CMS zeroes in on wound therapy

Saturday, January 31, 2009

BALTIMORE--CMS plans a review of all devices and codes included in the negative pressure wound therapy (NPWT) product category, the agency announced in January, leading manufacturers and providers to jockey for position.

NPWT codes have not been reviewed since 2005, according to Susan Morris, KCI’s vice president of health policy. Since then, many products have been added to the codes, she said.

“A lot of the products do not have any evidence of clinical and cost-effectiveness,” Morris said. “There is no evidence all of these products are interchangeable.”

The Medicare Improvements for Patient and Providers Act included a provision calling for an evaluation of the NPWT codes. The coding system is designed to classify similar products into categories for efficient claims processing.

KCI considers its flagship V.A.C. therapy system, however, to be a better product than others on the market. If, as part of the review, the company proves its case and gets its own code, that could mean higher reimbursement for the system.

But KCI may have a tough time proving that, said Bernie Laurel, vice president of Medela Healthcare Americas.

“The hurdle is the same for any of us, which is to provide clinical comparability for the patient,” he said. “I wouldn’t necessarily separate what we offer from anybody else. But we are going to show our (data) and I feel positive and confident that we will make it hard for KCI to achieve its objective.”

The NPWT market id dominated by KCI, Medela and Smith & Nephew - all of whom both manufacture and supply their products. When Round 1 contracts were awarded for national competitive bidding, KCI and Medela were not among the winners (see story).

That raised concerns that only inexperienced providers would be able to treat severely compromised patients with complex wounds. NPWT requires significant training and expertise, Morris said.

“It’s important to not only have clinically effective products but also the service and support that goes along with it is just as important,” she said. “CMS awarded contracts to suppliers who not only did not have access to these products, they had no experience or training.”

But under the current system, many patients are excluded from the therapy anyway, Laurel said.

“I believe there’s too many patients left behind,” he said. “One of the drivers against using it at home is it’s too expensive. I am not sure NPWT has to be delivered in such a costly way.”

CMS has partnered with the Agency for Healthcare Research and Quality to conduct the evaluation.