Verdict is in?

Sunday, May 31, 2009

WASHINGTON--A preliminary review of negative pressure wound therapy (NPWT) found little difference among devices, possibly paving the way for the category to be included in an upcoming round of national competitive bidding.

The code review was mandated by the Medicare Improvements for Patients and Providers Act (MIPPA), which was passed in July 2008 as part of a delay for NCB. MIPPA excluded NPWT from Round 1 of the program to allow time for an evaluation of the clinical benefits of the pumps (See HME News, September 2008). NPWT codes had not been reviewed since 2005. Since that time, many products have been added to the category.

The review, conducted by the Agency for Healthcare Research and Quality (AHRQ), found that there was a lack of significant data to distinguish the therapeutic benefits of one NPWT device over another.

Pump manufacturer KCI considers its V.A.C. therapy system to be a better product than others on the market and therefore merits its own code.

“They didn’t say they were the same, they just couldn’t find any difference,” said Susan Morris, KCI’s vice president of health policy. “It remains our position that as long as there is no evidence that these other products are clinically comparable, then you can’t put them in the same code.”

Morris blamed the findings on the narrow group of data included in the review.

CMS is expected to make a coding decision after reviewing comments on the AHRQ draft. The comment period ended April 24.

Most likely, the pumps will be included in future rounds of NCB, say stakeholders.

Officials at pump supplier Smith & Nephew said that was fine by them.

“Smith & Nephew and their respective corporate partners have embraced the NCB process previously and will actively participate in the proposed next round, if and when the product category is included within the process,” said Randy Carson, manager, health policy and reimbursement.

NPWT has come under scrutiny before. Most recently, an OIG report issued in March stated that Medicare pays too much for the therapy. Providers pay, on average, $3,604 for new pumps, according to the report. Medicare reimburses $1,716 a month for the pumps for the first three months and $1,287 for months four through 13. Utilization of the pumps jumped 444% between 2001 - when Medicare began paying for them - and 2004.