Medicare is expected to spend more than $15 billion by the end of 2025 on wound care products that have been linked to waste, fraud and abuse, according to a study published by the National Association of Accountable Care Organizations and the Institute for Accountable Care Oct. 23.
Here are five key takeaways from the report:
1. Spending on skin substitutes climbed to $7.7 billion through July, and is projected to reach as much as $15.4 billion by the end of 2025 — 55% more than was spent in 2024
2. “We’re in a current year that is on pace to outpace the prior year’s spending, and the prior year spending was double the year before that,” Emily Brower, president of NAACOS, told Medpage Today in an Oct. 27 report, describing the acceleration in costs as “jaw-dropping.”
3. According to Medpage, new versions of skin substitutes have come on the market in recent years, but these products are “frequently misused and their costs are often inflated by legally murky reimbursement schemes.”
4. In one case, a Texas woman racked up more than $10 million in claims, according to reports from one accountable care organization. Lisa Dombro, president of medical group Ilumed, told Medpage that there is “no vehicle” for holding individuals in these cases accountable.
5. Another ACO shared stories about patients receiving these products and needing increasing levels of pain medication to tolerate the procedures. In one story, a patient’s wounds were so neglected that maggots worked their way into the tissue, resulting in one of the patients’ legs being amputated.
“This is not a victimless crime,” Ms. Brower said.
