Practices and Challenges of Medical Care, Guidance, and Billing Following the Introduction of the Lower Limb Wound Care Management Fee: A Nationwide Survey of Physicians

Abstract

 This cross-sectional study aimed to investigate the practices of diagnosis, guidance, and billing related to the newly introduced Lower Limb Wound Care Management Fee established in the 2022 Medical Fee Revision, and to examine the associated factors. An online survey was conducted from July 30 to September 30, 2024, targeting physicians who had undergone management fee training and were working full-time at certified facilities nationwide. A total of 435 responses were collected. The results showed that some physicians, despite working at certified facilities, were not claiming the fee. Moreover, some physicians with prior experience reported that they were not claiming it. Our findings suggest that it is difficult for physicians, particularly in small-scale facilities, to fulfill billing requirements due to the burden of providing guidance without sufficient team support. In addition, although the current fee applies only to wounds on the foot, multiple physicians responded that wounds on the lower leg（crus）should also be included in the fees, indicating clinical challenges in managing such cases. These findings highlight structural issues in the current billing criteria and healthcare delivery. Future improvements in interprofessional collaboration, team-based care systems, and the refinement of billing requirements are needed.