ComplicationsLiving with Type 1 Diabetes

Will Foot Ulcer Treatment Survive Medicare Rollback?

A state-of-the-art wound therapy that prevents amputations is under threat from proposed cuts in Medicare reimbursement rates, according to regenerative medicine experts.

Organogenesis has pioneered a form of wound care therapy called Apligraf, which uses human skin tissue to create a living dressing to treat diabetic foot ulcers and other stubborn skin wounds. Shire Pharmaceuticals has created Dermagraft, a similar human cell-based dressing that also has become popular for treating diabetic foot ulcers. The two rivals have banded together with other regenerative medicine companies to sound the alarm of an anticipated change in compensation guidelines by the Centers for Medicaid and Medicare Services (CMS).

The new CMS billing structure bundles these more-advanced wound care products with traditional wound care treatments. Currently, a unit of Apligraf costs about $1700, but company representatives warn that it would be bundled under a CMS compensation category that pays roughly half that rate. In an interview with bioflash, Organogenesis CEO Geoff MacKay predicted that the price imbalance would create a disincentive for hospitals to use the treatment. Dr. Lee Rogers, co-director of the Amputation Prevention Center at Valley Presbyterian Hospital, warns that the new compensation scheme would make the newer treatments economically untenable in an editorial for Podiatry Today.

“No hospital or doctor can afford to absorb a $600 loss every time they use a product,” Dr. Rogers writes.

Foot ulcers are a leading cause of
amputations among people with diabetes.

Diabetic foot ulcers are one of the leading causes of amputation for people with diabetes. T1 and T2 populations are at risk for developing foot ulcers because they often experience diminished sensation or loss of sensation in their feet due to neuropathic or vascular damage caused by repeated elevated blood glucose levels. The loss of sensation can cause foot injuries to go unnoticed for those with diabetes who aren’t paying close attention to their feet care. To complicate matters, once injured, the skin of a person with diabetes often has diminished ability to heal.

Studies have shown that this new wave of live-cell dressing works better than other dressings in treating foot ulcers and preventing amputations. A 2012 study conducted by European and Australian researchers at the Diabetic Foot Clinic at King’s College Hospital in London found that Apligraf was nearly twice as effective (51.5% to 26.3%) as traditional wound care in closing diabetic foot ulcer wounds during a 12-week test period, for example. A 2003 study on Dermagraft undertaken throughout 35 U.S. health care centers also showed significant improvement of the treatment over traditional wound treatments during a 12-week period (30% to 18.3%). Both studies also show that diabetic foot ulcers are notoriously difficult to treat, even with the best of treatments, underscoring why it’s important to keep all options for wound treatment on the table, wound care specialists say.

shutterstock_64602217_Money_Pinching_300pxThis uncertainty surrounding the future of wound care billing is also occurring in many other fields of medicine, as CMS is implementing a new payment scheme that moves away from a fee-for-service pay structure into a bundled payment care model in an attempt to incentivize cost-savings while rewarding improved medical outcomes. (It should be noted that the CMS pay structure shift is separate from the changes now being implemented under the Affordable Care Act, also known as Obamacare.) The new price for living-cell wound therapy was part of a 700+page CMS document detailing the new pricing structure; the changed pricings are scheduled to go into effect at the beginning of 2014.

In an interview with Insulin Nation, Organogenesis spokeswoman Angelyn Low says the wording of the new pricing rules is still open to interpretation, and regenerative medicine companies are waiting to see how CMS will implement the new pay structure.

However, the impact is already being felt in the industry. In a recent Fierce Biotech article, CEO MacKay warned his staff of “heartbreaking” staff cuts to make the new pricing structure work. Low concedes that major changes will be needed to follow the new CMS standard.

“If it is kept as written, it would certainly mean we would need to change our business model,” Low says.

Thanks for reading this Insulin Nation article. Want more Type 1 news? Subscribe here.

Have Type 2 diabetes or know someone who does? Try Type 2 Nation, our sister publication.

Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

Related Articles


  1. Hey! I know this is kind of off topic but I was wondering
    which blog platform are you using for this website?
    I’m getting sick and tired of WordPress because I’ve had problems with hackers and I’m looking
    at options for another platform. I would be great if you could
    point me in the direction of a good platform.

  2. xuzkwaoa,A fascinating discussion is definitely worth comment. I do think that you ought to publish more on this topic, it may not be a taboo fufxmbpq,subject but generally folks don’t talk about such subjects. To the next! All the best!!

  3. “Hi! I just wanted to ask if you ever have any trouble with hackers? My last blog (wordpress) was hacked and I ended up losing months of hard work due to no back up. Do you have any methods to prevent hackers?”

  4. dvdhzomnvq,Very informative useful, infect very precise and to the point. Im a student a Business Education and surfing things on Google and found your website and found it very informative.

  5. wxryeiz,Thanks for ones marvelous posting! I actually enjoyed reading it, you will be a great author.I will always bookmark your blog and will kmpyggnibrj,come back from now on. I want to encourage that you continue your great writing, have a nice afternoon!

  6. Having read this I believed it was really enlightening. I appreciate you taking the time and effort to put this short article together. I once again find myself spending way too much time both reading and commenting. But so what, it was still worthwhile!

  7. “Great – I should definitely pronounce, impressed with your web site. I had no trouble navigating through all tabs as well as related information ended up being truly simple to do to access. I recently found what I hoped for before you know it at all. Reasonably unusual. Is likely to appreciate it for those who add forums or anything, website theme. a tones way for your customer to communicate. Excellent task..”

  8. Wonderful blog! I found it while searching on Yahoo News.
    Do you have any tips on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get there!

  9. tvrtyzaess New Yeezy,Are you searching for top class Escort service in Noida and want to enjoy with them, hire sexy girls from top Greater Noida escort service and enjoy full night.

  10. “I have noticed that of all varieties of insurance, medical insurance is the most dubious because of the turmoil between the insurance plan company’s obligation to remain making money and the consumer’s need to have insurance plan. Insurance companies’ profits on health and fitness plans are certainly low, thus some firms struggle to make money. Thanks for the concepts you reveal through this web site.”

  11. Does your site have a contact page? I’m having problems locating it but, I’d like to
    send you an email. I’ve got some creative ideas for your blog you might be interested in hearing.
    Either way, great website and I look forward to seeing it grow over time.

  12. I’d like to thank you for the efforts you’ve put in writing this site. I really hope to view the same high-grade blog posts by you later on as well. In fact, your creative writing abilities has encouraged me to get my own, personal site now 😉

  13. You made some really good points there. I looked on the net for more info about the issue and found most people
    will go along with your views on this site.

  14. I’ve been browsing online more than 4 hours today, yet I never found any interesting article
    like yours. It’s pretty worth enough for me. Personally,
    if all website owners and bloggers made good content as you did, the internet will be
    a lot more useful than ever before.

  15. Undeniably consider that which you stated. Your favorite reason seemed to be
    at the net the simplest factor to consider of. I say to you, I certainly get annoyed whilst other folks think about concerns that they just don’t recognize about.
    You controlled to hit the nail upon the top and outlined out the whole thing without having side-effects ,
    other people could take a signal. Will probably be back to get more.
    Thank you

  16. the Swedish company filed an antitrust lawsuit in Europe, claiming that Apple abused its control over the App Store and made an offer to promote Apple’s services. Apple denied the allegation.

  17. “ItВЎВ¦s actually a cool and useful piece of information. IВЎВ¦m glad that you just shared this helpful information with us. Please keep us informed like this. Thank you for sharing.”

  18. A cored-out white React foam midsole with salmon plugs then completes the look. A perfect shoe for the warm weather ahead, you can check these new womens Reacts out in detail below, and expect a release on and at select sportswear stockists in the coming weeks for $130 USD.

  19. They had a very productive conversation about keeping the media platforms open for 2020, said adviser Kellyanne Conway Wednesday morning. The president is very concerned about what he sees as losing followers or people being blocked for certain actions. Thats obvious.

  20. Raja’s elder brother, who continues to work as a police officer, apologized to the Jones family and complained that Raja had been unfairly treated for what he called “a bad decision.”

  21. If one of the three were to succeed, he would become only the second-ever sitting House member to ascend to the White House, since James Garfield in 1880.

  22. After going over a handful of the blog posts on your website, I honestly
    like your way of writing a blog. I saved it to
    my bookmark website list and will be checking back soon. Please check out my website as
    well and tell me your opinion.

  23. 317091 983489Of course like your web site but you need to have to check the spelling on several of your posts. Several of them are rife with spelling difficulties and I discover it very bothersome to tell the truth nevertheless Ill surely come back once more. 474389

  24. qsyzbwsfo,Definitely believe that which you said. Your favourite justification appeared to be on the net the simplest thing to remember of.

  25. Nice post. I used to be checking continuously this blog
    and I am inspired! Very helpful information specially the final section 🙂 I take care
    of such info a lot. I was seeking this particular information for a very lengthy time.
    Thank you and good luck.

  26. I wish I had the luxury of viewing my fertility in the way that many others do: as something optimistic and uncomplicated. My 26-year-old self had no idea how fragile the future can be,Jordan and how lucky I was to not have had to consider how Id create a family someday.

  27. “You could definitely see your enthusiasm within the work you write. The sector hopes for more passionate writers such as you who aren’t afraid to mention how they believe. All the time go after your heart.”

  28. Howdy this is somewhat of off topic but I was wondering if blogs use WYSIWYG editors or if you have to manually code with HTML.
    I’m starting a blog soon but have no coding know-how so I wanted to get advice from someone with experience.
    Any help would be greatly appreciated!

  29. “Its like you read my mind! You appear to know a lot about this, like you wrote the book in it or something. I think that you could do with a few pics to drive the message home a bit, but other than that, this is fantastic blog. A great read. I’ll certainly be back.”

  30. “I’ve learned some new things through your web site. One other thing I would really like to say is always that newer computer os’s are likely to allow more memory to use, but they furthermore demand more ram simply to run. If someone’s computer could not handle extra memory plus the newest software requires that memory space increase, it may be the time to buy a new PC. Thanks”

Leave a Reply

Your email address will not be published.

Back to top button