UBCNews - Business - Time Is Running Out: Rural Diabetes Management & Medicare’s New Wound Care Rules

Episode Date: December 24, 2025

Hey everyone, welcome back to the show. Today we're tackling something that's gonna affect millions of Americans, especially those dealing with chronic wounds. New Medicare rules taking effect in January 2026 are set to completely reshape mobile wound care in remote areas. If you or someone you know relies on at-home wound treatment, this conversation is critical. I'm joined today by a guest who's been on the frontlines of this issue. Welcome. KureCare is a division of Veracor Group LLC City: Miami Address: 1150 NW 72ND AVE Website: https://curewounds.com

Hey everyone, welcome back to the show. Today we're tackling something that's going to affect millions of Americans, especially those dealing with chronic wounds. New Medicare rules taking effect in January 2026 are set to completely reshape mobile wound care in remote areas. If you or someone you know relies on at-home wound treatment, this conversation is critical. I'm joined today by a guest who's been on the front lines of this issue. Welcome. Thanks for having me. This is honestly one of the most urgent topics in health care right now, and I'm glad we're talking about it. So let's start with the basics. What exactly is changing with these new Medicare rules, and why should patients be concerned right now? Great question. Starting January 2026, Medicare is completely overhauling how it pays for cellular

and tissue-based products, often called CTPs or skin substitutes. These are advanced therapies used to treat chronic wounds like diabetic foot ulcers and venous leg ulcers. The old system allowed some pricing manipulation. Now Medicare is moving to a flat rate for most skin substitutes across physician offices, mobile clinics, and hospital outpatient departments. A few biological products will continue under the old payment rules, but most will see this standardized payment. Mm-hmm, I see. For context, some treatments were being reimbursed at over $1,000 before. This represents cuts of up to 80% in many cases.

And here's the thing, mobile wound care providers already operate on thin margins. They're driving an hour to rural homes, carrying equipment, spending time with patients who can't leave their houses. The reimbursement for these visits doesn't cover what it actually costs to provide care in remote settings. Wait. So mobile providers were relying on reimbursement from these advanced therapies to offset the cost of actually getting to patients? Exactly. Historically, the appropriate use of skin substitutes help balance the economics. Providers weren't grafting everyone, maybe fewer than 10% of patients, and they followed strict criteria. But when that revenue disappears overnight, the whole model collapses. And it's about more than business viability. We're talking about patient access.

Millions of Americans live with chronic wounds. And estimates suggest over 10 million Medicare beneficiaries annually require wound care, with total treatment. costs running into tens of billions of dollars. That's staggering. And you mentioned diabetic foot ulcers. How serious are those? Incredibly serious. Diabetic foot ulcers precede roughly 85% of lower limb amputations in people with diabetes. And the outlook after amputation is grim, the five-year mortality rate exceeds 50%, which is actually higher than the pooled five-year mortality of all cancers combined. So when we talk about access to advanced wound care, we're literally talking about preventing amputations and saving lives. I remember one patient, an elderly woman in a rural area,

who told me she'd rather risk infection than burden her family with another hospital trip. That conversation stuck with me because it showed how isolation and limited options affect real decisions. Wow, that's powerful. Now, that point about patient access and isolation, really sets up our next piece, the day-to-day impact on care delivery. But first, a quick word from our sponsor. Chronic non-healing wounds require specialized care and support. CureCare, a division of Veracore Group LLC, combines advanced biologic wound care products

with Medicare billing support and provider systems. Whether you're a clinic looking to grow or a patient-seeking resources, cure care serves as a partner in the healing process. Learn more at curewounds.com. Picking up on that patient access and isolation issue, how do these policy changes actually affect day-to-day patient care? Well, patients who rely on mobile care often can't access traditional clinics. They live an hour or more away, lack transportation, or have mobility issues.

When mobile providers lose the ability to offer advanced therapies in the home, wounds deteriorate rapidly. We've seen patients end up hospitalized with sepsis because the wound didn't heal. And here's the irony, shifting patients from mobile care to inpatient care will cost Medicare far more in the long run. So this is kind of an overcorrection to address fraud? That's what many stakeholders are saying. Yes, there was fraud, providers applying graphs unnecessarily or excessively, but CMS allowed pricing manipulation to escalate for years without intervention, then implemented abrupt payment cuts. The compliant providers who followed strict protocols are now being punished.

alongside the bad actors. And patients genuinely needing these therapies are caught in the middle. You know, it's like punishing everyone in the class because one student cheated on a test. Right? Exactly. There's also the wiser prior authorization program launching in January in six states,

including Texas and Arizona. What's that about? It uses AI and human review for high-risk Medicare Part B services, including skin substitutes. providers are bracing for AI-driven denials and appeals that can drag on for over a year. One physician said he's planning to stop using skin substitutes altogether and send patients for surgical debraidment instead,

even though these products clinically work. That's the real tragedy here. Effective therapies being abandoned because of administrative burden. That's heartbreaking. So what about innovation? Are there alternatives that could preserve outcomes? Innovation will be critical, but it's challenging. CMS has indicated they plan to differentiate products based on FDA regulatory classification in future policy adjustments, which could help.

But for January 2026, most products face that flat payment rate with the exception of certain biologicals. And right now, many alternative therapies compatible with mobile care don't match the outcomes of grafting, and some are actually sold to providers at a cost higher than the reimbursement rate. So providers literally lose money using them? Right. You can't operate at a loss. Remote patient monitoring has potential, but too often the technology companies benefit more financially than providers. The challenge is that innovation must account for economic sustainability, and clinical effectiveness alone isn't enough.

This brings us to what patients can actually do. What steps should you or your loved ones take before these rules hit? First, if you have a chronic wound or are at risk, especially with diabetes or cardiovascular disease, seek evaluation now. Don't wait until January. Second, document everything, your wound history, previous treatments, mobility limitations. Third, ask your provider about treatment options available today versus what might be restricted later. And fourth, understand your insurance. whether you're in traditional Medicare or Medicare Advantage, because spending patterns differ significantly between them.

Can you break down that difference? Sure, traditional Medicare spent over $5.6 billion more on skin substitutes compared to Medicare Advantage from 2019 to 2023, partly because traditional Medicare had limited utilization controls. Medicare Advantage plans already use prior authorization more aggressively. So if you're in traditional Medicare, these changes will feel more abrupt. What about families and caregivers? What's their role here?

Families need to be proactive advocates. If your loved one has a wound that isn't healing after four weeks of standard care, that's a red flag. The new rules actually require wounds to show at least a 50% reduction in ulcer area after four weeks before advanced therapies are covered. So timing matters. It really does. Families should also look into transportation options if mobile care becomes unavailable. and honestly, prepare for potential gaps in access. Are there any legislative efforts to modify these rules?

Yes, Senator Bill Cassidy introduced the Skin Substitute Access and Payment Reform Act of 2025. His proposal includes establishing payment limits based on a volume-weighted average of current product prices to ensure fair and consistent reimbursement while lowering costs and preserving patient access. In other words, it's designed to modernize the payment system, without completely eliminating coverage for those who truly need these therapies. But it's unclear whether that legislation will pass before January. So to everyone listening, time is really of the essence here. Definitely. This affects real people.

Venus leg ulcers, for example, represent 60 to 80% of all leg ulcerations, with recurrence rates as high as 70%. These aren't rare conditions. And when access to effective treatment disappears, my contacts at CureCare tell me we'll see increased hospitalizations, more amputations, and ultimately higher costs for Medicare anyway. What's your biggest takeaway for our audience? Don't wait. If you need wound care, seek it now.

Understand your options, document your condition, and advocate for yourself or your loved ones. These policy changes are coming, and once they hit, access will be significantly more restricted, especially for rural and mobility limited patients. The time to act is now, not later. That's critical advice. Thank you so much for breaking this down.

This is a defining moment for wound care, and hopefully this conversation helps people take action before it's too late. Thanks for giving this the attention it deserves. And to all our listeners, stay informed, stay proactive, and we'll see you next time.