Ostomy surgeries, including colostomies, ileostomies, and urostomies, are life-saving procedures that significantly impact patients’ quality of life. However, access to quality care and essential supplies is a critical concern for individuals living with an ostomy. Despite advancements in medical technology and the development of innovative ostomy products, the policies surrounding reimbursement, coding, and coverage for these supplies have not kept pace. This has left countless patients navigating a fragmented system, often paying out of pocket for the care and supplies they need to live comfortably and healthily.
Recognizing these widespread issues, the Wound, Ostomy, and Continence Nurses Society™ (WOCN®) is taking action.
This spring, WOCN will host the Ostomy Policy Revision Strategy Meeting, a pivotal two-day event in Philadelphia that will bring together key stakeholders to discuss the systemic challenges in ostomy care related to access to care. The Ostomy Policy Strategy Meeting is also part of a broader initiative led by the WOCN Ostomy Policy Revision Taskforce, a team of dedicated experts to ensure the outcomes of the meeting lead to tangible improvements in ostomy care policies nationwide.
A Unified Approach to Change
For too long, efforts to improve ostomy care policies have been fragmented, with individual groups working independently to push for changes in reimbursement, coding, or coverage. While these efforts have been well-intentioned, progress has been limited.
The WOCN Society’s Ostomy Policy Revision Strategy Meeting represents a significant step forward—a chance to hear the voices of stakeholders across the ostomy care landscape and present a collective case for change that tackles several obstacles.
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- Inadequate Reimbursement: Many reimbursement rates for ostomy supplies haven’t been updated in over a decade, failing to reflect the costs of newer, potentially more effective products Additionally, some essential products lack appropriate billing codes, resulting in no reimbursement for the latest advancements available on the market.
- Coding Challenges: Current Healthcare Common Procedure Coding System (HCPCS) codes often lack sufficient detail to capture the full range of ostomy products developed in the past ten years, leaving providers and patients without adequate coverage.
- Coverage Disparities: Gaps in care and coverage for individuals with ostomies vary drastically across states, creating unnecessary barriers for patients and significant inequities nationwide.
- Lack of Published Research: The absence of large-scale studies examining the financial impact of inadequate reimbursement on patients with chronic ostomy care needs.
“Our goal is to bring relevant stakeholders to the table,” Kathleen Lawrence, MSN, RN, CWOCN, CWOCNF, WOCN Public Policy and Advocacy Coordinator explains. “This is the first time a group this diverse has come together to collectively address these issues. From product manufacturers to clinicians to patient advocates, we’re building a coalition to tackle these problems head-on.”
The Ostomy Policy Revision Strategy Meeting
Bringing together a range of stakeholders from across the healthcare spectrum—including patients, providers, payers, manufacturers, durable medical equipment (DME) distributors, and professional organizations—this meeting will serve as a structured platform to analyze the critical matters surrounding ostomy care.
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- Analyze Current Challenges: Identify deficiencies in HCPCS codes, reimbursement rates, and coverage policies for ostomy supplies.
- Develop Recommendations: Propose actionable updates, such as fee schedule increases, revised coding guidelines, and solutions for statutory limitations.
- Disseminate Findings: Prepare a comprehensive report of recommendations to share with healthcare policymakers, insurance providers, and other relevant stakeholders.
By uniting such a diverse group of voices, the WOCN Society aims to create meaningful, unified proposals that meet the real needs of patients and providers.
A Shared Commitment to Progress
The WOCN Society understands that achieving lasting improvements in ostomy care policies will be a challenging journey. But we’re eager to get started—fostering collaboration among stakeholders, developing actionable recommendations, empowering patients, and advocating for change.
WOCN® will continue to provide updates on this critical work. Want to be the first to hear announcements and important news? Be sure to subscribe to get the latest noteworthy happenings and other timely WOC industry-related information from your WOC Community of OpportunityTM .