The Impact of CTP Changes on Provider Types

• CMS (US) — flat CTP pricing (~$127/cm²): Replacing HOPD packaged pricing corrects prior losses and enables hospital outpatient departments to treat large wounds (e.g., VLUs, pressure ulcers) by purchasing products per cm² below the flat rate.

• Care-setting effects: HOPDs benefit most; skilled nursing facilities and brick-and-mortar offices remain viable; home/mobile practices may be most affected depending on their economic models, though not all rely on CTP margins.

• Product handling considerations: Clinically effective human skin products require special temperature-controlled handling, prompting workflow and inventory changes across settings without negating clinical value.

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. 

So the feedback that we get is how might smaller practices, or hospital-based or mobile clinicians experience these changes differently. And in some ways this is a fantastic change for the hospital-based outpatient department. That's where I've spent my career. We have all been telling Medicare for 10 years that package pricing was implemented badly. It was badly calculated. And as a result, the only things we've been able to do in the HOPD is treat very tiny wound sizes because we had to buy it by the piece. We weren't buying things by the square centimeter, and given the amount of money available in the package pricing, most hospitals have been losing money off of skin substitutes. The clinicians may not even have been aware of how much money the hospitals have been upside down on those products. 
 
So now what that means is a hospital-based outpatient departments suddenly can treat a wound as big as they need to treat because they can purchase a product, as long as they pick a product that costs less than $127 per square centimeter, they can now treat large VLUs, large pressure ulcers, whatever it is that they intent to treat. So big change that’s positive for the hospital-based outpatient department. 
 
I think that practitioners most affected are those going in the home and that is going to have to be decided based on what their whole economic model is for home care. I know there are many mobile practices that have been going into the home seeing patients before skin subs came around. So not every mobile practice business model is dependent on that. 
 
Skilled nursing, I think it's still very viable for those docs. And also, even in the office, the brick-and-mortar office, I think it’s a viable thing. The most interesting conversation is around the fact that some of the products that may best from the standpoint of health economics and health outcomes are live tissue products like Apligraf or TheraSkin or the other human skin products. And those come live and so not every environment can handle a product that supposed to be climate controlled for whatever reason. So live may not be quite the right word but they are not shelf life products; they require special handling. 
 
So I think one of the strange impacts is going to be asking themselves if they can handle a product that requires special handling and in terms of temperature. But I’ve found those products to be fantastic clinically so that will involve some changes in the way products are ordered and stored and won’t necessarily be pulling them off the shelf but I don't think that's a bad thing. I think it's just a downstream reality that different products are going to be used and people are going to have to learn different products.

Dr. Fife is the Chief Medical Officer of Intellicure, LLC.