Access Crisis Feedback Form

Access Crisis Feedback Form

Have recent policy or reimbursement changes affecting cellular, acellular, and matrix-like products (CAMPs), also referred to as skin substitutes, created barriers to patient access, or limited your ability to provide care using these clinically proven therapies? We invite you to share your experience. Your input is essential to informing evidence-based advocacy efforts aimed at protecting patient access.
0-3031-5051-100101-150151-200201-250251-300More than 300
InfectionReadmissionSepsisAmputationDecreased Quality of Patient's LifeAdditional Wound DevelopmentWound DeterioratedWound Grew in SizeSurgical Debridement in the Operating Room SettingRequires or Required Rotational Flap or GraftOther
Delays in obtaining authorization for CAMPs for beneficiaries who meet clinical criteriaIncreased denials for CAMP use despite patients meeting applicable coverage determinationsReduced ability to deliver timely, appropriate wound care when patients require advanced therapies beyond standard careReduction in patient outreach, staffing, or clinical capacityClosure or planned closure of a wound care practice or service lineWISeR CMS ModelAudit ClawbacksCMS fixed fee per sq cm reimbursement schedule for CAMPsNo significant impact observed
Share your personal experience of the skin substitute access crisis here:*
Provider Name*

First NameLast Name
Practice Name / Group Name
NPI Number
Licensure Type
Practice Location

CityState

Zip Code
AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
CGSNGSWPSPalmettoFirst CoastNovitasNoridian
Traditional Office/ Clinic (POS 11)Home (POS 12)Assisted Living (POS 13)Mobile Unit/Portable/RV (POS 15)Off Campus Outpatient Wound Center (POS 19)Urgent Care Facility (POS 20)On Campus Outpatient Wound Center (POS 22)Ambulatory Surgery Center (POS 24)Skilled Nursing Facility/Nursing Facility (POS 31/32)Programs for All-Inclusive Care for the Elderly (PACE) Center (POS 66)Inpatient Rehabilitation Facilities (POS 61, 62 or 21)Public Health Clinic (POS 71)Rural Health Clinic (POS 72)Veterans ClinicVeterans HospitalOther
E-mail*
example@example.com
Consent and Use of Information
By entering and submitting information through this form, you acknowledge and consent that the Wound and Hyperbaric Association (WHA) may use the information you provide for internal evaluation, research, advocacy planning, and program improvement related to patient access to cellular, acellular, and matrix-like products (CAMPs).

You further acknowledge and agree that WHA, or a public relations firm acting on WHA’s behalf, may contact you to verify or clarify the information submitted. Verified information may be used to support advocacy activities intended to address current CMS policies that may adversely affect Medicare beneficiary access to CAMPs.

WHA will not disclose, sell, or distribute your information to third parties for commercial marketing or other commercial purposes. Information may be shared with agents or contractors working on WHA’s behalf solely for validation, analysis, communications, or advocacy support consistent with these purposes.
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