CMS CTP Pricing Changes Could Shift Wound Care Volume to Academic Centers—and Limit Patient Access

Finalized CMS pricing and regulatory changes for cellular and tissue-based products (CTPs) are expected to significantly alter where—and how—wound care is delivered. In this interview, an academic wound care specialist explains why private practices may pull back from CTP use, how academic and hospital-based centers could see rising patient volumes, and what this shift could mean for patient access, practice sustainability, and evidence-based decision-making. 

• CTP Volume Is Likely to Shift from Private Practice to Academic Settings - Reduced financial incentives, increased clawback risk, and finalized CMS pricing may discourage private practice clinicians from offering CTP applications. As a result, more patients may be referred or transferred to academic and hospital-based wound centers, where facility fees and existing vendor relationships help offset costs. 
• Patient Access Could Worsen Despite Centralization of Care - While academic centers may absorb more CTP cases, longer wait times are already a concern—often weeks to months compared to same- or next-day access in private practices. This shift risks delaying care for complex wound patients, potentially impacting outcomes and limb salvage efforts. 
• Providers Must Reevaluate Product Selection, Contracts, and Protocols - Both academic and private providers will need to renegotiate vendor contracts, reassess product cost-effectiveness, and align CTP use more tightly with evidence-based criteria. Shelf stability, shipping timelines, graft size limitations, and missed appointments now carry greater financial risk, making adjunctive therapies and revised care protocols increasingly important. 

Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text.   

When it comes to CTPs in the academic setting for at least for practitioners in wound care and the academic side, which I can speak to, I think what is going to happen is we may have an increase in volume of patients, and then I guess that may allude to some other discussions we'll have later on when it comes to this. But essentially what I think is, we're going to have an influx of patients because of the patients that are being managed by private care docs may have to be transferred over only because of the incentive to provide these skin substitutes on these patients just is not going to be there. And most of the friendlier products, without naming a brand in particular, typically are favorable more so in the academic setting, our hospital settings.  

So I think that's where the favorable delta variance for these applications will be. Unfortunately, I mean, I would love if my private practice cohorts could still be able to do this and actually make enough for them to have that delta for them to be worthwhile, but there's a lot of risk with the clawbacks and everything going on that they may not be incentivized to want to apply these in their practices based on the current fee schedule that's been finalized by CMS. With that also being said, it is going to be, I think a lot of the legacy CTP companies may have an advantage, but that's more so an opinion, because some of them already have established relationships with the academic centers and they also do have favorable delta variants when it comes to application in both the outpatient setting and in the surgical setting for these patients. 

But that is really what I think is going to happen. And when it comes to private practice, I do think the private practice docs may not be as intrigued or interested in the skin sub application realm given the fee schedule that's there, just because of how much money they have to spend to get this product. Then if they got to apply it and then they have to wait to get the billing and then actually get the fees that's been negotiated and finalized just may not be worth it for their practice. It actually could be more expensive for their practice as well. So hopefully that address some of those concerns. But essentially what I think is going to happen is right now, I think applications are going for both private practice and academics balance, and I think it's going to weigh higher on the academic side only because of the finalized price that was released by CMS. 

Whether I agree with it or disagree with it doesn't necessarily matter, but it kind of is what it is when it comes to that. Yeah. So this shift for the shift or the finalized ruling with the CTP regulations definitely will shift patient access and it actually will decrease patient access because I mean now my waiting times for a new patient, I mean, it fluctuates, but sometimes my waiting times for a new patient for a wound care center, it could be a month. If they were able to go to a private practice doc that had an open slide, it could be a day. So it can change the patient access side, especially now if I end up getting the influx of patients, now that month can go into two months, three months, before a patient can even be seen and they still have to wait 30 days of care and they haven't seen a provider because the providers may not even want to actually see wounds anymore because some of them highly dependent on that skin grafting to subsidize for their standard of care patients, if that makes sense. 

Because to kind of balance out, because not every patient that has a wound needs these CTPs, which I always want to emphasize. But what happens is these patients who have normal standard of care that aren't getting CTPs, getting a lot of addressing changes, coming to these doctor's office fairly frequently average out these balances for these patients because the patients that are getting CTP applications, they were getting enough money to balance out and made it worthwhile for private practice doctors to actually want to do wound care. Because in the academic side, we also get a facility fee, which could also make wound care expensive, but there's a facility fee that these individuals pay or their insurance pay when they come to see us at these academic institutions. So it still calls burdensome to the healthcare system, but I definitely think my private practice colleagues play a vital role in wound care and limb salvage. 

And obviously I understand what they have to do for financial reasons, they have to discontinue or not even really carry much CTPs because the incentive is not there for them, which I understand because they have to be able to pay their employees and pay their rent and pay for their materials because it's very expensive, especially with inflations and everything else going on. The biggest challenge, which I probably should have addressed earlier, the biggest challenge that providers are going to face really is the renegotiation. So renegotiating the existing contracts that you have with some of these companies to see if it actually will be worth it when you purchase this product to be able to use it and then actually get a profit from it when applying. Do I think there were some products that were given way too much profit for what was going on? Agreed, which is why the government had to step in and provide more regulations. 

But I think a biggest thing as a provider is deciding which products you're going to align yourself with. Also from a evidence-based medicine standpoint, which always should be there other than just the financial incentive that was going on before, but you have to stick with the evidence-based, which I believe they'll cover in future releases. CMS will cover which products meet those criteria, but also looking at the cost-effectiveness of it is how the shelf stability, how long it takes to ship it, can it be used within a certain timeframe, things like that. Because if a patient misses an appointment, then you're stuck with this product that you have to try to get a refund for. So that is also something to take in consideration for these practitioners. I don't think it's an easy situation. Even for us in academic medicine, we're going to have to go through our hospitals or going through the contract renegotiations to make sure we're still not losing money on these applications, especially also when it comes to certain sizes. 

Now we may only be limited to a certain size graft because of this final ruling. And that's the biggest thing too. So now you have to be more judged when you're going to put on these grafts versus when you're not going to put on these graphs for skin substitutes. At what point do you do so – if the wound is a certain size and it's not moving, you have to get more creative with different products or other different adjunctive modalities such as hyperbarics, topical oxygen, TCC total contact casting, which I hope you're already doing before you apply these grafts, but are even getting vascular involved because now if you put this graft on, you're actually losing money on these patients and costing money to the practice itself versus making some money towards it. So it's a lot of decisions that the practitioner themselves have to make. And I do think some protocols will have to be revamped both from the academic side and those that are private practice or hospital academic side or just pre-hospital without academics. 

There have to be some protocol changes, which at least at our institution, we're already starting to have internal talks and preparing for all of those and hopefully everything will be favorable for the patients. Even then, the insurances too can start dropping certain products as well based on these rulings. So it's very concerning, but we got to adjust to take care of our patient. 

Dr. Johnson is a Clinical Assistant Professor of Orthopaedic Surgery-Foot and Ankle at the University of Michigan, and is the Founder and CEO of AJ Educational Empowerment.