UBCNews - Business - What Every Medicare Patient With a Non-Healing Leg Wound Should Do Before 2026

Episode Date: December 12, 2025

Welcome back, everyone. Today we're talking about something that could affect millions of Medicare beneficiaries starting January 2026. If you or someone you know has a chronic wound—diabetic foot ulcers, pressure injuries, venous leg ulcers—this conversation is urgent. I'm joined by a guest who's been following these policy changes closely. So, let's get into it. What exactly is happening with Medicare wound care coverage next year? 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 could affect millions of Medicare beneficiaries starting January 2026. If you or someone you know has a chronic wound, diabetic foot ulcers, pressure injuries, venous leg ulcers, this conversation is urgent. I'm joined by a guest who's been following these policy changes closely. So let's get into it. What exactly is happening with Medicare wound care coverage next year? here. Thanks for having me. Starting January 1st, 2026, Medicare is implementing new local coverage

determinations that will drastically change how patients access advanced wound treatments. The biggest shift? There's now a mandatory four-week standard treatment trial before Medicare will cover advanced therapies, like skin substitutes or cellular treatments. And during that four weeks, your wound has to show at least 50% healing progress before you can move forward. Four weeks is a long time when you're dealing with a non-healing wound. What's driving these changes? This is really a cost control issue. Medicare Part B spending on skin substitutes increased from $256 million in 2019 to over $10 billion in 2024.

That's a massive increase, and CMS is trying to rein it in. They're reclassifying many of these products. as supplies rather than high-priced biologics. The new flat rate is about $127 per square centimeter across all sites of care. So they're essentially standardizing payments and limiting what qualifies for coverage. How does this affect someone who needs treatment right now? Right. If you have a chronic wound today, you still have access to the current system where physicians have broader discretion in choosing treatments.

But come January, you'll face those most of the medical wound today, you'll face those most of the current system, you'll face the current system, you'll face the current system, you'll face the patient mandatory waiting periods, and stricter evidence requirements. Only treatments on a select approved list will qualify. And honestly, the documentation requirements are becoming much more intensive. CMS is emphasizing documentation as a core safeguard against over-utilization. That's concerning, especially when we think about what delays can mean for wound patients. What does the research tell us about postponing advanced care? During the pandemic, when vascular care was temporarily postponed, amputation rates jumped dramatically.

The number of major amputations increased from 18% in 2019 to 42% in 2020 in one study from the Netherlands. That's a 133% increase directly tied to delayed care. Last month, a provider told me he's seeing more patients waiting too long, and the outcomes are heartbreaking. delays lead to severe infections, increased hospital admissions, and ultimately more amputations. Those numbers are staggering. So for listeners out there, have you ever wondered how a policy change could directly impact your health outcomes? Because this is exactly that scenario. Exactly. And the consequences extend beyond healing time. The human cost is real. Minority populations, including black patients,

experienced significantly higher rates of limb loss during periods of restricted health care access. These policy barriers don't affect everyone equally. Vulnerable populations bear the greatest burden. Right, and that's where early action becomes so important. That point about early intervention and documentation really sets up our next topic, how technology and telemedicine can help patients.

But first, a quick word from our sponsor. If you struggle with a chronic wound, now is the time to act. CureCare operates through a nationwide network of over 500 certified wound care specialists who know how to manage Medicare coverage before the 2026 restrictions take effect. They streamline access to Medicare-covered regenerative therapies, reducing delays during qualifications. According to Cure Care, 95% of qualified patients receive full Medicare coverage for treatments that can heal wounds up to 90% faster than traditional methods. Learn more at curewounds.com. Picking up on that early intervention and how patients can act now, how is telemedicine playing a role in managing chronic

wounds, especially for patients in rural areas? Telemedicine and remote monitoring are becoming essential tools, particularly for patients who live far from specialists. You know, in rural communities, wound care access has always been challenging. With telehealth, patients can have their wounds evaluated remotely, receive guidance on dressing changes, and maintain consistent contact with specialists without driving hours for each appointment. Mm-hmm. Interesting point.

Remote monitoring involves patients or caregivers, taking photographs of wounds, using smartphones or tablets, tracking measurements, and reporting symptoms through digital platforms. Specialists can review this data in real, time and adjust treatment plans accordingly. This is particularly useful for documenting the healing progress that Medicare's new policies will require.

Having that continuous documentation trail could actually help patients meet those stricter evidence requirements we talked about earlier. So technology might help with both access and compliance. That's a silver lining in all this. And I suppose there's a bit of irony here. We're using cutting-edge tech to prove that. we need cutting-edge treatments, what should patients be doing right now

before these changes hit? First, document everything. Gather all medical records related to your wound, photographs, treatment timelines, previous therapy outcomes. Create a detailed wound diary tracking healing progress, pain levels, any complications. This patient-generated evidence could be vital when appealing coverage decisions

or demonstrating medical necessity. In other words, comprehensive records are your best defense when facing new restrictions. Second, consult with a wound care specialist immediately to assess whether advanced treatment options are appropriate now, while current coverage rules are still in effect. So the window is really closing here. What happens to someone who starts treatment in December versus someone who waits until February? That's the big question. Patients who begin advanced treatments under current guidelines may get continued access even after restrictions take effect.

Those who wait could face that mandatory four-week trial period, and if their wound doesn't show 50% improvement, they might not qualify for advanced therapies at all. The reduced reimbursement rates could also cause some providers to stop offering certain services and regenerative products like those from cure care if they can't cover their costs, potentially shrinking provider networks. makes sense. Right, so the issue goes beyond patient eligibility. Provider networks could shrink too. For everyone listening who might be affected by this, what's the single most important action to take this month? Schedule a consultation with a certified wound care specialist as soon as possible. Don't wait to see if your wound will heal on its own. Early intervention is key. I mean, really, getting treatment before the clock runs out could be the difference between healing and losing a limb. The advanced wound care market was estimated to be between $11 and $15 billion in 2024

and is projected to grow significantly over the coming years. But if patients lose access to these therapies because of policy changes, all that innovation becomes irrelevant for the people who need it most. Well said, this has been an eye-opening conversation about how policy decisions directly impact patient care. To everyone out there managing a chronic wound, the message is clear. Act now, document thoroughly, and seek specialist guidance before January. Thanks for breaking this down with us today. Thanks for having me.

This is definitely something people need to hear about.