by Caroline Fife, M.D. | Jul 30, 2025 | Fight the Good Fight, Healthcare Payment Policy
I should leave the coverage interpretation to the professionals. I appreciate all of you who tell me when I make a mistake. Donna Cartwright — who is a genuine expert — provided corrections on that UHC policy: “Epifix and Grafix are the only amniotic...
by Caroline Fife, M.D. | Jul 9, 2025 | Fight the Good Fight, Healthcare Payment Policy
CMS has released Quality Payment Program (QPP) performance data for 2023. Under the QPP, payment “adjustments” (bonuses and penalties) occur two years after the “performance year,” so that 2023 scores impact a practitioner’s 2025 Medicare payments. It’s important to...
by Caroline Fife, M.D. | Jun 23, 2025 | Fight the Good Fight, Pressure Cooker: Rethinking Pressure Ulcers
Dear Dr. Fife, I am writing this letter as a general surgeon who is deeply concerned about our healthcare system. As you have pointed out in your blog, physician payments by CMS and private insurers are a fraction of what they were 20 years ago because physician...
by Caroline Fife, M.D. | Jun 20, 2025 | Fight the Good Fight, Pressure Cooker: Rethinking Pressure Ulcers
The National Quality Forum (NQF) has issued a request for public comment about their update on Serious Reportable Events (SREs). Every hospital-based outpatient wound center (HOPD) and “mobile” wound care practitioner needs to read this carefully. I hope all of you...
by Caroline Fife, M.D. | Jun 16, 2025 | Fight the Good Fight
I hear the most interesting things about when Medicare rules apply and about the requirements of the Merit-Based Incentive Payment System (MIPS). For example, two years ago, a doctor whose practice involved the application of CTPs/skin substitutes on patients in the...
by Caroline Fife, M.D. | Jun 13, 2025 | Fight the Good Fight
I had a great time talking to Elizabeth Anderson of SmartTRAK about what the real world analysis of diabetic foot ulcer and venous leg ulcer patients revealed, including the astounding similarity of their underlying medical conditions and medications. The prevalence...
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 9, 2025 | Fight the Good Fight
HHS-OIG identified $1.3 billion in potential savings if #Medicare reimbursed provider-based facilities at the non-facility rate. Related reports include recommendations for legislative action and areas where congressional oversight may be warranted. See also: Site...
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 4, 2025 | Fight the Good Fight
Dr. Jay Shah is a well-known wound care practitioner, and he is now the President of the Texas Medical Association (TMA). Being active in organized medicine is a sacrifice. I am grateful and excited that a wound care practitioner holds a position of such influence!...
