We’re a week from Thanksgiving and still awaiting the final home health rule that could reconfigure Medicare competitive bidding and accreditation in drastic ways.
As I wait, I’m also thinking of sulfonamides, aka sulfa drugs, because of a book: The War I Finally Won, by Kimberly Brubaker Bradley. I’m thinking about how an innovation can change everything.
During World War II, Ada and her younger brother have been evacuated from London and taken in by Susan, who’s been alone since her partner, Becky, died several years earlier from pneumonia. When Susan herself becomes ill with pneumonia, the children are terrified — until a family friend tells them about “wonderful” sulfa.
“More than 90 years ago, sulfonamides changed modern medicine,” the Cleveland Clinic’s website says. “These were some of the first widely used antibiotics. Sulfonamides weren’t the first antibiotics. But they were some of the best antibiotic drugs available for about a decade after their discovery. Deaths from infectious diseases fell by about 28% in the United States after sulfonamides became widely available in the mid-1930s.”
While most medical advances unfold over long periods, sulfa drugs and other antibiotics were an evolutionary leap: They cured bacterial infections instead of relieving symptoms. They changed the way health care approached bacterial illness.
‘Skin’ that heals
In wound care, traditional best practices have emphasized keeping wounds clean, debriding when needed, keeping them beneficially moist and protected, and using negative pressure wound therapy when applicable.
The approach has been to protect wounds while the body heals itself. But now, skin substitutes actively participate in the healing process.
“Skin substitutes are advanced wound care solutions that mimic natural skin to promote effective healing,” said the Limb Preservation Center of East Tennessee. “They’re used for treating difficult wounds like diabetic ulcers and burns. A skin substitute enhances healing through multiple mechanisms, reducing healing time and scarring … Unlike average bandages, these high-tech materials are designed to act like real skin.”
Some skin substitutes include “natural proteins like collagen and elastin, which are found in healthy skin,” the Limb Preservation Center added. “Synthetic materials created in labs are available, as well. Some substitutes even include living human cells or special molecules that encourage healing.”
Skin substitutes can “act as a scaffold that supports new cell growth,” or they can “deliver growth factors and bioactive molecules that stimulate cell migration and repair, accelerating tissue formation.” They also protect against bacteria and modulate immune responses, which creates a better environment for healing, the Limb Preservation Center noted.
In the Calendar Year 2026 Medicare Physician Fee Schedule final rule released Oct. 31, the Centers for Medicare & Medicaid Services (CMS) capped funding for skin substitutes at $127.28 per square centimeter per application, a rate that the Medicare Access to Skin Substitutes (MASS) Coalition warns will grievously restrict access for patients.
CMS has railed against “skyrocketing” Medicare expenditures for skin substitutes, and of course reducing waste, fraud and abuse is critical. Bad players hurt those who abide by Medicare rules, and they hurt Medicare beneficiaries most of all.
But rising expenditures don’t tell the full story, such as how skin substitutes can lower overall expenditures by shortening healing times and keeping patients out of hospitals. True innovation — when new technology reshapes what’s possible — needs appropriate funding. Patients deserve that.
In a book I’m currently reading (The Knife of Never Letting Go, by Patrick Ness), skin substitutes are so efficacious, affordable and easy to use that the two teen protagonists apply them with great success. They even use one to treat their dog, Manchee, whose tail is injured.
I feel fortunate to have seen several evolutionary products in my lifetime. Smartphones, for example, are so robust that it’s hard to remember life without them.
I hope that sooner than later, we feel the same way about skin substitutes and the healing they bring about.
