CTP Regulatory Shifts: Thoughts on Business Model Diversification and Marketing

Jim McDannald, DPM, explains why practices overly dependent on a single payer or procedure are most vulnerable to reimbursement shifts—and how diversification, smart marketing, and building true profit centers can stabilize growth during regulatory uncertainty.

• Know your numbers before policy changes force you to. If more than 50% of your revenue comes from one payer or one CPT family, you’re exposed. Practices hit hardest by skin substitute changes weren’t blindsided by CMS—they were blindsided by their own revenue concentration.
• Diversification means building profit centers, not just adding services. Sustainable diversification requires a defined patient problem, a marketing system that attracts those patients, and the operational capacity to deliver care profitably. Equipment alone doesn’t create revenue—systems do.
• Don’t go silent—lean into expertise and outcomes. Regulatory shifts should change how care is delivered internally, not how expertise is communicated externally. Practices that stay visible, educate referral sources, and focus messaging on patient outcomes gain authority while competitors pull back.

Look at two things, I would say, when it comes to diversification of your revenue streams. (First,) concentration dependency. If more than 50% of your revenue comes from one payer or one procedure category, you're exposed. The practices that are going to get hit the hardest by skin sub changes weren't surprised by the policy. They're surprised by their own numbers, really. So you should run things like a simple report. What percentage of your revenue is Medicare? What percentage is one specific CPT code family? If you can't answer those questions in 60 seconds, that's your first problem, I would say. The second thing is watch what auditors are watching. So when MAC contractors start asking for more documentation on something, that's your early warning system. I think a lot of people maybe were caught off guard because for whatever reason they didn't see that coming. But the scrutiny usually starts before the cutting starts.

Once you see a little bit of friction in the system, it's probably a sign that either Medicare or insurance providers are going to go after a certain procedure or a certain CPT code. People are curious about what a realistic diversification strategy looks like for a practice that's currently maybe 70% wound care? You're not going to flip that overnight and you shouldn't try to. The goal is really building kind of a second revenue engine within the practice while the first one is still running. So start with what you already have. Most wound care practices see patients with diabetic foot complications. That's a natural bridge to things like preventative care, custom orthotics, vascular screening, referrals, and then people, if they choose to, can look into different kinds of cash pay modalities that compliment your clinical skills. So whether that be shockwave therapy or some form of regenerative medicine or different types of recalcitrant wounds that are not responding to necessarily traditional approaches, those aren't replacements for wound care.
There are additions that don't depend on the same kind of reimbursement roller coaster that people are on right now. I think the mistake is thinking that you need to become a completely different practice and you don't. You need to add revenue streams and services that aren't correlated to the same kind of policy risk that you had with skin substitutes. People are sometimes curious about what's the difference between adding a service and actually building a sustainable profit center. Adding a service is buying a piece of equipment or putting it on your website. Building a profit center is creating the entire system around it, the patient pipeline, the staff training, the follow-up protocols, the marketing that actually brings in the right patient. So I see it constantly. A practice buys a $40,000 piece of equipment and does three treatments in six months and calls it a failure.

And it wasn't the fact that the product or the machine or the modality was a failure and the technology was still good, it was the failure and the ability to build demand for it. So a real profit center has three components. One, a defined patient problem it solves, two, a marketing system that consistently attracts those patients. And three, operational capacity to deliver the service profitably. If you're missing any of those three, you've got an expense and not necessarily a profit center, but sometimes we hear a lot is about how do you mark your practice when the regulatory landscape keeps shifting. So what you do is you focus on what doesn't change. Patients still have problems and they're still looking for solutions. The regulatory stuff matters for your billing department and your compliance. But the marketing should be talking about patients and their outcomes, their quality of life, and their ability to go back to doing what they love doing. So we treat chronic wounds. Doesn't need to change based off of skin substitute reimbursements. What changes is how you deliver the care internally, not how you talk about it externally. The practices that pause their marketing during uncertainty are the ones that lose ground. Your competitors aren't stopping. The patients are searching for help and they're not able to find you. If you go dark, you're just handing marketing share over to somebody else.

Another topic that people will bring up is, should I lean into or away from wound care expertise in my messaging right now? So people are concerned that should we still push this in a way that shows us and shows patients our expertise? And I would say, really, people need to lean into that. Your clinical expertise didn't change because CMS changed a policy. Here's the thing, patients don't know what skin substitutes really are. They don't care about CPT codes. They care that they've got a wound on their foot for the last eight months and it won't heal. That problem is still real and you still solve it. So I would avoid leading into specific products or techniques that are kind of in regulatory flux.

That's not the stuff you want to market or show externally. Lead with the outcome that you provide for patients. Lead with your expertise in healing complex wounds. The delivery mechanism can evolve behind the scenes. The worst thing you can do is signal uncertainty to referral sources. If primary care docs think you're backing away from moon care, they'll probably going to find someone else that can help them with those types of patients. And also people will talk about, should we stay silent during all this stuff going on, or should I use it as an opportunity? And I would say that going silent tells everyone, your patients, your referral sources, your community that you don't know what to do. That's the opposite of what you want them to think. The opportunity here is positioning yourself as the steady hand while everyone else is panicking or disappearing, you're the one showing up with valuable information. Continue to educate, continue to be visible. I'd actually argue that uncertainty is the best time to establish authority. For example, during the pandemic, the clinics that continued to market and show their services were the ones that patients came back to. So write up articles explaining what the changes mean for patients. Host lunch and learns for referring physicians so they understand the situation, be the person who makes sense of the chaos. The practices that emerge stronger from disruptions aren't the ones who hunker down. They're the ones who step up.

Dr. McDannald is the Founder and CEO of Podiatry Growth.