by Caroline Fife, M.D. | Jul 17, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The proposed rule for Hospital Outpatient Prospective Payment System (HOPPS) has been posted. Like all of the proposed payment policies, it’s massive and you need to read it yourself. CMS is proposing to “unbundle” “skin-substitutes” in the hospital outpatient...
by Caroline Fife, M.D. | Jul 15, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
CMS has released the proposed CY 2026 Physician Fee Schedule. CMS is proposing to continue to pay for CTPs that have a biologic license agreement (BLA) using ASP +6%. However, all other products would be paid at $125.38/cm2 (prior to the application of the geographic...
by Caroline Fife, M.D. | Jul 11, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Summary of the WISeR (Wasteful and Inappropriate Service Reduction) Model for Medicare (The summary below is partially excerpted from a more detailed review by Julie Rhodovi) Federal Register CMS Page and CMMI Page Model Original Medicare’s fee-for-service payment...
by Caroline Fife, M.D. | Jul 1, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
In yesterday’s press release, the specific mention of the abuse of “skin grafts” (sic) is from minutes 4:50 to 5:31 Excerpt from remarks by Matthew Galeotti, Head of the Department of Justice (DOJ) Criminal Division, June 30, 2025: “Many of the defendants charged as...
by Caroline Fife, M.D. | Jun 30, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
Today the Department of Justice (DOJ) held a press conference which was led by Dr. Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid (CMS) and officials from the DOJ, announcing the results of its 2025 National Health Care Fraud Takedown. The...
by Caroline Fife, M.D. | Jun 27, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
The Houston Chronicle has reported that a Houston podiatrist and his business partner have been charged with $45 million in healthcare fraud in relation to the billing of bioengineered skin substitutes Dr. David Jenson and Nestor Refael Romero Magallanes are...
by Caroline Fife, M.D. | Jun 25, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
An article by SmartTRAK shows that Cellular Tissue Products (CTPs) / Skin Substitutes in the Physician Office and Mobile environment grew by over $5 Billion between 2021 and 2024 compared to only $1 Billion in all other care settings combined. The U.S. CTP/skin...
by Caroline Fife, M.D. | Jun 11, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I got this letter from a Physical Therapist, and I am publishing it anonymously with his permission. –Caroline Dear Dr. Fife, I am a physical therapist (PT) specializing in wound care. A PT acquaintance of mine has partnered with a Nurse Practitioner (PT) in a...
by Caroline Fife, M.D. | Jun 5, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight, Healthcare Payment Policy
There’s a new article in Health Affairs about “site neutral” payments that could change everything for hospital-based outpatient departments – and by that, I mean, possibly end them. However, I have been wrong about this threat for more than a decade – which means...
by Caroline Fife, M.D. | Jun 2, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
I had a great time speaking at the WOCN conference in Orlando! I was asked to provide an update on “Skin Substitutes.” I will give you a few highlights from the talk. I reviewed the reasons we need skin substitutes, such as the huge percentage of patients suffering...
