UBCNews - Business - Need Treatment For A Diabetic Foot Ulcer? Why Starting Wound Care Is Crucial Now

Episode Date: December 12, 2025

Welcome back, everyone. Today we're talking about something that affects millions of people with chronic wounds, and honestly, the timing couldn't be more critical. We're looking at major Medicare changes coming January 1, 2026, that could seriously impact access to wound care treatments. KureCare a division of Veracor Group LLC City: Miami Address: 1150 NW 72ND AVE Website: https://curewounds.com

Welcome back, everyone. Today we're talking about something that affects millions of people with chronic wounds, and honestly, the timing couldn't be more critical. We're looking at major Medicare changes coming January 1st, 2026, that could seriously impact access to wound care treatments. Yeah, and I want to emphasize that word, critical. We're talking about diabetic foot ulcers, venous leg ulcers, pressure sores, slow healing surgical wounds. These aren't minor issues. They affect about 10.5 million Medicare beneficiaries and the reimbursement system is about to change dramatically. So let's break this down. Which Medicare changes are we talking about specifically? Okay so CMS that's the Centers for Medicare and Medicaid Services is

implementing a complete overhaul of how they reimburse skin substitutes. They're consolidating everything into a single site neutral policy. What used to be reimbursed as high-priced products will now be classified as wound care management supplies, paid as incident to supplies under the physician fee schedule. And that sounds pretty technical, but what does it actually mean for patients? Well, here's the thing. Spending on these products jumped from about $252 million in 2019 to over $10 billion in 2024. CMS has raised concerns about fraud in this space, which is part of why they're acting. They're proposing to pay for skin substitutes at a flat rate, and CMS expects these changes

to reduce Medicare Part B expenditures for skin substitutes by nearly 90%. Wow, 90%. That's enormous. Exactly. And that's why patients need to understand the urgency here. Once these changes take effect, we could see disruptions in coverage, access to certain treatments, and providers may not be able to offer the same range of regenerative options they do now. I mean, it's really about acting before the door closes on easier access. Right. So we've established that the POSBORs that the POSERO, policy is changing and the financial impact is huge.

Have you ever wondered how a policy change could affect your own health care options? That point about the flat rate payment sets up our next piece. What patients should actually do now? But first, a quick word from our sponsor. If you're living with a chronic wound and covered by Medicare, now is the time to look into your treatment options. CureCare connects patients with regenerative wound care treatments through a nationwide network of over 500 certified specialists.

Their platform includes an eligibility assessment tool to help determine if you qualify for Medicare coverage, plus real-time analytics to track your healing progress. 95% of qualified patients in their network are Medicare covered. Learn more at cure wounds.com. Picking up on that flat rate payment, how should patients handle this situation before January 2026? Great question.

First, if you have a chronic wound that hasn't healed with standard care, get evaluated now. Don't wait. The new rules will require patients to undergo a mandatory four-week trial of standard wound care before Medicare will even consider covering advanced therapies. And wounds must show at least 50% healing progress during that standard care period before patients can access skin substitutes or other advanced treatments. Mm-hmm. Interesting. Absolutely.

and documentation is going to become even more critical. CMS is emphasizing documentation as a core safeguard against over-utilization. That means providers will need to demonstrate medical necessity and appropriateness for every single application. If you start treatment now, you're getting in before those stricter documentation requirements fully kick in. What about the coverage itself? Will Medicare Part B still cover wound care services? Yes, Medicare Part B will continue to cover essential wound care services. as long as the care is medically necessary and supervised by a health care professional.

That includes professional evaluation, debridement, wound dressing, chronic wound care services, and infection control. But the key change is how advanced products, those skin substitutes, get reimbursed and what evidence you'll need to qualify. So you're still covered, but the pathway to accessing advanced treatments is narrowing. So to everyone listening, if you're dealing with a wound that just won't heal, what are the concrete steps you should take right now? Three things. One, talk to your doctor about whether you're a candidate for regenerative treatments before the policy changes. Two, make sure you understand your eligibility.

There are assessment tools available that can help determine if you qualify for Medicare coverage. And three, if you're approved, start treatment as soon as possible. Once January 2026 hits, you might face additional hurdles or delays. And I'm curious, what happens to people who wait until after January 1st? Well, they'll likely encounter longer wait times because of those mandatory standard care periods. They may also face more limited options, since the payment structure could mean some providers won't be able to offer certain treatments anymore. Plus, the documentation burden increases, which can slow down approval processes. You know, it's almost like waiting for a sale that never comes.

Except in this case, the opposite happens and things get more expensive and complicated. You mentioned earlier that the coverage determination is changing. Can you explain that a bit more? Sure. Starting in 2026, under the local coverage determination for cellular and tissue-based products, only those with peer-reviewed clinical evidence supporting efficacy in diabetic foot ulcers or venous leg ulcers will be reimbursed. That means CMS is tightening the standards. They want proof these treatments actually work. It's part of their push toward cost-effective innovation and responsible utilization.

Makes sense from a policy standpoint, but it definitely creates urgency for patients. Have you seen people who've waited too long to seek treatment? I have, yeah. I remember one patient who had a venous leg ulcer that he kept putting off, thinking it would get better on its own. By the time he finally came in, it had been a pain. nine months and the wound was significantly worse. Treatment took longer and was more complicated than it would have been if he'd sought help earlier. That delay cost him months of discomfort.

That's a powerful reminder. What's the takeaway here for anyone listening who might be on the fence? Don't wait. If you have a chronic wound and you're on Medicare, the window to access current treatment options without additional barriers is closing. Get evaluated, understand your eligibility, and if you qualify, start treatment before January 2026. Your health and your healing timeline could depend on it. I mean, this is really one of those situations where time matters as much as the treatment itself. Really important information. Thanks so much for breaking this down and helping our listeners understand what they need to do.

The message is clear. Act now, talk to your health care provider, and don't let policy changes become a barrier to healing. Absolutely. having me.