Why It Matters
Smith & Nephew Inc. is lobbying on the Medicare physician fee schedule and hospital outpatient payment rules governing skin substitutes, wound-care products for which the Centers for Medicare & Medicaid Services (CMS) finalized a single payment rate of approximately $127.28, effective Jan. 1.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported that Medicare Part B spending on skin substitutes rose from approximately $250 million in 2019 to more than $10 billion in 2024, a trend it said raised major concerns about fraud, waste and abuse.
By the Numbers
Smith & Nephew's in-house third-quarter lobbying report listed $480,000 in expenditures, up $130,000 (37.1%) from $350,000 in the third quarter of 2025.
Across all four registrants, Smith & Nephew reported $560,000 in third-quarter lobbying activity. Outside firms accounted for $80,000 of that total: Nickles Group LLC reported $60,000; Cornerstone Government Affairs Inc. reported $20,000; and Hogan Lovells Cadwalader US LLP reported $0.
The in-house filing listed four lobbyists: Josh Jackson, director of public policy and government affairs; Mona Thinavongsa, senior manager of public policy and government affairs; Paul Seltman, senior vice president of global public policy and government affairs; and John Martin Jr., senior director of public policy and government affairs. Jackson appeared on the filing for the first time and previously worked for the House Science, Space and Technology Committee during the 111th Congress.
Broader Context
CMS finalized its calendar-year physician fee schedule on Oct. 31, 2025, establishing a payment rate of approximately $127.28 for skin substitutes billed as incident-to supplies, effective Jan. 1. On Nov. 21, 2025, CMS also finalized its hospital outpatient payment policy, using a single rate across three regulatory categories of skin substitutes.
Rep. Buddy Carter (R-GA) introduced H.R. 5768, the Skin Substitute Access and Payment Reform Act, on Oct. 17, 2025. The bill was referred to the House Energy and Commerce and Ways and Means committees and had seven cosponsors in the supplied legislative record. No Senate companion or action beyond committee referral was identified.
Eight organizations, including the Camden Coalition, the Coalition to Transform Advanced Care (C-TAC), and Accountable for Health, wrote to CMS in September 2025 to support the proposed $125-per-square-centimeter payment rate. They cited concerns about patient harm and excessive utilization.
The American Podiatric Medical Association (APMA) urged CMS not to finalize the policy, arguing that flaws in the proposed payment methodology could harm patients with wounds. Although APMA acknowledged the nearly 40-fold increase in Medicare skin substitute spending between 2019 and 2024, it advocated a different payment methodology.
Smith & Nephew's filing also disclosed lobbying on Section 301 tariffs related to forced labor. The Office of the U.S. Trade Representative (USTR) initiated investigations into 60 economies on March 12 and announced tariffs on July 23, generally at rates of 10% or 12.5%, subject to product exemptions and special treatment for certain trading partners.
The filing also listed defense appropriations and the Base Erosion and Anti-Abuse Tax (BEAT). Congress approved a fiscal 2026 defense appropriations measure on Feb. 3, providing approximately $838.7 billion in discretionary funding, according to the supplied legislative information. Public Law 119-21, enacted in 2025, lowered the BEAT rate to 10.5% for tax years beginning after 2025.
The Bottom Line
Smith & Nephew's in-house lobbying expenditures fell from $430,000 in the first quarter of 2025 to $340,000 in the fourth quarter, then rose to $480,000 in the third quarter of the current year. That was the second-highest amount reported across the seven quarters from 2025 through the third quarter, behind $490,000 in the second quarter.
Jackson joined the company's disclosed in-house lobbying roster in the third quarter, with no lobbyists removed. H.R. 5768 remains at the committee-referral stage in the supplied legislative record, with no House floor vote scheduled. Unless enacted, the bill would expire at the conclusion of the 119th Congress.
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