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2023 QPP Performance Data are Out: 14.56% of Practitioners Will See a Penalty in Their 2025 Medicare Payments

2023 QPP Performance Data are Out: 14.56% of Practitioners Will See a Penalty in Their 2025 Medicare Payments

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...
A Ruptured Appendix and a Broken System

A Ruptured Appendix and a Broken System

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...
Must Wound Clinics & Mobile Practitioners Report Pressure Injuries / Ulcers Occurring in the Home as SREs?

Must Wound Clinics & Mobile Practitioners Report Pressure Injuries / Ulcers Occurring in the Home as SREs?

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...
Myth of the Day: “I am Exempt from MIPS Because I am a ‘Mobile’ Practitioner”

Myth of the Day: “I am Exempt from MIPS Because I am a ‘Mobile’ Practitioner”

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...
Insights Involving Real-World Evidence and Wound Care

Insights Involving Real-World Evidence and Wound Care

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...
The Age of Wisdom and the Age of Foolishness: A Tale of Two Wounds

The Age of Wisdom and the Age of Foolishness: A Tale of Two Wounds

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...
$1.3 Billion in Potential Savings if Medicare Paid HOPDs at the “Non-Facility” Rate

$1.3 Billion in Potential Savings if Medicare Paid HOPDs at the “Non-Facility” Rate

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...
Site Neutrality – a Looming Disaster or an Opportunity?

Site Neutrality – a Looming Disaster or an Opportunity?

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...
Well-Known Wound Care Practitioner Jay Shah, President of the Texas Medical Association “Let Doctors be Doctors” Podcast

Well-Known Wound Care Practitioner Jay Shah, President of the Texas Medical Association “Let Doctors be Doctors” Podcast

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!...
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...
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Wound Care Reimbursements

Recent Articles

  • Just Released: Hospital Outpatient Proposed Rule Would “Unbundle” Cellular Tissue Products (CTP) / Skin Substitutes in the HOPD July 17, 2025
  • BREAKING NEWS! 2026 MPFS Proposed Rule Sets Single Payment Amount for all “Skin Substitutes” at $125.38/cm2 July 15, 2025
  • Pressure Injury: a Hospital Harm Measure in 2025 that Includes STAGE 2 Pressure Ulcers – This is Out of Control July 14, 2025
  • BREAKING: Another Fatal Hyperbaric Chamber Fire July 11, 2025
  • CMS Prepares to Launch a Prior Authorization Model for “Skin Substitutes” in Traditional Medicare as Part of the WISeR Initiative July 11, 2025

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