American Professional Wound Care Association Recent News

Rethinking regulatory tiers: Medicare real-world evidence shows CAMP outcomes are independent of FDA regulatory classification

Fri, 13 Mar 2026 15:47:37 GMT

tettelbach-et-al-2025-rethinking-regulatory-tiers-medicare-real-world-evidence-shows-camp-outcomes-are-independent-of (1)_Page_11.png

When Compliance Is Not Enough: Skin Substitute Audits, Due Process, and the Collapse of Wound Care Practices

Tue, 03 Feb 2026 16:24:09 GMT

B. Moira Sykstus, MHA, CPCO, CPMA, RRT, CHT, DAPWCA

Over the past two years, Medicare’s oversight of skin substitute products has shifted from targeted program-integrity review to a level of enforcement that many providers now describe as existential. Across the country, wound care practices—many of which serve the most medically complex and socially vulnerable patients—are reporting debilitating financial losses, forced closures, and in some cases, the loss of Medicare billing privileges, even while disputed claims remain under formal appeal.

These outcomes raise urgent questions not only about audit methodology, but about Medicare’s obligations to providers and beneficiaries under federal law.

The human cost of retrospective enforcement

Skin substitute therapies are not theoretical services. They are applied to patients with chronic, non-healing wounds, often after months or years of unsuccessful conservative care. Providers purchase these products up front, at costs that can exceed thousands of dollars per unit, with no guarantee of reimbursement once an audit is initiated.

When Medicare later recoups payment—sometimes months or years after care was rendered—the provider does not merely lose revenue. They lose capital already expended, with no mechanism to recover those costs from manufacturers or distributors. Unlike an evaluation and management service, a skin substitute application leaves behind irreversible financial exposure.

In recent enforcement actions, providers report that:

Entire payment streams have been frozen based on a small number of disputed claims;
Extrapolation methodologies have multiplied alleged overpayments far beyond the original audit sample;
Practices have been forced to lay off staff, reduce services, or close entirely;
In at least one reported instance, a provider’s Medicare billing privileges were revoked on the basis of three claims, all of which were under timely appeal.

For those practices, the appeals process offered no meaningful protection. By the time due process could be exercised, the business no longer existed.

When “fraud” becomes a label, not a finding

Medicare regulations clearly distinguish between fraud, abuse, and payment error. Fraud requires intent. Abuse requires reckless disregard. Documentation disputes and medical-necessity disagreements are meant to be resolved through the claims and appeals process.

Yet in the current enforcement climate, providers report that allegations of fraud are sometimes asserted before appeals are exhausted, and in some cases before adjudication at any appeal level. Payment suspensions, recoupments, and privilege revocations proceed while providers are still exercising rights explicitly granted under the Medicare statute.

This approach risks transforming fraud from a legal conclusion into a procedural shortcut, applied when spending patterns are unpopular or politically untenable, rather than when evidence supports intentional wrongdoing.

Due process delayed is due process denied

Medicare’s appeals system is designed to ensure fairness. Providers are entitled to:

Redetermination and reconsideration;
Administrative Law Judge (ALJ) review;
Judicial review where appropriate.

However, these protections are meaningful only if providers can survive long enough to use them.

When payment is suspended or recouped immediately—particularly in high-dollar service lines like skin substitutes—the appeals process becomes academic. A practice that cannot meet payroll or pay vendors cannot wait years for an ALJ decision, even if the ultimate ruling would favor the provider.

This reality has led many compliance professionals to question whether current enforcement practices effectively nullify statutory appeal rights, undermining the procedural safeguards Congress intended.

Medicare’s obligations—to providers and to patients

Medicare’s responsibilities extend beyond safeguarding the Trust Fund. Under federal law, the program has dual obligations:

To patients:

Ensure reasonable access to medically necessary care;
Avoid policies that drive providers out of underserved areas;
Support continuity of care for beneficiaries with complex medical needs.

When wound care programs close or curtail services due to audit pressure, patients lose access to advanced therapies that may prevent infection, hospitalization, or amputation.

To providers:

Apply coverage policies prospectively, not retroactively;
Enforce compliance in a manner that is proportional and evidence-based;
Respect due process rights throughout the audit and appeals continuum;
Distinguish clearly between policy disagreement and fraudulent conduct.

A system that penalizes good-faith providers for operating within existing coverage guidance—only to later revise payment policy—risks eroding trust and participation in the program itself.

A path forward

None of this is an argument against oversight. Fraud should be identified and addressed decisively. But indiscriminate enforcement harms the very goals Medicare seeks to achieve.

A more balanced approach would include:

Targeted audits focused on demonstrable outliers;
Suspension of recoupment while timely appeals are pending;
Clear, prospective guidance when payment policy changes;
Recognition of the unique financial exposure inherent in high-cost biological therapies.

Without such reforms, the current trajectory threatens to replace compliance with fear—and patient care with avoidance.

Conclusion

The story of skin substitute audits is no longer just about documentation or utilization. It is about whether Medicare’s enforcement mechanisms respect the rule of law, economic reality, and patient access.

When compliant practices close, when privileges are revoked mid-appeal, and when providers are financially destroyed before due process is complete, the system has failed—not just providers, but the beneficiaries it exists to serve.

APWCA: CALL TO ACTION: Oppose LCD as written! CONTACT LEGISLATORS TODAY - set to go into effect 4/13

Mon, 07 Apr 2025 16:49:23 GMT

Attention APWCA Members & Stakeholders:

CALL TO ACTION
We need your voice once again!

A peer-reviewed manuscript accepted to be published in the Journal of Wound Care The hidden costs of limiting access: clinical and economic risks of Medicare’s future effective cellular, acellular and matrix-like products (CAMPs) Local Coverage Determination - has become available and makes it clear: Medicare’s forthcoming LCD “Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers,” set to take effect April 13, 2025, will cause significant harm to the patients we serve.

This policy imposes a rigid cap of eight CAMP applications over a 16-week episode of care regardless of clinical response. As providers on the front lines of wound care, we know this will:

Worsen outcomes by increasing amputations, hospitalizations, and ED visits
Restrict access for the most vulnerable Medicare beneficiaries
Prevent physicians from exercising clinical judgment and practicing according to training
Ignore critical real-world evidence that proves the value of these treatments

While the Alliance of Wound Care Stakeholders recently voiced support for the LCD, the APWCA strongly disagrees with its current form and urges Congress to intervene. Our patients deserve better.

What You Can Do

We’re asking every APWCA member to email one or more of the Congressional contacts listed below and urge them to oppose this future effective LCD as written. Tell them it puts patients at risk, undermines medical practice, and widens disparities.

Personalize your message with:

Your experience treating hard-to-heal wounds
The impact of CAMPs on patient outcomes
Your concerns with a one-size-fits-all reimbursement cap

Legislators the APWCA Encourages Our Members to Contact - Organized by State

Alabama

Sen. Katie Britt – maggie_mcpherson@britt.senate.gov
Rep. Dale Strong – sophia.warner@mail.house.gov

California

Sen. Alex Padilla – john_chambliss@padilla.senate.gov

Colorado

Rep. Diana DeGette – david.steury@mail.house.gov

Florida

Rep. Neal Dunn – tucker.williamson@mail.house.gov
Rep. Gus Bilirakis – chris.jones@mail.house.gov
Rep. Sheila Cherfilus-McCormick – angelle.kwemo@mail.house.gov
Sen. Rick Scott – thomas_power@rickscott.senate.gov

Georgia

Rep. Rich McCormick – ayush.nallapally@mail.house.gov
Rep. Rich McCormick – lizzie.orr@mail.house.gov (additional contact)

Indiana

Sen. Jim Banks – Elle_Rogers@banks.senate.gov

Iowa

Rep. Mariannette Miller-Meeks – blake.thelander@mail.house.gov

Massachusetts

Rep. Jake Auchincloss – jess.wysocky@mail.house.gov

Minnesota

Rep. Pete Stauber – Sean.Sullivan@mail.house.gov
Rep. Tom Emmer – Liz.Stinebaugh@mail.house.gov

Missouri

Sen. Josh Hawley – Alex_Lawrence@hawley.senate.gov
Rep. Jason Smith – Ari.Kirsh@mail.house.gov

New York

Rep. Claudia Tenney – jack.boyd@mail.house.gov

North Carolina

Sen. Thom Tillis – garrett_daniel@tillis.senate.gov

Pennsylvania

Rep. Dan Meuser – joseph.arbie@mail.house.gov
Sen. John Fetterman – caroline_shaffer@fetterman.senate.gov
Rep. Mary Gay Scanlon – emily.kastenberg@mail.house.gov
Rep. Mike Kelly – alex.sells@mail.house.gov

Tennessee

Rep. Chuck Fleischmann – ian.merritt@mail.house.gov
Rep. Diana Harshbarger – peter.stein@mail.house.gov

Texas

Rep. Dan Crenshaw – colin.yokanovich@mail.house.gov
Rep. Nathaniel Moran – cruz.perez@mail.house.gov
Rep. Brandon Gill – graham.wise@mail.house.gov
Rep. Joaquin Castro – eyole.mbongo@mail.house.gov
Rep. Tony Gonzales – david.maestas@mail.house.gov
Rep. Beth Van Duyne – brayden.woods@mail.house.gov
Sen. John Cornyn – Jeffrey_Last@cornyn.senate.gov
Sen. Ted Cruz – maura_mcnamara@cruz.senate.gov
Rep. Marc Veasey – Sequoia.Ragland@mail.house.gov

Utah

Sen. Mike Lee – ryan_neuhaus@lee.senate.gov
Rep. Burgess Owens – cody.rowe@mail.house.gov

Download Article

Let Congress hear from the clinicians who know the risks best. Contact them today—before April 13.

Thank you for your dedication to evidence-based care and patient advocacy.

Sincerely,

The APWCA Leadership Team

www.apwca.org

Don't miss out! Register today for November 19th!

Tue, 29 Oct 2024 20:24:16 GMT

Don't miss out! Register today!

Wed, 02 Oct 2024 06:09:24 GMT

APWCA SIGs (Special Interest Groups)

Tue, 17 Sep 2024 14:14:59 GMT

In support of its ongoing efforts to enhance quality wound care through promoting inter-professional collaboration, the American Professional Wound Care Association (APWCA) is launching several Special Interest Groups (SIGs). We are inviting interested individuals to join and participate in these SIGs.

Limb Salvage/Preservation
Advanced Practice Practitioner (APP)
Coding, Compliance and Reimbursement
Mobile Wound Care/Post Acute Care
Nutrition (RD/RDN)
Physical Therapy (PT)
Podiatry (DPM)
Research

Please click here to express your interest.

Reimbursement Thursday Tidbits

Thu, 04 Jul 2024 12:00:00 GMT

Ever wish your MAC (Medicare Administrative Contractor) had a report card you could fill out? They do!

How Can I Give Feedback About My MAC?

· J5 - Wisconsin Physician Services

· J6 - National Government Services

· J8 - Wisconsin Physician Services

The links above send you to an email address specifically for provider and beneficiary feedback regarding their specific MACs. Send a shout out for a great interaction, or a wish list for interactions that may not meet your expectations.

Thursday Tip: ASP Drugs and Biologics Quarterly Update April 2024

Thu, 23 May 2024 15:30:00 GMT

Highlights from the ASP Quarterly Update

ASP Skin Substitute Codes added effective April 1, 2024

HCPCS	Descriptor
Q4184	Cellesta or duo per sq cm
Q4168	Amnio band, 1 mg
Q4188	Amnio armor 1 sq cm
Q4259	Celera per sq cm
Q4271	Complete ft per sq cm
Q4281	Barrera sl or dl per sq cm
Q4283	Biovance tri or 3l, sq cm
Q4310	Procenta, per 100 mg

Packaged Skin Substitute Codes added effective April 1, 2024

HCPCS	Descriptor	Low/High
Q4305	American Amnion ac tri layer per sq cm	Low
Q4306	American Amnion ac per sq cm	Low
Q4307	American amnion per sq cm	Low
Q4308	Sanopellis per sq cm	Low
Q4309	Via matrix	Low
Q4310	Procenta Per 100 mg	Low

2024 JWC Award Winners - APWCA Receives Silver Honor!

Tue, 27 Feb 2024 14:01:49 GMT

The 2024 JWC Award winners have now been announced!

The American Professional Wound Care Association (APWCA) is honored to be the recipient of the Silver Medal in the award category of Cellular, Acellular, and Matrix-like Products (CAMPs). This achievement was made possible thanks to the innovative research carried out by our exceptional APWCA members.

The JWC awards event, also known as 'The Olympics of Wound Care,' held its annual celebration of excellence in research on February 23rd. Nominees included individuals, teams, organizations, societies, companies, and charities whose work has made a significant impact over the previous year.

Congratulations to all the winners of the Journal of Wound Care Awards 2024. Your remarkable contributions to the field of advanced wound care have had a substantial impact on the lives of patients worldwide. You can find the complete list of winners at https://lnkd.in/gcbrJ7tp.

New in 2024 - APWCA Quarterly Webinar Series

Fri, 16 Feb 2024 14:59:36 GMT

The American Professional Wound Care Association (APWCA) is pleased to introduce our newest educational offering. Throughout 2024 there will be quarterly webinars sponsored by our generous sponsors each season. Please save the dates to join us for these informative online events:

SPRING: Wednesday, March 27, 2024
SUMMER: Wednesday, June 12, 2024
AUTUMN: Wednesday, September 11, 2024
WINTER: Wednesday, December 11, 2024

APWCA is pleased to announce that ARANZ Medical will be sponsoring our second webinar in the 2024 Quarterly Series!

In thanks to their generous sponsorship, this webinar is FREE TO ALL!

Highlights from Wound Week™ 2023

Mon, 01 Jan 2024 05:35:23 GMT

There were around 230 people onsite
Over 100 exhibitor representatives from:
34 different companies & other non-profits
18 different educational sessions presented by:
32 faculty presenters
A dozen companies participated in the Hands On Skills Workshop
2 Preconference Workshops and:
1 Post Conference Workshop were offered
The American Board of Wound Healing (ABWH) Exam was conducted
8 MAPWCA designations were awarded
There were nearly 60 poster presentations and:
A half-dozen oral abstracts were presented
27.75 AMA PRA Category 1 Credits™ for Physicians were available.
The same 27.75 ANCC were available to Nurses and CEPU to Dietitians

OOPS Update - CMS Issued Correction

Fri, 22 Dec 2023 16:50:00 GMT

Great News!!! CMS has issued a correction to the 2024 rates for outpatient hyperbaric oxygen therapy, reversing the 41.5% rate cut and increasing reimbursement from the 2023 rates. This would not have been possible without the advocacy of wound care providers, such as our APWCA members, as well as from the support of health care institutions, associations and stakeholders which included NetHealth, RestorixHealth, the Undersea & Hyperbaric Medical Society, The National Group, Epstiein Becker & Green, Healogics, the American Professional Wound Care Association, Dobson and Davanzo, The Alliance of Wound Care stakeholders, and the American Hospital Association. The CMS took extraordinary efforts to investigate this matter and to issue a correction prior to the end of the year.

The CY 2024 HBO₂ APC rate is $132.21. The APC rate increased $7.14 or 5.7% over the current year 2023.

You can find the updated payment files here for OPPS and here for ASCs.

May this make your Holiday Season a little Merrier.

SIGN ON TODAY - before December 8th!

Sat, 02 Dec 2023 22:05:57 GMT

Collective letter to the HSS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure

As you may be aware, Medicare reimbursement for hyperbaric oxygen (HBO2) therapy will be cut by 41.5% in 2024 if the Centers for Medicare and Medicaid (CMS) does not issue a correction to the Outpatient Prospective Payment System (OPPS) fine rule. These cuts will devastate patient access to HBO2 therapy across the United States.

Stakeholders are encouraged to sign this letter to the HSS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure to urge CMS to reverse these cuts and implement a 3% increase in the reimbursement that was initially noted in the 2024 OPPS proposed rule.

If you are inclined, please click this link to sign the letter here, along with the hundreds of other stakeholders.

Signatures due by Friday, December 8th!

CMS Change in Hyperbaric Oxygen Therapy

Wed, 29 Nov 2023 14:46:10 GMT

URGENT: CALL TO ACTION!

Comments to CMS must be submitted before December 10th

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized Medicare payment rates for Hospital Outpatient Prospective Payment System (OPPS) services for calendar year (CY) 2024.

In the final rule, the facility fee (APC rate) for hyperbaric oxygen therapy (G0277) was reduced to $73.64 per 30-minute segment from the current rate of $125.07 per 30-minute segment.

This is an unsustainable 41.5% decrease. CMS provided no warning or rationale regarding this unexpected change from the proposed rate of $134.51 (initially published in July 2023). Had this been published in the proposed rule, stakeholders would have had the opportunity to comment.

This reduced rate will go into effect on January 1, 2024, unless successfully challenged.

APWCA is urging all members to submit comments directly to CMS before December 10th.

New APWCA President, William H. Tettelbach, MD, FACP, FIDSA, FUHM, MAPWCA, CWSP, has provided a sample letter for reference and welcomes everyone to draw from his message if they like.

In commenting, please refer to file code CMS-1786-FC and submit in one of these ways:

Electronically. You may submit electronic comments on this regulation to https://www.regulations.gov. Once there enter CMS-1786-FC in the search box then follow the "Submit a comment" instructions.

By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services; Attention: CMS-1786-FC, P.O. Box 8010, Baltimore, MD 21244-8010.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1786-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

President's Message

(Past member) — Mon, 24 Jan 2022 01:53:06 GMT

A message from President Jeffrey Niezgoda.

APWCA Trivia Tuesday

(Past member) — Tue, 16 Nov 2021 21:20:01 GMT

From 5th edition of Wound Care Essentials Practice Principles

Using the International Skin Tear Advisory Panel (ISTAP) classification system, what type of skin tear is seen here on the upper extremity?

A. Type I
B. Type 2
C. Type 3
D. Type 4

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Wed, 10 Nov 2021 21:52:50 GMT

From 5th edition of Wound Care Essentials Practice Principles

Which of the following would be considered abnormal in the inflammatory phase of wound healing?

A. Redness
B. Bleeding
C. Pain
D. Swelling
E. Heat

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Tue, 26 Oct 2021 17:03:24 GMT

Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

Choose the false statement about scurvy;

A. A severe problem of sailors during the great explorations of the 15th and the 16th century
B. considered a disease of the past only
C. results in altered collagen synthesis causing blood-vessel fragility, bleeding gums, gingival hypertrophy
D. People living in social isolation and affected by psychiatric disorders (such as autism and anorexia nervosa), alcohol abuse disorders, or malabsorption (especially caused by digestive surgery) are at increased risk of scurvy
E. The most common laboratory finding of scurvy is normochromic normocytic anemia

More information on scurvy here.

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Wed, 20 Oct 2021 17:09:40 GMT

Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

A Martorell Ulcer is defined as:

A. Venous ulcer with malignant transformation
B. Traumatic ulcer with secondary infection by maggots
C. An atypical pressure ulcer that develops in paraplegic patients
D. Hypertensive leg ulcer, rare, progressive, painful, necrotic ulceration
E. Predominantly identified in the pediatric population

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Wed, 13 Oct 2021 18:08:33 GMT

Submitted by M. Mark Melin, MD, FACS, RPVI, FACCWS, FAPWCA

58 year old female with a history of metastatic renal cell to lungs and right femur (successful prior surgical management 2 year prior) presents with a 3 month history of new right thigh wounds.

The most appropriate next step:

A. Apply amniotic graft
B. Levine culture and start oral antibiotics
C. Apply neomycin
D. Obtain Moh’s surgical consult
E. Biopsy wounds

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Advocacy Update

(Past member) — Wed, 13 Oct 2021 15:29:43 GMT

Your APWCA leadership feels the Medicare National Correct Coding Initiative (NCCI) procedure-to-procedure edit that bundles skin substitute / CTP application with application of a Unna boot is inappropriate. As such, APWCA collaborated with the Alliance of Wound Care Stakeholders to submit a letter to the NCCI Contractor asking that this edit be deleted and explaining why this edit should be deleted. Read more here: https://www.woundcarestakeholders.org/advocacy/submitted-comments/letter-to-the-national-correct-coding-initiative-ncci-contractor

APWCA Trivia Tuesday

(Past member) — Tue, 05 Oct 2021 17:06:52 GMT

Today's #TriviaTuesday was submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

Based on this wound, which instrument should be selected? Swipe for options.

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

Last Week for vTail - Register Now!

(Past member) — Thu, 30 Sep 2021 19:28:38 GMT

Have you tried the new app for wound clinicians? vTail was designed by Wound Care Industry Experts for Wound Care Clinicians. This app provides more efficient communication between clinicians and wound care manufacturing companies. The added bonus? For every APWCA registration, vTail will donate $30 to the APWCA. Register in the app today! https://join.vtail.co/apwca

APWCA Trivia Tuesday

(Past member) — Tue, 28 Sep 2021 16:28:31 GMT

Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

All of the following are appropriate patients for hyperbaric oxygen therapy referral except:

A. 78-year-old male with hematuria 3 years post radiation for prostate cancer
B. 47-year-old female with non-healing VLU of 3 months duration and acute cellulitis
C. 65-year-old male with T2 diabetes and chronic midfoot ulceration with + probe to bone
D. 50-year female with cyanosis of a TRAM flap 2 days post-op

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

"The Frank & Lizzie Show" New Episode

(Past member) — Thu, 23 Sep 2021 19:34:29 GMT

On this episode, Frank & Lizzie sit down with Dr. Marc "Dutch" Matthews from the Arizona Burn Center to discuss his experience with Vashe, a hypochlorous acid preserved wound cleanser solution. Dutch explains how this pH skin neutral wound solution has helped changed his practice for the better, but more importantly the lives of his patients.

Click here to watch!

APWCA Trivia Tuesday

(Past member) — Tue, 21 Sep 2021 14:53:31 GMT

Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

A positive Stemmer sign is diagnostic for:

A. Osteomyelitis
B. Venous Hypertension
C. Lymphedema
D. Lipedema
E. Melanoma

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Tue, 14 Sep 2021 15:36:19 GMT

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

This demonstrates which wound characteristic?
A. Tunneling
B. Undermining
C. Depth
D. Epiboly
E. Necrotic Margin

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA + vTail: Download Today!

(Past member) — Thu, 09 Sep 2021 18:12:49 GMT

The APWCA is excited to share our partnership with vTail! The vTail application was designed by Wound Care Industry Experts specifically for Wound Care Clinicians like ourselves. The app’s main purpose is to provide more efficient communications between clinicians and wound care manufacturing companies. For every person that downloads the app - vTail will donate $25 to the APWCA. Downloading this app will help APWCA to continue to offer education and outreach to members and bolster the offerings at Wound Week in Philadelphia next February! Use the QR code or below or this link to download the app today. https://join.vtail.co/apwca.

APWCA Trivia Tuesday

(Past member) — Tue, 07 Sep 2021 17:42:19 GMT

Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

According to the TIME principle of wound bed preparation, what barrier to wound healing does M represent?

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

APWCA Trivia Tuesday

(Past member) — Tue, 31 Aug 2021 15:02:51 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS. Image provided by Selvam J. Watts from Chennai, India.

Which is true regarding darker skin tones?

A. People with darker skin tones develop higher stage pressure ulcers.
B. Consider variances in skin tone color when assessing skin.
C. The perceptions of people with dark skin tones are under-examined.
D. Current skin assessment protocols are less effective for people who have darker skin tones
E. All the above

Check your answer at apwca.org/trivia-tuesdays every Wednesday!

Wound Week 2022

(Past member) — Thu, 26 Aug 2021 14:54:07 GMT

Wound Week 2022 is happening February 24-27 at the Loews Philadelphia Hotel! To be a sponsor or exhibitor at the event (or for more information) go to https://www.apwca.org/ww22exhibitors-sponsors or e-mail exhibits@apwca.org today.

APWCA Trivia Tuesday

(Past member) — Tue, 24 Aug 2021 14:36:07 GMT

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

The BEST description of the wound base is:

A. Filiform Fibrin
B. Edematous Carboxymethylcellulose
C. Free Range Myiasis

D. Ascariasis Diabetica

Check your answer at apwca.org/trivia-tuesdays.

Wound Week 2022

(Past member) — Thu, 19 Aug 2021 15:45:11 GMT

The call for abstracts portal is open for Wound Week 2022! The submission deadline is Sunday, October 31 at 11:59pm (CST) and author notification of acceptance or rejection will occur by email to the presenting authors on Monday, November 15, 2021, at 11:59 pm (CST).

Click here for more information.

APWCA Trivia Tuesday

(Past member) — Wed, 18 Aug 2021 14:36:57 GMT

Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA.

In the Proliferative stage of acute wound healing, tissue regeneration relies primarily on the activity of this cell:

A. Macrophage
B. Fibroblast
C. Neutrophil
D. Protease

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Tue, 10 Aug 2021 19:05:47 GMT

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

This presentation should raise suspicion for which of the following?

A.Preauricular cellulitis
B.Anterior Extension of Ulcerative Mastoiditis
C.Atypical Ulceration
D.Fulminant Otitis Externa

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Tue, 03 Aug 2021 19:34:55 GMT

Submitted by Mark Melin, MD, FACS, RPVI, FACCWS.

Micronized Purified Flavonoid Fraction (MPFF) are beneficial in treating venous leg ulcerations due to:

A. Improvement of lymphatic tone
B. Improved red blood cell deformability
C. Decreased ICAM and VCAM biomarkers
D. All of the above
E. A and C

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Tue, 27 Jul 2021 16:15:31 GMT

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS.

The most likely etiology of this presentation is?

A. Acute Venous Congestion
B. Infected Diabetic Foot Ulcer
C. Acute Traumatic Hemorrhage
D. Acute Arterial Ischemia
E. COVID Complications

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Wed, 21 Jul 2021 19:11:47 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA.

What type of factors determine what method of debridement is most effective?

A. Wound presentation and evaluation
B. Economic factors
C. Patient history and examination
D. Previous wound history
E. A, B, D
F. All the above

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Tue, 13 Jul 2021 14:54:25 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Is this an adequate ulcer debridement?

A. Yes
B. No, only periwound callus was removed and there is still non-viable tissue in the wound bed

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

(Past member) — Wed, 07 Jul 2021 15:30:32 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA.

Which statement is true of substance abusers and injection-related abscess, sore or open wounds?

A. Substance abusers will develop an injection-related wound within a one-year period.
B. Education about substance abuse, skin issues, and wound care is vital in helping the user and healthcare staff.
C. Compassion is lacking for this wound population.
D. All the above.

APWCA Trivia Tuesday

Tue, 29 Jun 2021 18:50:05 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

When applying a total contact cast, which of the following is true:

A. The foot should be perpendicular to the leg
B. The foot should be plantarflexed on the leg
C. The cast should come above the fibular head
D. The cast should be as tight as possible

Check your answer at apwca.org/trivia-tuesdays.

NEW! APWCA/ASWC Webcast Series Released

Thu, 24 Jun 2021 20:15:41 GMT

The American Professional Wound Care Association (APWCA) is proud to announce a NEW webcast series in partnership with Advances in Skin & Wound Care (ASWC).

In the first webcast, Elizabeth Faust, MSN, CRNP, CSWS, CWOCN-AP, DAPWCA, of the American Professional Wound Care Association interviews three leaders of the World Council of Enterostomal Therapists (WCET) on their recent article about the International Ostomy Guideline 2020. The discussion includes the inception of the guideline, the extensive work that went into creating a guideline suitable for resource-limited and resource-abundant countries, key takeaways for various members of the healthcare team, and the importance of preoperative education and stoma site marking. Be sure to watch all the way to the end for a big announcement from the WCET.

TONIGHT! APWCA 20th Anniversary Celebration

Wed, 23 Jun 2021 14:45:35 GMT

The APWCA is Celebrating 20 Years of Advancing Wound Care - TONIGHT!

You are invited to help us celebrate the 20th anniversary of the American Professional Wound Care Association at a virtual party!

When? TONIGHT! Wednesday, June 23, 2021 at 7:00 PM ET

Where? Zoom Meetings – Please register below to receive the link to join.

Members and non-members alike are invited to join us. You can:

Meet the current APWCA leaders and management team
Learn how the APWCA advocates for wound care practitioners
Hear about member benefits
Find out more about the APWCA 2022 Annual Meeting
Discover opportunities to get involved
Win prizes – including free registration to the APWCA 2022 Annual Meeting!

Register at no cost using the link below. After registering, you will receive a confirmation email containing information about joining the event.

Register here: https://zoom.us/meeting/register/tJMsdeirrT8oHNNCSaIIJjKulVv59CjMiltz

APWCA Advocacy Update

Wed, 23 Jun 2021 14:45:14 GMT

The APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to the Centers for Medicare and Medicaid Services regarding Medicare Coverage of Innovative Technology and the Definition of “Reasonable and Necessary”. In this meeting we recommended that the Medicare Coverage of Innovative Technology rule be implemented immediately.

APWCA Trivia Tuesday

Tue, 22 Jun 2021 16:23:22 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient already has an amputation of their hallux Which of the following is the most important for this patient right now?

A. Perform debridement
B. Perform non-invasive vascular studies
C. X-ray
D. Test for COVID-19

Check your answer at apwca.org/trivia-tuesdays.

NEW "The Frank & Lizzie Show" Episode

Thu, 17 Jun 2021 20:21:15 GMT

APWCA Trivia Tuesday

Tue, 15 Jun 2021 20:49:47 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient already has an amputation of their hallux and 1st metatarsal head. Which surgical procedure is now most appropriate?

A. Removal of 2nd metatarsal head
B. Removal of 3rd metatarsal head
C. Removal of 4th metatarsal head
D. Removal of all remaining metatarsal heads

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Thu, 10 Jun 2021 17:15:21 GMT

The APWCA collaborated with the Alliance of Wound Care Stakeholders to meet with the Centers for Medicare and Medicaid Services on April 9, 2021 regarding the methodology for CTP reimbursement in the hospital outpatient department and to advocate for the interests of APWCA members and our patients.

APWCA Trivia Tuesday

Tue, 08 Jun 2021 16:33:29 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What type of wound presents with characteristics of a scale-like skin that resembles a crocodile hide, and can often result in amputation and death?

A. Russian Magic NF
B. Krokodil Skin Induced Necrosis
C. Desomorphine Fasciitis
D. Croc-NSFI

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 01 Jun 2021 18:45:46 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What factors should be considered when selecting a wound dressing?

A. Dressing technology
B. Size
C. Absorbency
D. Bacteriostatic properties
E. Multifunctionality
F. Anti-biofilm properties
G. A, B, D
H. B, D
I. All the above

Check your answer at apwca.org/trivia-tuesdays.

Join Us for the APWCA 20th Anniversary Party!

Thu, 27 May 2021 17:25:08 GMT

The APWCA is Celebrating 20 Years of Advancing Wound Care

You are invited to help us celebrate the 20th anniversary of the American Professional Wound Care Association at a virtual party!

When? Wednesday, June 23, 2021 at 7:00 PM ET

Where? Zoom Meetings – Please register below to receive the link to join.

Members and non-members alike are invited to join us. You can:

Meet the current APWCA leaders and management team
Learn how the APWCA advocates for wound care practitioners
Hear about member benefits
Find out more about the APWCA 2022 Annual Meeting
Discover opportunities to get involved
Win prizes – including free registration to the APWCA 2022 Annual Meeting!

Register at no cost using the link below. After registering, you will receive a confirmation email containing information about joining the event.

Register here: https://zoom.us/meeting/register/tJMsdeirrT8oHNNCSaIIJjKulVv59CjMiltz

APWCA Trivia Tuesday

Tue, 25 May 2021 17:42:36 GMT

Submitted by Elizabeth Faust, MSN, CRNP, CSWS, CWOCN-AP, DAPWCA

A skilled provider should always debride necrotic tissue.

A. True
B. False

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Wed, 19 May 2021 19:09:23 GMT

Submitted by Charles A. Andersen, MD, FACS, MAPWCA

A 62 year old diabetic male presents to the hospital wound care clinic with pain in his right foot and wounds on his toes. The patient states that he has been having pain in his calf with ambulation for the past 2 years. His pain initially occurred after ambulating two blocks and was relieved by rest. Over the past 6 months his walking distance has gradually decreased, now the patient states he can only walk a few feet and has pain at night relieved by hanging his foot over the side of the bed. He now has wounds involving his toes.

Part 5: The patient should have an arteriogram performed with the goal to attempt revascularization.

A. True
B. False

Part 6: Revascularization is indicated to facilitate a TMA vs. a BKA amputation.

A. True
B. False

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 11 May 2021 18:39:04 GMT

Submitted by Charles A. Andersen, MD, FACS, MAPWCA

Part 3: The pain he is experiencing at night is neuropathy.

A. True
B. False

Part 4: The gangrenous toes are a result of “Diabetic Small Vessel Disease”.

A. True
B. False

Check your answer at apwca.org/trivia-tuesdays.

NEW "The Frank & Lizzie Show" Episode

Tue, 11 May 2021 15:00:49 GMT

APWCA Trivia Tuesday

Wed, 05 May 2021 14:26:35 GMT

Submitted by Charles A. Andersen, MD, FACS, MAPWCA

Part 1: Many patients especially patients with diabetes have very significant PAD have no symptoms.

A. True
B. False

Part 2: Because the patient has diabetes he probably has small vessel disease and should be taken to the OR for a BK Amputation

A. True
B. False

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 28 Apr 2021 15:40:09 GMT

Your APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to the Centers for Medicare and Medicaid Services (CMS) in support of the National Coverage Decision (NCD)for Autologous Blood-Derived Products for Chronic Non-Healing Wounds.

APWCA Trivia Tuesday

Tue, 27 Apr 2021 14:30:34 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

Which type of debridement methods can be used in biofilm management?

A. BEAMS
B. Conservative sharp debridement
C. Autolysis
D. All the above

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 20 Apr 2021 15:52:24 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

A chronic wound can be defined as:

A. A wound with slow progression that is interrupted by only intrinsic factors.
B. A wound that has a slow progression through the healing phases, delayed or stalled healing due to intrinsic and extrinsic factors that impact on the individual and their wound.
C. Chronic non-healing wounds are wounds that have failed to progress through a timely sequential of repairment.

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 13 Apr 2021 16:26:33 GMT

Submitted by Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS

This open wound shows granulation tissue developing on exposed bone. What is BEST explanation for this physiology?

A. Indicates the presence of malignancy
B. Suggests active osteomyelitis
C. Occurs only with an intact viable periosteum
D. Represents a genetic aberranc
E. Likely due to prior grafting with CTP

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 06 Apr 2021 15:47:32 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What types of skin manifestations have been reported in frontline workers due to wearing PPE for extended periods of time?

A. Acne, rash
B. Aggravation of dermatoses
C. Skin breakdown nasal bridge, ears, and face
D. All the above

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 30 Mar 2021 16:27:20 GMT

Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA

Patient is a 90-year-old female with a non-contributory PMH who initially presented to the outpatient wound department with a trauma-induced right anterior leg wound in January of 2017. Non-invasive arterial testing demonstrated and right ABI of 1.07, a TBI of .48 and mild dampening of the pulse volume tracings. The wound required six months of compression and local care, including cellular and/or tissue-based products (CTP) to heal. The patient returned two months after initial discharge complaining that the wound appeared healed but was still painful and somewhat pruritic. Venous reflux study was negative and she was referred to her PCP for follow-up. The patient again returned to the outpatient wound department in August of 2020 after suffering mild trauma to the same location as the previously healed wound. After four months of care the wound appeared healed only to have the patient return one month later in January of 2021 stating the wound had gradually reappeared.

A. Compression therapy
B. Repeat non-invasive arterial studies
C. Wound biopsy
D. Debridement and CTP application(s)

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 24 Mar 2021 14:37:00 GMT

https://www.woundcarestakeholders.org/images/October_2020_Alliance_Comments_to_HOPPS_Final.pdf

APWCA Trivia Tuesday

Tue, 23 Mar 2021 15:33:22 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

Wounds connected with infection can include:

A. Necrotizing Fasciitis
B. Fournier’s gangrene
C. Actinomycosis
D. Cellulitis
E. All the above

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 16 Mar 2021 16:09:02 GMT

Submitted by Richard E. Schlanger, MD, PhD, FAPWCA, CWSP, FACS

This is a 58-year-old gentleman who is a truck driver by trade. He reported to his local emergency room because of general malaise, joint pain and a swollen left shoulder. According to the admission record, there were no unusual findings including no injuries, cuts and bruises. Over the next 12 hours the patient declined fairly quickly becoming hypotensive, tachycardic and required pressor support. He was transported by air to a medical center and taken emergently to the OR because of skin changes and loss of pulse and sensation. At the time of surgery most of the distal vessels were thrombosed and the muscle look like it was “cooked".

The most likely diagnosis is:

A. Septic emboli
B. Soft tissue necrosis
C. Compartment syndrome
D. Rattlesnake bite

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 10 Mar 2021 17:12:17 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comment to CMS’ Proposed CY2021 Hospital Outpatient Prospective Payment System. In these comments, we supported inclusion of synthetic CTPs in the definition of “skin substitutes” but expressed significant concerns with the Agency’s proposed establishment of the code C1849 (“Skin substitute, synthetic, resorbable skin substitute per square centimeter) to define an entire class of non- branded products and its placement in the OPPS high cost payment package. The Alliance reviewed the impacts of this code as proposed and submitted a number of alternative recommendations.

https://www.woundcarestakeholders.org/images/October_2020_Alliance_Comments_to_HOPPS_Final.pdf

APWCA Trivia Tuesday

Tue, 09 Mar 2021 19:22:10 GMT

Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with wounds should consume a food high in vitamin C every day. Which food is best to meet this goal?

A. Fresh orange
B. Bowl of oatmeal
C. Grilled skinless chicken breast
D. Bran muffin

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Tue, 02 Mar 2021 15:13:04 GMT

Submitted by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA

What type of preventional goals should be considered in patients at risk for pressure injury wounds?

A. Risk management
B. Nutritional management
C. Medical devices
D. Interventional methods
E. Skin management
F. All the above
G. 1, 4, 5

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Wed, 24 Feb 2021 20:00:42 GMT

Submitted by Frank Aviles Jr, PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, DAPWCA, MLD/CDT Instr

70 year old patient presents to your clinic with left lower extremity swelling. Hx of prolonged standing, fall sustained 4 months prior, and limited mobility.

Based on your assessment, which treatment intervention is recommended:

A. Diuretics
B. Compression
C. Pumps
D. Complete Decongestive Therapy
E. Venous ablation

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 24 Feb 2021 19:50:02 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comment to CMS’ Proposed CY2021 Hospital Outpatient Prospective Payment System. In these comments, we encouraged use of the “Cellular and/or Tissue Based Products for Wounds “(CTPs) terminology in policymaking, in place the currently used “skin substitutes.”

https://www.woundcarestakeholders.org/images/October_2020_Alliance_Comments_to_HOPPS_Final.pdf

APWCA Advocacy Update

Wed, 24 Feb 2021 19:48:58 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit a letter to the United States Pharmacopeia's (USP) advocating the need for a wound care subcategory in the USP Medicare Model Guidelines. Establishment of this subcategory would help to distinguish the chronic wound products from other subcategories - which in turn would better protect coverage of wound care products under Medicare Part D.

https://www.woundcarestakeholders.org/images/Oct_13_2020_Alliance_of_Wound_Care_Stakeholders_Comments_Regarding_the_USP_DC_2021.pdf

APWCA Trivia Tuesday

Tue, 16 Feb 2021 17:50:13 GMT

Submitted by Frank Aviles Jr, PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, DAPWCA, MLD/CDT Instr

70 year old patient presents to your clinic with left lower extremity swelling. Hx of prolonged standing, fall sustained 4 months prior, and limited mobility.

Based on the presentation, what could be the cause of the swelling:

A. Cardiac related condition
B. Chronic venous insufficiency
C. Primary lymphedema
D. Secondary lymphedema
E. Lipedema

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Wed, 10 Feb 2021 19:40:33 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

This patient presents with color changes to their toes after extended cold exposure. What is the most appropriate treatment?

A. Femoral - popliteal artery bypass
B. Forefoot amputation
C. Sharp debridement
D. Hyperbaric oxygen

Check your answer at apwca.org/trivia-tuesdays.

Pressure Injury Survey

Tue, 09 Feb 2021 19:06:41 GMT

Those who took the pressure injury survey on the 5th or 6th are asked to retake it due to an unforeseen error in demographics. If you would like to retake it you will have to do so with a DIFFERENT EMAIL address. Only one take is given per email.

Retake the survey at: https://singuser2f928039.iad1.qualtrics.com/jfe/form/SV_6zYWTJlECYrlNxH

APWCA Trivia Tuesday

Wed, 03 Feb 2021 20:25:05 GMT

Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

A patient is diagnosed with heart failure and a wound and must follow a specific diet. Which spices are okay for the patient to use daily?

A. Onion salt and garlic powder
B. Ginger and bay leaves
C. Sea salt and pepper
D. Garlic salt and nutmeg

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 27 Jan 2021 21:10:58 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to CMS urging the Agency to withdraw its proposed rule “Securing Updated and Necessary Statutory Evaluations Timely” (SUNSET). The Alliance expressed concern that the SUNSET proposal would place significant new administrative burdens on HHS Agencies at a time when resources and time must be allocated to addressing the Covid-19 Public Health Emergency (PHE) and noted many unintended consequences that could result.

https://www.woundcarestakeholders.org/images/Dec_2020_Alliance_Comments_Proposed_SUNSET_regulation_FINAL.pdf

APWCA Trivia Tuesday

Tue, 26 Jan 2021 22:53:17 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

What is the most appropriate surgical procedure to offload this 5th toe #ulcer?

A. Remove the head of the 5th toe proximal phalanx
B. Remove the 5th metatarsal head
C. Flexor tenotomy
D. Extensor tenotomy

Check your answer at apwca.org/trivia-tuesdays.

APWCA Trivia Tuesday

Wed, 20 Jan 2021 22:14:36 GMT

Submitted by Nancy Collins, PhD, RDN, LD, NWCC, FAND

All of the following are needed for strong bones except:

A. Calcium
B. Magnesium
C. Thiamine
D. Vitamin D

Check your answer at apwca.org/trivia-tuesdays.

APWCA Advocacy Update

Wed, 13 Jan 2021 21:58:50 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to CMS’ proposed rule regarding Medicare Coverage of Innovative Technology and their new definition of “reasonable and necessary.” As part of these comments, the recommendation was made that CMS issue a separate proposed rule regarding the definition of reasonable and necessary in which they provide significantly more information.

https://www.woundcarestakeholders.org/images/November_2_2020_Alliance_Comments_MCIT_Final.pdf

APWCA Trivia Tuesday

Wed, 06 Jan 2021 22:22:13 GMT

Submitted by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

What is the most appropriate modality to offload this plantar 1st metatarsal head diabetic foot ulcer?

A. Surgical shoe
B. Total contact cast
C. Forefoot wedge shoe

D. Rearfoot wedge shoe

Check your answer at apwca.org/trivia-tuesdays.

APWCA is waiving past dues for lapsed members!

Thu, 17 Dec 2020 17:20:11 GMT

Join or renew your membership today to take advantage of all the member benefits, including:

Use of Professional Member Credentials — FAPWCA, DAPWCA, MAPWCA
Complimentary monthly subscription to Advances in Skin and Wound Care peer reviewed journal
Complimentary annual subscription to WoundSource
Weekly Wound Care Report eNewsletter — Keep up with latest wound care research, products, and industry news
Access to wound care experts for clinical and reimbursement information — Medical Advisory Board
Wound Care Government Representation/Wound Care Alliance Stakeholders
Conference Discounts – including Wound Week
Professional Society Collaboration

APWCA Advocacy Update

Thu, 17 Dec 2020 17:18:52 GMT

Your APWCA collaborated with the Alliance of Wound Care Stakeholders on a comment letter to the Centers for Medicare and Medicaid Services (CMS) in response to the 2021 Proposed Physician Fee schedule. In this letter we asked CMS to maintain the patient’s home as an “ originating site” option for telemedicine after the COVID-19 Public Health Emergency is over.

APWCA Advocacy Update

Wed, 25 Nov 2020 17:39:54 GMT

Your APWCA collaborated with the Alliance of Wound Care Stakeholders on a comment letter to the Centers for Medicare and Medicaid Services (CMS) in response to the 2021 Proposed Physician Fee schedule. In this letter we asked CMS to create a MIPS Value Pathway (MVPs) for Chronic Wound Management and utilize the QCDR measures which already exist for wound care.

Join a Special Interest Group!

Tue, 24 Nov 2020 18:12:25 GMT

The American Professional Wound Care Association is proud to announce new specialty interest groups. Please see the categories below led by APWCA Board Members:

Advanced Practice Providers led by Elizabeth Faust, MSN, CRNP, CWS, CWOCN-AP, DAPWCA
Limb Preservation led by Charles A. Andersen, MD, FACS, MAPWCA
Nutrition led by Nancy Collins, PhD, RDN, LD, NWCC, FAND, DAPWCA
Physical Therapy led by Frank Aviles Jr, PT, CWS, FACCWS, CLT, ALM, AWCC, DAPWCA, MLD/CDT Instr
Research led by Sandeep Gopalakrishnan, MS, PhD, DAPWCA

To join a specialty interest group, log in to your APWCA profile at apwca.org to edit your profile. Find the field labeled 'Special Interest Group'. Here you can choose which special interest group(s) you would like to join. You may join more than one special interest group.

Once logged in to the APWCA website, members can view all specialty group discussion boards. Go under the 'Member Portal' tab and click on 'Specialty Interest Groups'. From here you will find the links to each discussion board. You must select your specialty interest group(s) in your APWCA member profile to post in your specialty group(s).

APWCA Advocacy Update

Tue, 03 Nov 2020 16:26:53 GMT

Your APWCA collaborated with the Alliance of Wound Care Stakeholders on a comment letter to the Centers for Medicare and Medicaid Services (CMS) in response to the 2021 Proposed Physician Fee schedule. In this letter we asked CMS to apply the new, increased values of certain E/M codes to the values of global procedures.

APWCA Advocacy Update

Thu, 08 Oct 2020 16:06:31 GMT

Your APWCA collaborated with the Alliance of Wound Care Stakeholders on a comment letter to the Centers for Medicare and Medicaid Services (CMS) in response to the 2021 Proposed Physician Fee schedule. In this letter we opposed proposed cuts in reimbursement to certain surgical procedures and physical therapy services.

APWCA Advocacy Update

Mon, 14 Sep 2020 17:18:57 GMT

The APWCA collaborated with the Alliance of Wound Care Stakeholders in submitting a letter to the Centers for Medicare and Medicaid Services (CMS) DME Contractors disagreeing with preliminary determination to not cover topical oxygen therapy for would healing, urging the DME MACs to consider the available evidence on a per wound-type basis and make wound type-specific coverage determinations.

APWCA Advocacy Update

Fri, 28 Aug 2020 16:32:08 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders in submitting a letter to the Centers for Medicare and Medicaid Services (CMS) flagging the differing interpretations of the three payment methodologies that CMS has been considering in HOPD / ASC proposed rule making regarding payment for skin substitutes / CTPs. We specified our understanding of each methodology and outlined issues to consider for each methodology. This was all done with advocacy for our members and our patients in mind.

APWCA Advocacy Update

Mon, 17 Aug 2020 14:12:31 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to the Centers for Medicare and Medicaid Services (CMS) that requested the following waivers be initiated during the COVID-19 Public Health Emergency:

Relax documentation needed for advanced wound products prior to initiation of these therapies
Relax the definition of a “qualifying wound” as it pertains to coverage for Surgical Dressings
Allow an overlap of coverage within the two separate benefits of Part A and Part B
Allow reimbursement for DME Removable Cast Walkers (HCPCS L4361 and L4387) for patients with diabetic foot ulcers when other methods of offloading are not feasible

APWCA Advocacy Update

Tue, 21 Jul 2020 11:52:39 GMT

APWCA collaborated with the Alliance of Wound Care Stakeholders to submit comments to the Centers for Medicare and Medicaid Services (CMS) that supported the following COVID-19 provisions:

Reimbursement for telehealth at the non-facility rate, as appropriate, when submitted with a 95 modifier and the place of service corresponding to where that service would have been provided had the service been rendered in person
Expansion of telehealth services generally
Choice of medical decision making or total time when determining the level of office/outpatient E/M furnished via telehealth
Ability to provide virtual check-ins, telephone E/Ms, and e-visits to both new and established patients;
Ability to provide direct supervision via real time interactive audio and video technology; and
Coverage and payment for telephone evaluation and management services

APWCA Advocacy Update

Mon, 06 Jul 2020 13:43:18 GMT

APWCA representation participated in a Noridian Healthcare Solutions Contractor Advisory Committee meeting regarding development of their “Wound Care and Skin Substitutes” Local Coverage Determination / Local Coverage Article. Noridian does not currently have an active “Wound Care and Skin Substitutes” Local Coverage Determination / Local Coverage Article, and APWCA was present at this meeting to protect the interests of our members and our patients as these policies are developed. Noridian Part B administers Medicare services in California, Nevada, Oregon, Washington, Idaho, Utah, Arizona, Montana, Wyoming, North Dakota, South Dakota, Alaska, and Hawaii.

Watch Now! Prevention of Mask Related Skin Damage

Thu, 25 Jun 2020 19:23:48 GMT

APWCA Members Minute with Elizabeth Faust

APWCA Advocacy Update

Wed, 01 Apr 2020 15:41:46 GMT

Over the last month, your APWCA leaders have collaborated with the Alliance of Wound Stakeholders and other organizations on communication with the Centers for Medicare and Medicaid Services (CMS) regarding payment methodology for cellular and/or tissue based products for wounds (CTPs) provided in Hospital Outpatient Departments and Ambulatory Surgery Centers. CMS has expressed an interest in changing the current bundled payment mythology for these services and our communication has focused on protecting the interests of our members and our patients.

Alliance of Wound Care Stakeholders Update

Wed, 22 Jan 2020 15:23:08 GMT

The APWCA contributed to a successful effort to reverse a dangerous policy that limited ulcer debridements. Wisconsin Physician Services (WPS) is a Medicare Contractor responsible for six states. They released a Local Coverage Determination (LCD) for ulcer debridement that did not include stage II pressure ulcers or diabetic foot ulcers in its list of covered conditions. The APWCA is a proud member of the Alliance of Wound Care Stakeholders and contributed to their fight against this policy. After many letters and in-person testimony, WPS revised this LCD to include stage II pressure ulcers and diabetic foot ulcers in the list of covered conditions. Advocacy for both you and your patients is part of your APWCA member benefits!

Alliance of Wound Care Stakeholders Update - Quarter 2

Fri, 05 Jul 2019 19:31:50 GMT

Your APWCA recently collaborated with the Alliance of Wound Care Stakeholders and others in an effort to combat an unfair policy from WPS Government Health Administrators. WPS is the Part B Medicare Administrative Contractor (MAC) for Nebraska, Kansas, Iowa, Missouri, Michigan, and Indiana. WPS released the Local Coverage Article, "A55909: Wound Care Coding Companion for Wound Care L37228”. This article excluded coverage for CPT 97597 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less) when the depth of the ulcer debrided is limited to breakdown of skin. A letter was written to WPS challenging this exclusion and requesting that WPS provide peer-reviewed literature that supports this exclusion.

APWCA contributes to effort to thwart unfair skin substitute coverage policy

Tue, 25 Jun 2019 12:00:00 GMT

APWCA contributed to the effort by the Alliance of Would Care Stakeholders over the last couple months to oppose Noridian’s new policy article governing use of skin substitutes. This article dictates coverage in the absence of a Local Coverage Determination and limits the indication of skin substitute use.

See the full article here.

APWCA contributes to effort to oppose United Healthcare’s limits on skin substitute use

Tue, 25 Jun 2019 12:00:00 GMT

This year APWCA contributed to the effort by the Alliance of Wound Care Stakeholders to oppose United Healthcare’s policy which limits the use of skin substitute products.

See the full article and read United Healthcare’s Response here.

APWCA Submits Comments on 2019 Part B Physician Fee Schedule Proposed Rule

Tue, 04 Jun 2019 12:00:00 GMT

Last year, on behalf of its members, the APWCA submitted a comment letter to CMS regarding the 2019 Medicare Part B Physician Fee Schedule. A copy of the full letter is attached below.

The APWCA argued against:

Consolidation of payment for levels 2-5 office and other outpatient E/M services
New E/M codes for “podiatry services”
The application of the MPPR concept to E/M coding
The raise to 30 of the score needed to avoid a MIPS penalty
Change to the small practice MIPS bonus

The APWCA commented on some specific RVUs and responded to their request for information regarding postoperative visits following 10 day global procedures.

Final APWCA 19 MPFS Comment Letter.pdf

Alliance of Wound Care Stakeholders Update - June 3rd, 2019

Mon, 03 Jun 2019 12:00:00 GMT

The APWCA contributed to the comments recently contributed by the Alliance of Wound Care Stakeholders to the Physician- Focused Payment Model Technical Advisory Committee (PTAC) regarding a proposal regarding “Bundled Payment for All Inclusive Outpatient Wound Care Services in Non Hospital Based Setting” that was submitted by Seha Medical. The comment letter expressed concern regarding one all-inclusive payment as it would negatively affect the care that providers would be able to deliver. The fear that one all-inclusive payment could also limit the care that patients receive was shared. The letter pointed out that the proposal did not require the provider to adhere to a particular care model, follow a particular set of national guidelines or established protocols in order to achieve the desired cost and utilization objectives. Furthermore, the point was made that chronic ulcer patients often have multiple co-morbidities requiring treatment to optimize ulcer care, and this proposal did not account for that. The Alliance letter concluded with a request to not implement the proposal as written and an offer to serve as a resource to the PTAC if it wants to consider a bundled payment for wound care services.

APWCA comments to the CMS regarding the electronic clinical quality measure titles, "Hospital Harm - Hospital - Acquired Pressure Injury"

Wed, 08 May 2019 14:22:26 GMT

Last year, on behalf of its members, the APWCA submitted comments to CMS regarding the electronic clinical quality measure titled, “Hospital Harm – Hospital- Acquired Pressure Injury.” We expressed concern that the denominator had no exclusions and suggested that certain exclusions be included. A cope of that letter is below:

The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting excellence in wound healing and patient advocacy.

On behalf of the APWCA we appreciate the opportunity to comment on the electronic clinical quality measure titled, “Hospital Harm – Hospital- Acquired Pressure Injury.” We are concerned that the denominator has no exclusions. All hospitalized patients ages 18 years and older are included. We agree that pressure ulcers should be avoided in all patients when possible, but contend that all pressure injuries are not preventable. We agree with your statement in question #7 that “practices may change for end- of-life or hospice patients who have a comfort care-only order.” Comfort care-only orders can be captured in some EHR systems, but not all. There are also some hospitals still not using a fully functional EHR. Therefore, we do suggest denominator exclusions in this measure.

We suggest that the following exclusions be considered:
Palliative care
End of life care
Metastatic malignancies
Septic shock

As you know, the same critical pathologies that compromise perfusion to critical organs such as the heart, lungs, and brain also compromise perfusion to the skin!

Thank you for the opportunity to provide this feedback and for considering our suggestion

Robert Skerker, MD, FAPWCA
Medical Director, Morristown Wound Healing Center
APWCA liaison to the Alliance of Wound Care Stakeholders

Jeffrey D Lehrman, DPM, FASPS, MAPWCA
Medical Director, Center for Wound Healing and Hyperbaric Medicine at
Crozer-Chester Medical Center
APWCA Board of Directors

NCVH 2019 Annual Conference

Fri, 15 Mar 2019 21:41:54 GMT

NEW THIS YEAR! Special APWCA discounted rate of $299 (Enter code: APWCA-2019) to attend the 20th Anniversary NCVH 2019 Annual Conference, which now includes a day-long educational track focused on the interdisciplinary integrated team approach to wound care - Save hundreds of dollars!

APWCA will be presenting a full day didactic session on May 31st! See schedule of the day below:

10:00 - 11:20AM NCVH/APWCA Session IV: Reconstruction of Complex Tissue Defects in the Lower Extremities
10:00 - 10:10AM The Importance and Goals of Wound Healing in Limb Preservations, Charles Andersen, MD
10:10 - 10:20AM When to get a Vascular Consult and the Limitation of Non-Invasive Vascular Studies, Craig Walker, MD
10:20 - 10:30AM Identifying the Etiology of the Wound, Charles Andersen, MD
10:30 - 10:40AM Debridement of the Complex Wound: Extent, Tools and Frequency Stephanie Wu, DPM
10:40 - 10:50AM Controlling the Bacteria in the Wound: Topical vs. Systemic Treatment, Charles Southerland, DPM
10:50 - 11:00AM Venous Ablation for the Venous Leg Ulcers: Indications and Timing, Robert Coronado, MD
11:00 - 11:10AM THat is the Role of Cellular and or Tissue Based Products in Dermal Reconstruction: Evidence Based Medicine, Steven Kavros, DPM

11:20 - 1:30PM Lunch/Lunch Symposia/Exhibits

1:30 - 3:00PM [Podiatry and Wound Care] Session V: Reconstruction of Complex Tissue Defects in the Lower Extremities
1:30 - 1:40PM Hyperbaric Oxygen Therapy: What is the Evidence? Jeffrey Niezgoda, MD
1:40 - 1:50PM Vascular Imaging: Evidence to Improve Outcomes, Jeffrey Ross, DPM, MD
1:50 - 2:00PM When to Consider Flaps vs. Split Thickness Skin Grafts, Charles Southerland, DPM
2:00 - 2:10PM Taking the Mystery Out of Offloading: It is more than a Simple Insert, Steven Kavros, DPM
2:10 - 2:20PM Compression Therapy for Chronic Venous Insufficiency: Compression Wraps vs. Gradient Support Hose, Cheryl Bongiovanni, PhD
2:20 - 2:30PM Topical Oxygen: Hocus or Evidence Based, Stephanie Wu, DPM
2:30 - 2:40PM What is Feasible for Complex Would Healing in the Changing Economic and Reimbursement Environment, Steven Kavros, DPM
2:40 - 2:50PM Questions and Answers/Panel Discussion
2:50 - 3:00PM Closing Remarks, Frank Tursi, DPM

3:00PM Adjourn

Not All Foams Redistribute Pressure Equally

(Past member) — Tue, 12 Jun 2018 14:45:18 GMT

Recent research demonstrates the effectiveness of various foam dressings for pressure redistribution. Jeffrey Niezgoda, MD (APWCA Vice-President) recently published his findings in a poster presentation (SAWC 2018). His results demonstrated that all foams are not equivalent in the ability to provide pressure relief in patients at risk for developing pressure ulcers. OxyBand Rescue out performed all other foam dressings currently on the market, providing superior reduction in average pressures and peak pressures, while at the same time maximizing contact area. The NPUAP has recently published recommendations advocating the use of foam dressings to provide pressure redistribution in an attempt to reduce the risk of pressure ulcer formation in at risk patients. A copy of the Poster is provided.

Medicare Update: New Electronic Clinical Quality Measure

Fri, 23 Feb 2018 19:17:30 GMT

The Centers for Medicare and Medicaid Services (CMS) recently released an announcement seeking input from stakeholders on a new electronic clinical quality measure under development titled, “Hospital Harm – Hospital-Acquired Pressure Injury.”

This measure assesses the proportion of hospitalized patients 18 years and older who develop a new stage 2-4 pressure ulcer, deep tissue injury, unstageable pressure ulcer, or experience worsening of any of the above during their hospitalization.

We read the full description of the measure and provided the following feedback on behalf of APWCA membership:

Concern that the denominator has no exclusions; made the point all pressure ulcers are not preventable
Responded to one of the questions posed by the measure authors by explaining protocols may change for end-of-life or hospice patients who have comfort care-only orders

-- Clarified this could be difficult to track because comfort care-only orders may not be captured in some EHR systems and some hospitals are still not using a fully functional EHR

Suggested denominator exclusions be added to this measure, including:

-- Palliative care
-- End-of-life care
-- Metastatic malignancies
-- Septic shock

This is just one example of how APWCA advocates for our members. To learn more about your membership and benefits visit www.apwca.org.

If you would like to submit comments on your own, follow these instructions provided by the Alliance of Wound Care Stakeholders:

Current JIRA users with an active account select “Log In” at top right corner at http://jira.oncprojectracking.org

If you do not have a JIRA account, select “Sign up” at http://jira.oncprojectracking.org/login.jsp

1. Select “Projects” at top middle on home screen
2. Select “View All Projects”
3. Select “Quality-Measures” on left-side of screen
4. Select “Comments on eCQMs under development” project
5. To enter comments, select “Create” (orange button) at the top middle of the screen
6. Select the type of issue from the “Issue Type” drop-down menu
7. In “Summary” field, type the following title:
Hospital Harm – Hospital Acquired Pressure Injury
8. Select the measure name for comment on from the “Draft Measures” drop-down:
Hospital Harm – Hospital Acquired Pressure Injury
9. Fill out fields labeled “Contact name,” “Contact email,” and “Contact phone”
10. Enter comments in the “Description ”field or upload an attachment under the “attachment” field
11. Select “Create” at the bottom left to submit comments
12. For additional comments, select “Create another” and then “Create”

Attention: Tennessee, Alabama, and Georgia APWCA Members

Tue, 06 Feb 2018 17:28:12 GMT

Immediate Medicare Changes That May Affect You

The Medicare Administrative Contractor (MAC) for Jurisdiction J (Tennessee, Alabama, and Georgia) is transitioning from Cahaba to Palmetto. The Part A transition went into effect January 26, 2018 and Part A providers should already be submitting claims to Palmetto GBA. Cahaba has discontinued the receipt of Part A redetermination, reopening, and ADR submissions via the InSite Web Portal.

Any of your Part A Redeterminations, Reopenings or ADR responses should now be sent to:

Cahaba Medicare Part A
Post Office Box 6168
Indianapolis, IN 46206

If you have been communicating with Cahaba via FAX, you may find that some of those FAX lines are no longer functioning, including some that deal with Part B. If you need to communicate Part B information to Cahaba after January 26, 2018 they ask that you use this mailing address:

Cahaba Medicare Part B
Post Office Box 6169
Indianapolis, IN 46206

The Part B transition goes into effect February 26, 2018. Providers should note that their Local Coverage Determinations (LCDs) will transition from Cahaba to Palmetto. A listing of Palmetto LCDs can be found here: Software vendors should update their software to send claims to:

Part A:
Palmetto GBA
Attn: JJ Medicare Part A PO Box 100305
Columbia, SC 29202-3305

Part B:
Palmetto GBA
Attn: JJ Medicare Part B PO Box 100306
Columbia, SC 29202-3306

More information can be found at the Jurisdiction J Transition website: https://www.palmettogba.com/JJTransition

Drs. Kavros and Coronado Published in Advances in Skin and Wound Care

Thu, 25 Jan 2018 15:52:25 GMT

President, Dr. Steven Kavros, and member, Dr. Robert Coronado have been published in the February issue of Advances in Skin and Wound Care. ‘Diagnostic and Therapeutic Ultrasound on Venous and Arterial Ulcers: A Focused Review’ can be read online now.

APWCA Member Survey Concerning the Proposed Changes to the Pressure Ulcer Staging System

Mon, 06 Nov 2017 22:27:16 GMT

In August 2017, the APWCA distributed a survey to its members to collect their perceptions about change in the pressure ulcer staging system as proposed by the National Pressure Ulcer Advisory Panel (NPUAP). The proposed change was centered around the use of the term 'pressure injury' to replace 'pressure ulcer'.

An invitation email was sent to the APWCA's 1020 members. About 190 members accessed the survey and about 150 responses were submitted. This results in a response rate of 15% and provides a Confidence Interval of ± 7%. The survey consisted of 6 items. Each item and its results are appended in this report.

Results

A plurality of respondents (40%) felt that 'pressure ulcer' was the most acceptable term with 30% of respondents deeming both 'ulcer' and 'injury' to be acceptable.
A slight majority of respondents (58%) felt that Stage 1 and Deep Tissue Injury (DTI) should be included in the staging system despite the drawback of including lesion that occur in the absence of broken skin
A plurality of respondents preferred to keep the term 'stages' (43%) as opposed to 'categories' (28%) in describing the continuum of ulcerations included in the classification scheme.
An equal number of respondents felt that pressure ulcer (38%) or both pressure ulcer or injury (37%) were reflective of etiology.
A plurality of respondents (43%) felt that a change in terminology should be first addressed by entities charged with nomenclature and policy before changes are implemented. This indicates a desire for a procedural sequence to be undertaken before adopting new terminology.
A significant majority of respondents (70%) felt that 'injury' reflects an implication of harm even if it is unintended. This is an important finding as it reflects the fact that some respondents preferring 'injury' and those accepting of both 'ulcer' and 'injury' expressed this concern.

Conclusion

Taken together, the results indicate that while a plurality of APWCA respondents would prefer to keep the term ulcer, many would be accepting of the term 'injury'. That being said, if a change in terminology is to be pursued, the results indicate that two issues be addressed: 1) the implication of harm associated with the term 'injury' should be addressed and mitigated in some manner and, 2) a terminology change should be first addressed by entities charged with nomenclature and policy.

View Detailed Responses

Quality Payment Program Final Rule

Fri, 03 Nov 2017 20:35:46 GMT

The Quality Payment Program (QPP) Final Rule was released last night. We are still reviewing every detail and considering comments to submit, but below you will find some of the big points we have pulled out so far.

Threshold to avoid a penalty moves from 3 to 15 MIPS points
2014 and/or 2015 CEHRT allowed but bonus ACI points available if use only 2015 CEHRT
Eligible clinicians or groups with <= $90K Part B allowable or <= 200 Part B beneficiaries excluded
Cost category counts for 10% of MIPS score
Cost category score will be calculated by Medicare Spending per Beneficiary (MSPB) and total per capita cost measures
CMS will calculate Cost measure “performance” - nothing for us to report for that category
Clinicians affected by Harvey, Irma, or Maria that do not submit 2017 MIPS data will not have a negative adjustment in 2019
Clinicians affected by Harvey, Irma, or Maria can file a hardship exception application for Quality, ACI, and CPIA categories for 2018 performance period
Still only allowed one submission method per category
Quality category moves from 60% of MIPS score in 2017 to 50% in 2018
Clinical Practice Improvement Activity category still counts 15% - can still avoid penalty with just a perfect CPIA score
Clinicians in practices of 15 or less are exempt from ACI category and that 25% moves to Quality category
Exceptional performance threshold remains 70 MIPS points
Option to participate as a Virtual Group
2018 QPP Final Rule Reporting Periods: Cost - 12 mos, Quality - 12 mos, ACI - 90 days, CPIA - 90 days

Links: Full Release / CMS Summary Sheet

Nothing discussed in this communication guarantees coverage or payment. This is our interpretation of the Final Rule. Coverage and payment policies of governmental and private payers may vary from time to time and in different parts of the country. Questions regarding coverage and payment by a payer should be directed to that payer. APWCA does not claim responsibility for any consequences or liability attributable to the use of any of the information discussed in this communication.

New Study Demonstrates the Economic Costs; Medicare Policy Implications of Chronic Wounds

Thu, 12 Oct 2017 13:59:21 GMT

With quality measure-based payment models now driving Medicare reimbursement under MACRA (the Medicare Access and CHIP Reauthorization Act), wound care practitioners have faced a unique challenge: few reportable quality measures relevant to wound care.

A study recently published in the International Society For Pharmacoeconomics and Outcomes Research's Value in Health journal shows the full burden and cost of wound care in the US Medicare population, highlighting the need for CMS health policy makers to develop more appropriate quality measures, episode of care measures and reimbursement models for wound care. The findings - particularly the insights regarding the costs of diabetic foot ulcers and diabetic infections - are of particular interest to the podiatry community.

The study "An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds" analyzed 2014 Medicare data and determined the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by setting. The findings are compelling:

Chronic nonhealing wounds impact nearly 15% of Medicare beneficiaries (8.2 million).
A conservative estimate of the annual cost is $28 billion when the wound is the primary diagnosis on the claim. When the analysis included wounds as a secondary diagnosis, the cost for wounds is conservatively estimated at $31.7 billion.
- Surgical wounds and diabetic foot ulcers drove the highest total wound care costs (including cost of infections).
- On an individual wound basis, the most expensive mean Medicare spending per beneficiary was for arterial ulcers followed by pressure ulcers.
- Hospital outpatient services drove the greatest proportion of costs - demonstrating a major shift in site-of-service costs from hospital inpatient to outpatient settings.
- Surgical infections were the largest prevalence category, followed by diabetic wound infections.

This documentation of the economic impact of nonhealing wounds can be meaningful from a policy perspective moving forward. "The true burden of wound care to Medicare has remained relatively hidden and have not been a focus from a public policy standpoint in the U.S. We are hopeful that documenting the significant economic cost and impact of chronic wounds can influence priorities for Federal research funding in this space and for innovative payment approaches by the CMS, including quality and performance measures within MACRA," noted lead study author Dr. Samuel Nussbaum, Schaeffer Center for Health Policy and Economics, University of Southern California.

National quality measures have not been developed for use under MACRA's Merit-based Incentive Payment System (MIPS) that are relevant to the broad spectrum of wound care. With quality measure-based payment models driving Medicare reimbursement under MACRA, this is a problem for practitioners. "CMS needs to recognize the cost and prevalence of chronic wounds in the development of chronic care models and episodes of care. Chronic wounds can't be forgotten about if we want to drive better health outcomes and smarter wound care spending," said co-author Caroline Fife, MD, Medical Director, CHI St. Luke's Hospital (The Woodlands, Texas) and Executive Director, U.S. Wound Registry.

The study was funded by the Alliance of Wound Care Stakeholders, an association of clinician associations and medical specialty societies focused on promoting quality care and access to products and services for people with wounds and the providers who treat them. The Alliance has been leading advocacy initiatives to educate policy makers and regulators about the importance of more meaningful quality measures for the wound care space. The American Professional Wound Care Association is a member of the Alliance.

The full study is available online; the Alliance's comments to CMS seeking performance measures more relevant to wound care are posted on www.woundcarestakeholders.org.

Downloads: Full Article (PDF) / Fact Sheet / News Release

Update: New Novitas Wound Care LCD L35125

Fri, 06 Oct 2017 14:13:02 GMT

Novitas Solutions, Inc. is the Medicare contractor (MAC) for the following states and district:

Arkansas
Colorado
Delaware
District of Columbia
Louisiana
Maryland
Mississippi
New Jersey
New Mexico
Oklahoma
Pennsylvania
Texas

In January 2017, Novitas published a proposed rule for payment of wound care treatments to their beneficiaries which we thought was filled with many inconsistencies and confusion with aspects that did not seem to be based on the current state of wound care delivery by the wound care industry (many of whom are members of the APWCA). This proposed rule was subject to a 60 day comment period. APWCA, in conjunction with the Alliance of Wound Care Stakeholders, spoke on behalf of its Novitas members and submitted comments. Our voice was heard!

Novitas has just published their recently finalized LCD (Local Coverage Determination) L35125 entitled "Wound Care" which is due to go into effect on November 11, 2017. A copy of the entire LCD L35125 is available here. This update to membership is meant to review key points of the finalized LCD.

Surgical/excisional debridement of dermis, subcutaneous tissues, and fascia: There is no limit to the number of surgical debridements a patient may receive in a 360 day time frame. However, Novitas feels that greater than 8 debridements at any depth is "excessive". Therefore, the LCD states that should the patient require greater than 8 total debridements, "meticulous" documentation is necessary to explain why this "excessive" amount of debridement is indicated. Please keep in mind that providers should already be documenting medical necessity with each and every debridement. Please take this opportunity to review your documentation habits.
Surgical/excisional Muscle/fascia and bone debridement: Novitas feels that more than 5 total debridements that include muscle/fascia or bone in a 360 day period is "excessive" but will not place an "a priori" limit. Instead the LCD requires that more than 5 total debridements that include muscle/fascia or bone in a 360 day period be accompanied by "meticulous" documentation illustrating that the service is both medically reasonable and necessary.
Non-contact non-thermal Ultrasound for wound treatment (MIST): The LCD states it should be offered a minimum of 2-3 times per week. But, if no observable wound improvement is noted after 2 weeks (4-6 treatments), then this wound treatment is not reasonable or necessary. Furthermore, no more than 18 treatments in a 6 week period will be considered reasonable or necessary.
Negative Pressure Wound Therapy (NPWT): Two types are considered: a) that done with DME, and b) that done with disposable systems as an outpatient or homecare patient. Both are covered given proper indications and usage. The LCD states, "…the beneficiaries who undergo treatment utilizing negative pressure wound therapy, only a minority appears to require more than 6 NPWT services in a 120 day period to accomplish the desired objective of the treatment plan of the wound. Only when medical necessity continues to be met and there is documented evidence of clear benefit from the NPWT treatment already provided, should NPWT services be continued beyond this frequency or time frame."

There were numerous changes from the proposed LCD to the final LCD which was just published. The changes relevant to our comments include:

No frequency limit on total number of debridements in a year
No frequency limit on the total number of debridements including muscle / fascia and bone in a year
Disposable NPWT coverage was not removed as was proposed
Wound photography not required as proposed (but it is suggested especially when more than 8 total debridements or 5 debridements including muscle / fascia and bone are performed in a year)
Palliative wound care is covered
The statement in the proposed LCD that a wound needs to show a documented improvement of 10% per month or granulation tissue progression of 1 mm per month was removed

New ICD-10 Ulcer Codes You Need to Know

Tue, 26 Sep 2017 16:39:31 GMT

ICD-10 codes that start with L97- are used for non-pressure chronic ulcers of the lower limb. These codes are used for diabetic foot ulcers, stasis ulcers, and others. Since the onset of ICD-10, there were only five 6^th character options for these L97- codes. These were:

1 – limited to breakdown of skin
2 – with fat layer exposed
3 – with necrosis of muscle
4 – with necrosis of bone
9 – with unspecified severity

These did not leave the option to indicate with our codes that an ulcer had muscle exposed without necrosis of muscle or bone exposed without necrosis of bone. The APWCA worked with the Alliance of Wound Care Stakeholders to write to the World Health Organization (WHO) and explain this gap in code options and request that more options be created that would allow us to code these scenarios accurately.

Our efforts have been recognized! The WHO has announced new 6^th character options that can be used with all L97- codes. These go into effect October 1, 2017.

The following 6^th character options are being added:

5 – with muscle involvement without evidence of necrosis
6 – with bone involvement without evidence of necrosis
8 – with specified severity NEC

These new 6^th characters of “5” and “6” allow the option to indicate the ulcer is to the depth of muscle or bone without necrosis at that depth. The new 6^th character of “8” should be used if the severity of the ulcer is specified in the documentation, but none of the 6^th character options of 1-6 are appropriate.

These new 6^th characters can be used with any code that begins with L97-.

Note: Any ICD-10 code listed above that ends with a “-“ is not complete and requires more characters to complete the code.

Nothing discussed in this communication guarantees coverage or payment. The existence of an ICD-10 code does not ensure payment if it used. Coverage and payment policies of governmental and private payers may vary from time to time and in different parts of the country. Questions regarding coverage and payment by a payer should be directed to that payer. APWCA does not claim responsibility for any consequences or liability attributable to the use of any of the codes discussed in this communication.

Thank You Participants of APWCA 2017 National Clinical Conference

Wed, 20 Sep 2017 15:57:25 GMT

Thank you to all participants of the APWCA 2017 National Clinical Conference for helping make this year’s educational program a huge success! With almost 400 in attendance, 75+ presentations, standing room only review course, and a sold-out exhibit hall, this year’s meeting exceeded all expectations.

Presentations are available online for public viewing until September 30 http://www.apwca.org/2017-Presentations. Beginning October 1, educational content will be available to members only.

SAVE THE DATE and join us September 6-8, 2018 in Baltimore, MD for next year’s conference.

Masters Award (MAPWCA) Recipients: E. Cuauhtémoc Sánchez, MD; Cheryl M. Bongiovanni, PhD; Charles Andersen, MD; Tyler Sexton, MD; Randall Cook, MD; Steven Sprigle, PhD, PT along with President (L) Steven Kavros, DPM; Vice President (R) Jeff Niezgoda, MD and Conference Chairs Kathya Zinszer, DPM and Barbara Delmore, PhD, RN

APWCA well-represented at New Cardiovascular Horizons

Thu, 08 Jun 2017 21:23:58 GMT

APWCA was well-represented at the recent New Cardiovascular Horizons (NCVH) Annual Conference held in New Orleans on May 31-June 2. Steven Kavros, DPM, MAPWCA, FACCWS, CWS, APWCA President, presented excellent content during the Podiatry and Wound Care sessions including "Treatment of Ischemic Wounds with Non-Contact, Low-Frequency Ultrasound: The Mayo Clinic Experience" (View PDF) and "Improving Wound Healing Outcomes Using Hypocholorous Solution as a Therapy" (View PDF). He also participated in the NCVH Interview Arena to promote the upcoming APWCA National Clinical Conference, September 7-9, in Philadelphia, PA.

CMS 2016 Prior Year Benchmarks in the 2016 Quality and Resource Use Reports

Thu, 13 Apr 2017 21:42:31 GMT

This document provides the quality benchmarks and standard deviations for each quality measure that may be included in the Performance Year 2016 Quality and Resource Use Reports and used in the calculation of the 2018 Value Modifier. There are four types of quality benchmarks that may be used to calculate a TIN’s Quality Composite Score for the 2018 Value Modifier:

CMS-Calculated Outcome measures (Table 1)
Physician Quality Reporting System (PQRS) measures (Table 2)
Electronic Clinical Quality measures (eCQM) reported to the PQRS (Table 3)
Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures (Table 4)

Starting with the 2018 Value Modifier, separate benchmarks will be used for eCQM and non-eCQM PQRS measures. The benchmarks for each quality measure are based on the performance of all solo practitioners and groups nationwide in 2015, the year prior to the performance period. The benchmarking and measure calculation methodology is described at the end of this document.

Download full document from CMS here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PY2016-Prior-Year-Benchmarks.pdf

APWCA Position Statement – Revised NPUAP Pressure Ulcer Definition & Staging

Thu, 16 Feb 2017 22:52:18 GMT

The APWCA Board of Directors has reviewed the new NPUAP staging system. Additionally, we have reviewed responses from allied professional organizations, which have included commentary in support of as well as opposition to the new nomenclature presented by the NPUAP. The Board applauds the dedication and the continued effort that the NPUAP has consistently delivered to enhance and promote the quality of care provided to patients with pressure ulcers. The APWCA is confident that all issued statements and positions are well intended and primarily founded on patient centric motivations.

The APWCA is devoted to the best practice clinical algorithms, which include regulatory and policy guidance. As an organization committed to evidence-based best practice, we recognize that clinical standards, policy and nomenclature will change over time. Evolution in medicine and wound healing is based on new evidenced-based science, novel technology and an improved understanding of wound healing physiology.

The APWCA is a membership-based organization with thousands of talented and skilled wound healing experts. To issue a position statement without allowing our membership the opportunity for discussion and debate on this important topic would be inconsistent with the core principles of the APWCA. As an organization, we plan to fully explore and deliberate the changes in the very near future. Once we have accomplished our due diligence and allowed our membership to voice their opinions, we will join our colleagues and sister professional societies and issue a position statement. The APWCA will attempt to provide positive feedback and suggestions to improve and enhance the NPUAP staging system. In order to accomplish this goal, the APWCA Board of Directors will be sending a survey to all of the members to query your feedback on this important topic.

Click here to view/download our full position statement.

Sincerely,

Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP
President
American Professional Wound Care Association

American Professional Wound Care Association Call for Abstracts

Mon, 13 Feb 2017 16:48:53 GMT

American Professional Wound Care Association (APWCA) invites the submission of research abstracts for the 16th Annual APWCA National Clinical Conference, which will take place September 7-9, 2017 at the Loews Philadelphia Hotel, Philadelphia, PA.

Submission Categories:

Wound Healing

Limb Salvage

Hyperbaric Oxygen Therapy

To submit an application or for additional information about abstract format and guidelines, visit http://www.apwca.org/2017-Abstracts

The deadline for submission is Tuesday, August 1, 2017

If you have questions about abstract submission, please contact APWCA at 337.541.2240 or abstracts@apwca.org

APWCA Board Member Named Top Doctor

Tue, 06 Dec 2016 14:29:18 GMT

Congratulations to APWCA board member, Jeffery Lehrman, DPM, FASPS, FACFAS, MAPWCA, on being named a “Top Doctor” by a panel of physician peers in the current edition of MainLine Today Magazine.

APWCA PARTNERS WITH NCVH AT MEDICAL CONFERENCE

Thu, 27 Oct 2016 18:31:44 GMT

LAFAYETTE, LA — American Professional Wound Care Association (APWCA) Vice President, Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS, recently presented wound care content at the New Cardiovascular Horizons (NCVH) California meeting on October 22. The day-long meeting, entitled Changing Paradigms in Vascular and Venous Therapy: An Update on New Technology and Pharmacotherapy Options, was held at Gaia Hotel and Spa in Redding, California. Dr. Niezgoda also served as moderator for the session.

The Essentials in Wound Care session was offered by NCVH in partnership with the APWCA. Topics included Superficial Venous Disease and Diabetes and Its True Relationship to Peripheral Vascular Disorders. Copies of the session content are available for viewing here.

APWCA PARTNERS WITH NCVH AT MEDICAL CONFERENCE

Thu, 13 Oct 2016 21:09:00 GMT

LAFAYETTE, LA — American Professional Wound Care Association (APWCA) President, Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP, recently presented wound care content at the inaugural New Cardiovascular Horizons (NCVH) Minneapolis meeting on October 8. The day-long meeting, entitled Clinical Updates and Advances in Vascular Medicine, was held at the Hyatt Regency Minneapolis. Dr. Kavros also served as moderator for the session.

The session, entitled Essentials in Wound Care, was offered by NCVH in partnership with the APWCA and included Improving Wound Healing Outcomes Using Hypochlorous Solution as a Therapy, Hyperbaric Oxygen in the Outpatient Setting and Peripheral Arterial Disease and Chronic Venous Insufficiency Awareness: Essential to Healing Wounds.

Copies of the session content are available for viewing here.

About APWCA

The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting excellence in wound care and patient advocacy. Learn more about APWCA at www.apwca.org.

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APWCA LEADER APPOINTED TO NPUAP BOARD

Tue, 30 Aug 2016 13:10:27 GMT

LAFAYETTE, LA — Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, was recently appointed to the National Pressure Ulcer Advisory Panel (NPUAP) Board of Directors.

The NPUAP serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education and research. Recent NPUAP achievements include the collaboration with the European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) to develop a new pressure injury prevention and treatment clinical guideline. The intent of the collaboration is to advance international consensus in pressure injury prevention and management.

In her new role, Dr. Delmore will be responsible for helping to develop policy and set organizational goals for the NPUAP. Dr. Delmore also currently serves as a board member of the American Professional Wound Care Association (APWCA), which will allow for synergies and a sharing of knowledge between the two organizations. “I am very excited about my future role in continuing to collaborate with and build connections between APWCA and the NPUAP,” states Delmore.

Dr. Delmore will begin her term in office January 2017. She is currently Senior Nurse Scientist at NYU Langone Medical Center.

About APWCA

The American Professional Wound Care Association^® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting excellence in wound care and patient advocacy. Learn more about APWCA at www.apwca.org.

PREMINENT WOUND CARE ORGANIZATION NAMES BOARD

Thu, 12 May 2016 15:20:55 GMT

LAFAYETTE, LA — The American Professional Wound Care Association® (APWCA) recently announced newly-appointed leadership to its board of directors. Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP, was appointed incoming APWCA President. He will serve a three-year term and succeeds outgoing APWCA President, Thomas E. Serena, MD.

A list of the 2016 APWCA Board of Directors follows:

President:

Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP
Vascular Surgery Associates
Blaine, MN
Chief Medical Officer, Miromatrix Medical, Inc.
Eden Prairie, MN

Vice President:

Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS
WebCME
Greendale, WI

Secretary:

Kathya Zinszer, DPM, MPH, FAPWCA
Geisinger Medical Center
Danville, PA

Treasurer:

Stephen H. Sprigle, PhD, PT, AAPWCA
Georgia Institute of Technology
Atlanta, GA

Members:

Randall G. Cook, MD, FACS, FAPWCA
Jackson Wound & Hyperbaric Medicine Center
Montgomery, AL

Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU
NYU Langone Medical Center
New York, NY

Kevin R. Emmons, DrNP, RN, AGPCNP-BC, CWCN, DAPWCA
Rutgers School of Nursing-Camden
Medford, NJ

Barry M. Fabius, MD, CMD, FACP
United Healthcare Community Plan
Newark, DE

Caroline E. Fife, MD, CWS, FUHM, FAAFP, FACCWS
St. Luke's Hospital
Woodlands, TX
Baylor College of Medicine
Houston, TX

Tyson Green, DPM, FACFAS
Imperial Health - Center for Orthopaedics
Lake Charles, LA

Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA
Foot and Ankle Specialists of Delaware County
Springfield, PA

Christine Shettel, RN, BSN, CHWS, MAPWCA, PWRC
York, PA

Director Emeritus:

Federico Peguero, MD, MAPWCA
Lower Bucks Hospital
Bristol, PA

“I am very pleased with the ‘blue-ribbon’ board that we have assembled to lead APWCA into the future. Our goals and objectives for the organization will continue to strongly position APWCA as a leader in wound care education, advocacy and research. This group brings tremendous experience, leadership and enthusiasm to APWCA and will have a positive impact on membership,” states Dr. Steven J. Kavros, incoming APWCA President.

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