08/05/2025    From: Joseph Borreggine, DPM

WISeR (Wasteful and Inappropriate Service Reduction) Model

It looks like wound care is going to be facing
much needed upgrade since it has recently been
discovered that in 2019 the cost of wound care to
Medicare was $250 million and as of 2024 that cost
skyrocketed to $10 billion a year, which is more
than what they spent in this country on cancer
treatment in that same year. The number of
patients during that time who received wound care
only doubled meanwhile the cost went up 40 times.

Based on this amount of money being spent by
Medicare on skin substitutes, they decided to use
this new program, which is considered “voluntary.”
This will affect three MACs which include five
jurisdictions within those MACs and will only be
in six states. This program will be ongoing until
2031. Based on the results of this new voluntary
policy, it may include the entire country,
including all MACs jurisdictions and states.

They are looking to reduce and have a general cost
reimbursement for wound graphs to an all-time low
of $125 per square centimeter. I’m sure that’s up
for negotiation and probably will be a little bit
higher but will no longer have wound grafts
costing thousands of dollars per square
centimeter. How they determine the fee for graphs
is rather interesting and probably can be found in
the article below.

They currently consider these six states singled
out “the ground zero” for waste regarding wound
care (Arizona is #1), including the use of skin
substitutes for wound care. This program will only
include diabetic and venous ulcers. This will not
include any sort of traumatic wounds or
dermatological created wounds, such as MOH
procedures. Inpatient and emergency room rooms are
exempt.

The center of this program will include artificial
intelligence, which will determine whether or not
payment is required. This will include pre-payment
audit or prior authorization. The hope is this
will slow down the cost overruns based on waste.
They are not really looking at fraud and abuse or
so they say.

Unfortunately, artificial intelligence may be
wrong in reviewing records but will not be held
liable. Providers who comply and are found to be
diligent and their medical records will be given a
“golden ticket” to no longer have this pre-payment
audit or prior authorization and bill without
restriction.

CMS is currently taking comments for this policy,
which will be implemented as of January 1, 2026
information about this program was brought to the
stakeholders in July 2025 (a rather short time
frame). The new LCDs for wound care will probably
be implemented in January as well. Interestingly,
there are a number of MACs that do not have an LCD
for wound care. This will be very interesting to
see how this plays out over the next few months.

https://www.cms.gov/priorities/innovation/innovati
on-models/wiser

Joseph Borreggine, DPM, Fort Myers, FL

Other messages in this thread:

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08/13/2025    Paul Kesselman, DPM

WISeR (Wasteful and Inappropriate Service Reduction) Model (Joseph Borreggine, DPM)

Let me make some corrections to my friend and
colleague Joseph Borregine's comments on the WISer
program. This is a Voluntary program which is
available in only six states- New Jersey, Ohio,
Oklahoma, Texas, Arizona, and Washington. It is
open to any provider. practitioner, including DPMs
who provides a subset of specific procedures. It
is based on and does not usurp specific LCDs which
have jurisdiction over those procedures. It is not
biased for or against any specialist.

Dr. Borregine specifically stated that
dermatologists were exempt from this program. That
is false! Rather, it should have stated that post
Moh's surgery grafting is not subject to the WISeR
program. The reason is because MOHS surgery is NOT
listed as part of the LCD covering skin
substitutes of the Lower Extremity. The LCD for
skin substitutes specifically only addresses their
use on diabetic or venous wounds. That LCD also
does not address the use of skin substitutes on
the arm, hand, face or other body part other than
the lower extremities.

That LCD also does not address the use of skin
substitutes on the lower extremity or any other
body part due to acute traumatic wounds or due to
radiation, burns, trauma, etc. If on the foot or
lower leg, these too could be treated by a DPM but
would not be subject to the voluntary WISeR
program nor the LCD.

As for what APMA is doing about it, that is for
them to answer. In my opinion, this is a voluntary
program and only the best providers who have a
chance at gaining a bonus will bother to sign up
for it. Will it be expanded? Will P/A for CTP
become mandatory? This will play itself out as
more DME and CPT procedures are abused and P/A
programs show themselves to be effective at
cutting costs! Only time will tell. But the WISeR
program definitely DOES NOT discriminate against
DPMs.

Paul Kesselman DPM, Oceanside NY

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08/12/2025    Paul Kesselman, DPM

RE: WISeR (Wasteful and Inappropriate Service Reduction) Model (Joseph Borreggine, DPM)

Let me make some corrections to my friend and
colleague Joseph Borregine's comments on the WISer
program. This is a Voluntary program which is
available in only six states New Jersey, Ohio,
Oklahoma, Texas, Arizona and Washington.
It is open to any provider. practitioner,
including DPMs who provides a subset of specific
procedures It is based on and does not usurp
specific LCDs which have jurisdiction over those
procedures. It is not biased for or against any
specialist.

Dr. Borreggine specifically stated that
dermatologists were exempt from this program. That
is false! Rather, it should have stated that post
Moh's surgery grafting is not subject to the WISeR
program. The reason is because MOHS surgery is NOT
listed as part of the LCD covering skin
substitutes of the Lower Extremity.

The LCD for skin Ssbstitutes specifically only
addresses their use on diabetic or venous wounds.
That LCD also does not address the use of Skin
Substitutes on the arm, hand, face or other body
part other than the lower extremities. That LCD
also does not address the use of Skin Substitutes
on the lower extremity or any other body part due
to acute traumatic wounds or due to radiation,
burns, trauma, etc. If on the foot or lower leg,
these too could be treated by a DPM but would not
be subject to the voluntary WISeR program nor the
LCD.

As for what APMA is doing about it, that is for
them to answer. In my opinion, this is a voluntary
program and only the best providers who have a
chance at gaining a bonus will bother to sign up
for it. Will it be expanded:? Will P/A for CTP
become mandatory? This will play itself out as
more DME and CPT procedures are abused and P/A
programs show themselves to be effective at
cutting costs! Only time will tell.

But the WISeR program definitely DOES NOT
discriminate against DPMs.

For more information on the WISeR program, Please
Click on http://podiatrym.com/go.cfm?n=14795

Paul Kesselman DPM, Oceanside, NY