{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:16:46Z","timestamp":1783322206401,"version":"3.54.6"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In January 2026, the Centers for Medicare and Medicaid Services (CMS) implemented a major overhaul of Medicare reimbursement for skin substitutes in an effort to curb runaway spending. Between 2019 and 2024, annual Medicare Part B spending on these products increased more than 40-fold, from $250 million to more than $10 billion. Prior to the recent reform, CMS reimbursed clinicians for skin substitutes administered in nonfacility settings (eg, physician offices and patient homes) at a rate of an average sales price (ASP) of +6%. However, skin substitute manufacturers were omitted from federal ASP reporting requirements. Some manufacturers and clinicians exploited this exemption to enter spread pricing arrangements, whereby clinicians profited on substantial differences between Medicare reimbursement (calculated based on undiscounted list prices) and actual acquisition costs. The newly implemented payment policy eliminates the potential for spread pricing by setting a flat, site-neutral payment rate. In 2027, CMS intends to establish a 3-tiered payment system for skin substitute products based on US Food and Drug Administration regulatory classification. While these reforms represent a critical step forward, additional measures\u2014such as bundled reimbursement, expanded prior authorization, and evidence-based coverage policies\u2014may be necessary to ensure sustainable and effective wound care.<\/jats:p>","DOI":"10.1093\/haschl\/qxag164","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:50:15Z","timestamp":1782301815000},"source":"Crossref","is-referenced-by-count":0,"title":["Reforming Medicare payment for skin substitutes\u2014ripping off the bandage"],"prefix":"10.1093","volume":"4","author":[{"given":"Jad F","family":"Zeitouni","sequence":"first","affiliation":[{"name":"Texas Tech University Health Sciences Center School of Medicine Department of Otolaryngology, , Lubbock, TX 79430 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5747-8078","authenticated-orcid":false,"given":"Xiaodan","family":"Hu","sequence":"additional","affiliation":[{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST) , Columbus, OH 43210 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":false,"given":"Sanket S","family":"Dhruva","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of California, SanFrancisco School of Medicine , San Francisco, CA 94121 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-3320","authenticated-orcid":false,"given":"Joseph S","family":"Ross","sequence":"additional","affiliation":[{"name":"Section of General Medicine, Department of Medicine, Yale School of Medicine , New Haven, CT 06510 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-9075","authenticated-orcid":false,"given":"Vinay K","family":"Rathi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head & Neck Surgery, The Ohio State University College of Medicine , Columbus, OH 43212 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"2026070603021367700_qxag164-B1","author":"US Centers for Medicare & Medicaid Services"},{"key":"2026070603021367700_qxag164-B2","author":"Department of Health and Human Services: Office of Inspector General"},{"key":"2026070603021367700_qxag164-B3","author":"Kliff"},{"key":"2026070603021367700_qxag164-B4","author":"US Attorney's Office Southern District of Texas"},{"key":"2026070603021367700_qxag164-B5","author":"Snyder"},{"key":"2026070603021367700_qxag164-B6","author":"US Department of Health and Human Services, Office of Inspector General"},{"key":"2026070603021367700_qxag164-B7","author":"US Centers for Medicare & Medicaid Services"},{"issue":"16","key":"2026070603021367700_qxag164-B8","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1001\/jama.2025.16326","article-title":"Expanding prior authorization in traditional Medicare\u2014the WISeR model","volume":"334","author":"Rathi","year":"2025","journal-title":"JAMA"},{"key":"2026070603021367700_qxag164-B9","author":"Burke"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag164\/68609027\/qxag164.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag164\/68609027\/qxag164.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag164\/68609027\/qxag164.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:02:20Z","timestamp":1783321340000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag164\/8715896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":9,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag164","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,6,25]]},"article-number":"qxag164"}}