michael Crouch November 17, 2025
  • Skin Substitute / Cellular Tissue Product (CTP) Pricing and a Path Forward November 5, 2025

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