UBCNews - Business - Experts Weigh In On 2026 Medicare Changes & How They Could Affect Wound Patients

Episode Date: December 12, 2025

So, we need to talk about something that's flying under the radar for a lot of people right now. Starting January first, 2026, Medicare is rolling out some pretty significant changes that could seriously impact folks dealing with chronic wounds. We're talking about roughly 10.5 million Medicare beneficiaries who rely on wound care treatment. KureCare a division of Veracor Group LLC City: Miami Address: 1150 NW 72ND AVE Website: https://curewounds.com

So we need to talk about something that's flying under the radar for a lot of people right now. Starting January 1st, 2026, Medicare is rolling out some pretty significant changes that could seriously impact folks dealing with chronic wounds. We're talking about roughly 10.5 million Medicare beneficiaries who rely on wound care treatment. Yeah, and the timing here is critical. CMS detailed new reimbursement limits for cellular and tissue-based products, basically narrowing down to a select approved list. If your provider uses a product that's not on that list,

you could be looking at reimbursement denials or major disruptions in your care. Right. And we're not talking about minor policy tweaks here. The spending on skin substitutes, those wound care products, went from $256 million in 2019 to over $10 billion in 2024. CMS attributes that growth to abusive pricing practices and over-utilization, so they're stepping in. Exactly. But here's the thing.

When you slash reimbursements by up to 90%, as proposed, you're not cutting just costs. You're potentially cutting access. We could see more amputations, preventable complications, and honestly, higher health care costs down the line. That's the paradox, isn't it? You try to save money now,

but the long-term consequences might actually cost more. Have you ever wondered why Medicare added advanced wound care back in 2017 in the first place? It was because people were cycling through doctor's offices, urgent cares, hospitals, constantly seeking treatment for chronic wounds that wouldn't heal. The costs were escalating. Wounds weren't healing, leading to amputations. An amputation never really heals.

Either the person dies or they get multiple amputations before they die. That's the reality we might be looking at again. Mm-hmm. Sobering indeed. So let's break down what's actually changing. CMS has finalized reforms to Skin Substitute payments under the 2026 Medicare Physician Fee Schedule, establishing a flat rate of about $127 per square centimeter for most products used in non-facility and hospital outpatient settings.

And that flat rate represents a massive cut for many products. The Medicare Access to Skin Substitutes Coalition warned that this cover. change could eliminate reimbursement for numerous products used in physician offices and home settings. For patients dealing with diabetic foot ulcers, venous leg ulcers, and pressure wounds, those are the three primary chronic wound types affected. This is a huge deal. I mean, there's also the documentation side of this, right? CMS emphasized documentation as a core safeguard against over-utilization, so providers will need to demonstrate medical necessity and appropriateness for every intervention.

Definitely. The new policies emphasize evidence-based practice, standardized clinical thresholds, and more thorough documentation. That's going to create an administrative burden that many smaller clinics might struggle with. I remember talking to a clinic director last month who said half her staff's time already goes to paperwork, and that was before these new rules. Right, exactly. And when clinics close their doors, because they can't afford to deliver care, seniors lose. lose reasonable access to treatment. So here's a question for anyone listening. Do you know whether your current provider will be able to continue offering the same level of care under these new restrictions? That's the million dollar question.

Or should I say the $10 billion question, given what we just discussed about spending? Huh, well played. That point about documentation requirements sets up our next piece, what patients can actually do to prepare. But first, a quick work. from our sponsor. If you're a Medicare beneficiary with a chronic wound, now is the time to review your options.

CureCare provides regenerative wound care treatments through a nationwide network of over 500 certified specialists. They report that 95% of qualified patients receive Medicare coverage for their regenerative wound care treatments. With faster healing times compared to traditional methods, their team focuses on evidence-based protocols and streamline documentation to reduce barriers to care. To check your eligibility before the new policies take effect, visit curewounds.com. Picking up on documentation requirements, how should patients handle the transition to these new coverage standards? First, patients need to understand their current Medicare plan. Are you on traditional Medicare or a Medicare Advantage plan? Because Medicare Advantage plans often come with

network restrictions that may limit your ability to see wound care specialists. Review your plan annually and consult with your provider about what's actually covered. Right. And there's also the issue of durable medical equipment. Medicare Part B currently covers advanced dressings, compression garments, negative pressure wound therapy devices, all the supplies that wound care patients rely on, but proposed changes could limit what's included. Yeah, and treatments like hyperbaric oxygen, therapy and negative pressure wound therapy are costly. If reimbursement rates drop, patients

could face higher out-of-pocket costs. Imagine someone managing a diabetic foot ulcer who suddenly can't afford the device that's keeping them from losing a limb. That's a terrifying prospect. Now, one thing that came up during the pandemic was telemedicine for wound care patients, especially those in rural areas or with mobility issues. Recent legislation extended telehealth access through September 2025, but what happens after that? That's the question. The waiver allowing Medicare patients in non-rural areas to access telehealth from home runs through September 30th, 2025. After that, we don't have clarity. If coverage for telemedicine visits is reduced or restricted again, patients who relied on remote

consultations may face real challenges accessing care. In other words, they might lose the very lifeline that help them manage their wounds from home. I see. That makes sense. So to everyone listening, if you or someone you know is dealing with a chronic wound and relies on Medicare, what are the three most important steps they should take right now? One, stay informed about the upcoming policy changes. Two, review your Medicare plan details before the end of the year. And three, consult your health care provider to understand your coverage options and whether you need to secure treatment plans before January 1st. Don't wait until these restrictions are in place. Waiting is basically gambling with your health at this point. Because once the clock strikes midnight on New Year's, the entire situation

changes completely. And for 10.5 million Americans, this is more than a policy shift. It's potentially life-altering. Thanks for breaking this down with us today. Absolutely. This is about really people facing real consequences. The more we can inform patients now, the better prepared they'll be.