Wound care specialists, who treat burn victims and diabetics with foot ulcers, say the move to end coverage if a dressing is made of more than 50% honey by weight is arbitrary and makes no sense from a medical standpoint. A final LCD is pending.
Most consumers think of honey as a sweetener for tea or biscuits, but there’s another form—called medical grade honey—with properties that are a godsend to burn victims or diabetics who suffer foot ulcers.
Advances in wound care, some due to the treatment of injuries suffered by soldiers returning from Iraq and Afghanistan, have led to the development of surgical dressings that contain large amounts of medical grade honey. The idea, according to Kara Couch, NP, is to create a dressing that is cost-effective, has multiple functions, and is easy to use.
But after years of covering medical grade honey, Medicare made an abrupt about-face in January. While the decision was reversed somewhat, a pending local coverage determination (LCD) could end payment for dressings that are more than 50% honey by weight. The practical effect would mean the dressings aren’t covered at all, according to Couch and other wound care advocates around the country who have weighed in on the issue.
According to CMS regional spokeswoman Reina Becnel, a draft LCD issued August 6, 2015 included a section, “Dressing with Materials Not Recognized as Effective,” and medical grade honey was among those materials. A comment period on the draft ended September 21, 2015, and no date has been given for a final LCD.
Wound Care Specialists Say Honey is Effective
The “not recognized as effective” language baffles professionals like Couch who work with wound patients. Couch has seen firsthand in places like Walter Reed National Military Medical Center what medical grade honey can do. Burn victim Tiara Del Rio told her local paper in Peoria, Illinois, that medical grade honey “did wonders” for her face after a gas leak cause an explosion in her home.
In an interview with The American Journal of Managed Care, Couch said that if CMS does not fund dressings with honey, “you will be eliminating a basic tool of wound care.”
Obviously not every burn patient or diabetic is covered by Medicare. But because its footprint in the payer world is so large, its policies can have ripple effects across healthcare. Medicare’s refusal to cover medical grade honey could disrupt revenue streams to suppliers or cause them to have to reconfigure products to meet Medicare requirements, even if they are less effective clinically.
Qualities of honey have been documented for centuries, according to the Asian Pacific Journal of Tropic Biomedicine, which stated that, “Medical grade honeys have potent in vitro bactericidal activity against antibiotic-resistant bacteria causing several life-threatening infections to humans.”1
More recently, Couch said there are plenty of studies supporting honey’s effectiveness, but she said the problem is the reimbursement policies for medical grade honey had not been updated since 1994, and the wound care field has changed tremendously in that time. One issue, she said is that studies are still based on whether a wound is closed, and that standards are needed to measure effectiveness based on whether healing has progressed.
“We’ve come quite far, but there’s much farther to go,” Couch said.
No Basis for LCD Language, Advocates Say
The Alliance of Wound Care Stakeholders, which includes foot and ankle surgeons, podiatrists, dermatology nurses, vascular specialists, physical therapists, and many other groups, submitted comments that agreed with a need to update reimbursement policies to reflect changes in technology.
However, the Alliance took issue with eliminating “multi-component dressings” based on a 50% by weight standard, which the group said was “unsupported by evidence, too complicated to implement” and inappropriately put in place before the LCD under consideration was made final.2
Couch agrees that the process for updating the payment policy seemed arbitrary and out-of-touch with the realities of wound care technology. “To say that we’re going to cover based on the weight of the (material) is not the way to go.”
Wound care specialists are willing to start over with the Medicare Administrative Contractors to develop a better policy for paying for dressings, she said. There’s no question that a policy created in 1994 needs an overhaul. “We’ve come so far in wound care since that time,” Couch said. “We’re getting better at this.”
1. Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed. 2011;1(2):154-150.
2. Alliance of Wound Care Stakeholders website. http://www.woundcarestakeholders.org/images/documents/2015/Sept_21_2015_Alliance_surgical_dressing_comments_final.pdf. Published September 21, 2015. Accessed October 17, 2015.