Scrutiny continues for negative pressure

Sunday, March 22, 2009

WASHINGTON - The Office of Inspector General (OIG) last week said CMS pays way too much for negative pressure wound therapy (NPWT).

The report, "Comparison of Prices for Negative Pressure Wound Therapy," states that providers pay, on average, $3,604 for new pumps. Medicare reimburses $1,716 a month for the pumps for the first three months and $1,287 for months four through 13. 

This isn't the first time NPWT has come under scrutiny. Utilization of pumps jumped 444% between 2001--when Medicare began paying for them--and 2004.

"Utilization is going up because the product is effective and doctors are prescribing it," said Walt Gorski, vice president of government affairs for AAHomecare. "We don't control that. We hope they take a fair look at these issues and just don't raise objections simply because utilization rises."

CMS already plans to re-evaluate how it codes and pays for pumps. The Medicare Improvements for Patients and Providers Act (MIPPA) included a provision that excluded the category from Round 1 of national competitive bidding so the agency could conduct an evaluation. The agency is waiting for the results of a study comparing the clinical effectiveness of the pumps is due from the Agency for Healthcare Research and Quality in the next few weeks.

Still, in its report, the OIG recommends that the category be included in Round 2 of competitive bidding.

"This is a complex issue that is developing very quickly," Gorski said. "We want all the facts in before CMS starts making decisions."

While industry stakeholders weren't surprised by the report's findings, they hope that CMS looks at the service component of providing the therapy, as well as other long-term savings, something the OIG report does not, they say.

Additionally, the therapy keeps patients at home and out of costly institutional settings, says provider Tom Hanchar.

"We just had one guy who had been going to the wound doctor for 11 months for an ulcer that wouldn't heal," said Hanchar, president and CEO of Thomas International in Fort Wayne, Ind. "We had the wound closed--although not healed--in 10 days."

Download the report at