CTP Regulatory Shifts: What’s Next and a Practical Reality Check

• Diversification Is No Longer Optional - Practices that depend on a single reimbursement-driven revenue stream are exposed. Long-term stability comes from services patients value—regardless of payer shifts.
• Prevention and Value-Based Care Are Growth Engines - Comprehensive diabetic foot care programs that emphasize risk assessment, monitoring, and prevention align with where healthcare reimbursement is heading.
• Adapt Early—or Be Forced to Adapt Later - The most successful practices are transitioning before crisis hits, using existing patients, testing new offerings, and building sustainable models with runway to learn.

In this part of a recent interview with Jim McDannald, DPM, of Podiatry Growth, he shares how he sees practices adapting in light of regulatory changes, and what he predicts for those that do not find a way to do so.

Everybody kind of wonders what's next and what are the new, emerging, high-margin opportunities that aren't dependent on skin substitute reimbursement. So (there are) three areas that I'm watching closely. The first and foremost in my profession of podiatry is forms of minimally invasive surgery. The bunion market alone is projected to hit over a billion dollars in 2032. Patients want faster recovery, smaller incisions, less downtime. If you have surgical skills, that's a very highly valuable service that isn't going away. Second, I would say, is that there's forms of noninvasive care that can be beneficial for folks from a perspective of regenerative medicine and shockwave therapy. These are largely cash pay, which means that they're not the mercy of payer decisions. The patient pays for the outcomes and not for the insurance will cover. And third, the sleeper here is really, and this applies to everyone that deals with wounds, is that comprehensive diabetic foot care programs are just as viable and just as important as they always have been.

This is not just a wound care issue, but this is like a full continuum of care. Things like risk assessment, preventative care, accommodative orthotics, and monitoring. There's movement towards value-based models these days that reward keeping patients out of the wound care cycle in the first place. So the common thread is that either cash pay, surgically oriented, or those aligned with the healthcare reimbursement system as we know today, are going to head for better results and have more success in the future. Another one is, how do practices start transitioning their patient base now versus waiting for the crisis? And I would say start with patients that you already have and look at your wound care population. What else do they need? Many of them have biomechanical issues that contributed to their wounds. Many need better offloading, custom orthotics or gait assessment. You're not finding new patients.

You're serving your existing patients more completely. So they then adjust your marketing mix gradually. If 80% of your marketing budget is wound care-focused, shift 20 towards the services you're building. Test what resonates and then see what converts. The worst time to transition is when you're desperate. If you wait until the crisis hits, you're making decisions under pressure with no runway. So start now when you have the breathing room to experiment and learn. When I talk to other physicians and other wound care providers, I'm hearing in some of these conversations that there's a lot of frustration that they didn't see it coming, even though there had been some riding out the wall potentially for a while. There's some regret over reliance on one revenue stream, but also hearing real determination. I think the practitioners who've been through reimbursement cycles before know that this isn't the end.

It's a recalibration. The ones asking the right questions like how to diversify, where do I focus are going to come out stronger out of this than the ones that are just panicking and just not really sure what to do. So what concerns me is that practitioners who think they can just wait it out, who thinks things are just going to get back to normal, they won't. The practice that thrive will be the ones who adapt, not the ones who hope. There's a bit of a difference versus a tactic that you'll survive. This versus those who won't. Tactics that survive are the ones that are built on fundamentals. Obviously, you're providing a clear value proposition to patients. You have operational efficiency, diversified revenue tactics that won't survive are built on kind of arbitrage. Finding the gap between insurance pays and what it cost to deliver without creating real value for the patients.

That gap is always going to close. Eventually. If your strategy or you're working in a way that only works because of specific types of reimbursement rates, you don't have a real business model, you have a temporary opportunity. The question to ask yourself is, if this specific payment went away tomorrow, would patients still want what I offer enough to pay for it somehow? If the answer is yes, you've got something sustainable. If not, you're riding a wave that's going to eventually break and you're going to be kind of left out in the surf, so to speak.

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