A Closer Look at Potential Changes in Wound Care in 2024

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Today’s Wound Clinic or HMP Global, their employees, and affiliates.

Marcia Nusgart, RPh:
Hi. I'm Marcia Nusgart. I'm the chief executive officer of the Alliance of Wound Care Stakeholders.
 
Karen Ravitz, JD:
And I'm Karen Ravitz, and I'm the health policy adviser for the Alliance care stakeholders.
 
Q: What do providers need to know about in 2024?
 
Marcia Nusgart, RPh:
One is in the home health care rule. There were provisions for implementation of the Lymphedema Treatment Act, which is absolutely wonderful in the fact that now providers are going to be able to, I'll say, provide a number of different products. Some of these lymphedema, you know, treatment items, some of the compression stockings. So in the home health regulation, there were, number of different provisions, that we're going to implement the Lymphedema Treatment Act. And what this is gonna be wonderful for providers, you know, starting in 2024, they will be able to provide to their patients, various, you know, compression stockings that in the past, they couldn't provide once the wound was healed. The compression stockings were covered under the surgical dressing, local coverage determination.
 
But that was only good for when a patient had a wound. When the wound was healed, they wouldn't be able to cover them under the Medicare program. So what was wonderful is that there's now a new Medicare statute that will allow providers to be able to do that. So this particular home health regulation does outline how many stockings, whether they're nighttime or daytime stockings, That, the providers or suppliers are allowed to, provide, you know, to patients as well as a number of other areas. It'll mention about how much they're gonna get paid and both for the stockings as well as for if they're gonna be able to be paid for the services, which is, you know, the the thing and as well as, providing education about them, and areas like that.
 
So that's one area. And, again, we had a lymphedema work group to be able to educate CMS about this, particular issue.
 
Karen Ravitz, JD:
And there's a couple of others that I think are really important for providers. First of all, managed care is on everybody's mind. CMS is trying to enroll a 100% of beneficiaries into that program. They're at 50% right now. So there are some regulations that are being issued around managed care and specifically prior authorization, which is a really big deal for many providers.
 
Right now, you could have prior authorization in a managed care setting, and you're not gonna get prior authorized. There's no consistency about when you're gonna get prior authorized is better way to say that. And so they're putting out regulations that set forth how and when you can get prior authorization, how long it's supposed to take in order for them to issue it, if there's an appeals, how long the appeal will take, etcetera. So that is actually something that that industry and providers have been wanting for a very long time, and that regulation is coming out fairly soon.
 
Q: How can providers best prepare for potential changes in 2024?
 
Karen Ravitz, JD:
So I think they're moving in the right direction in that way and addressing prior authorizations and how to handle coverage, for example, where you might have coverage in traditional Medicare, but you have a managed care plan.
 
There's a lot of discrepancies happening in the wound care space right now, with respect to that. And so the government is trying to address that, and they've just come out with a Final Rule that has addressed that coverage component, and we're waiting for the prior authorization component to be released very soon. So I think that's probably another one that that would be very important for the provider community to know about. So the best way is just really to be aware and to stay on top of what is coming out. They always should be knowledgeable in their space, right, about any coverage policy that's being issued.
 
They need to know about it. So it’s reading up. It's participating in whether it's a specialty society or a clinical organization that might be able to provide. But they have to stay on top of that. So just like if you get something in your inbox that highlights an issue, don't just put it aside. You should really read it and understand.
 
And if you don't understand, ask questions. It's really important because there's a lot of changes happening in health care right now. And the best way to stay on top of it and to make sure that you are doing things properly in your business is to be part of a group, whether it's a specialty society or an association that represents you, it's really important to follow their lead and make sure you're not just pushing aside any updates or information that they're sending to you.
 
Marcia Nusgart, RPh:
And most of those clinical associations and physician specialty societies are members of the Alliance of Wound Care Stakeholders and the one and what Karen does so beautifully is that as soon as these regulations come out, we provide a summary to our members and outline the various issues that would be important to, to them And for them to be able to, you know, to follow in this area. So, so we and we would ask for anyone that is not a member of the alliance part of any of these groups to be able to please contact us, and we'd love to talk with you about being a member.
 
Karen Ravitz, JD:
Can I make another statement that I think is really important, and I think, hopefully, people will hear this, is that right now, there's a lot of technical expert panels or expert groups, that participate or a part of whether it's Medicare, whether it's the Medicare contractors, managed care organizations, health insurance companies, and they really do rely on experts to help them form policies, deal with appeals, et cetera? It's really, really important, and I can't stress this enough, for wound care clinicians to become part of those groups. Because otherwise, those decisions are being made by somebody else who doesn't have the expertise or the knowledge in wound care. So when there is an opportunity that presents itself to be part of a panel, to be part of an advisory group, I highly recommend that the providers who are either hearing or listening to this, hear that, and that they get more actively involved because that just betters the wound care space in general.
 
Marcia Nusgart, RPh:
Karen, I'm so glad you mentioned that because what was interesting is that what came across my desk, and I think just yesterday, that the Food and Drug Administration was looking for people to be able to serve on some of their advisory panels. One is, for the plastic surgeons. So I need I need to get that out to our members to be able to have any of our members who are plastic surgeons to be able to apply for this. I think the deadline's in December. But that I can't we can't underscore how important because things change when there are Wound care physicians, clinicians on any of these different panels or organizations will be part of this because, Again, not that many of these organizations really understand wound care, know the details about wound care.
 
So the more that we have wound care physicians, clinicians at the table to be able to educate those other areas of medicine because emergency room physicians aren't gonna really know, that much about wound care as well as, you know, so many of the others that might sit on some of these panels. So, so we would say volunteer for these, because what I we try to be able to do is whenever there's an opportunity that comes out to send those to our members. And we've had quite a few members, you know, volunteer for some of these panels, and it really made a difference in the hospital outpatient, panel just this year, because they were able to approve a number of different recommendations that perhaps wouldn't have been approved if you didn't have physicians and clinicians who knew wound care to be able to let everybody else that was on the panel say, this is something very important, and I know wound care. And I think that this needs to be able to be approved by the panel, and it was.