Observations on Potential Pivots and Continued Change

Mr. Nelson is the VP Sales & Marketing for Swift Medical and Founder of the WoundCareFund & Below the Knee.

• CMS/LCD changes are driving a shift to diagnostic decision support; spectral/fluorescence imaging provides a reimbursable component and dashboarding to triage staffing and allocate higher-acuity resources in wound centers and multi-state mobile care.
• Documentation/prior authorization: build defensible records now—audits can look back 6 years; high-volume CTP use justified by phone photos/paper rulers is flagged as risky.
• Market impact: smaller CTP manufacturers reliant on high ASP may collapse; larger diversified firms and mobile networks (CTP/CAMPs ≈10% of care) expect consolidation/M&A and supplier-provided prior-authorization/documentation services Q4 2025–early 2026.

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. 
 
Well, I mean, I've already spoken to several mobile groups. And these are more distribution providing groups, not the providers, that are already, you know, basically planning a vacation in January, and they're going to figure out what job they're going to have next year or what they're going to do. You know, I think smaller CTP manufacturers that were dependent upon the high ASP are going to collapse. And they probably should. I think if you don't have, if you've not built a business that can withstand, we live in a regulated environment. I've only ever worked in the MedTech industry. So if you build a business that cannot withstand regulatory changes or reimbursement shifts, then I'd say it's a business that has not been de-risked. So, you know, I think some of the consolidation we're going to see is justified. It's going to be painful, but it's justified. But I think out of that, we're going to see a market that's going to be stable is my hope. I think of the larger firms with diversified portfolios, right, they're going to be fine. You know, I think for them, there's acquisition opportunities. So I definitely think we're going to see consolidation from an industry perspective. I would expect that we're going to see that roll into the provider networks. So some of these larger mobile groups are probably going to acquire some of the smaller groups or their assets, and it gives them room to kind of grow. I've spoken with several mobile provider groups that cover multiple states. And, you know, CTP or CAMPs, you know, per their words, is probably 10% of their care. So they're going to feel this, but it's very manageable, and it gives them opportunities to kind of reassess, you know, where, and then, you know, obviously what other technologies do we pull in? You know, imaging is still a relatively new field. I mean, I was doing imaging when I first got into MedTech 20 years ago outside of wound. So it's not new, but it's new. And if we look at the spectral imaging, so, you know, like if you're using fluorescence appropriately, it does give you a reimbursable component. Is it going to offset all the skin sub? Absolutely not, right? But it gives you an opportunity to pull a device in that can drive efficiencies that can really help you do a much better job of cost savings. And the fact that I can reimburse for the use of that offsets the system itself. So I effectively have a chance to kind of get a free solution that really gives me an opportunity to kind of right-size my business, drive more efficiencies, and just get better, again, that data and get better visibility in the data so I'm providing the right point of care to the right patient. Now, I've got a big dashboard. I can look at all my patients and I can see, right, which ones are stalled, which ones are healing, what's my healing trajectory? And then I know which provider to maybe go deploy or send if I'm mobile or if I'm in a wound care center, I know who's coming in, and I'm better able to staff for the day. So I can really, you know, put my high dollar, my higher acuity, higher dollar cost toward the patients that need them and I can reserve maybe some of the lower care costs for the patients that are on a good healing trajectory. These imaging systems, the data with a good dashboard that give you that visibility. Otherwise, you're going through sticks of paper, right? We're really going through charts and that's just, we don't have time for that anymore.

I think they're already in process, you know, it's, you know, I equate that Halloween evening when we saw the CMS notification come out. You know, I'm a comedy movie buff, right? So if we recall back in the original Austin Powers movie, when they're looking at the steamroller from 100 yards away, moving in a glacial pace, and when it got to them, it ran them over. So we've known this was coming. LCD changes were 2 and a half years ago. Here it is, hokey-pokey, right? We're going to throw it out there. We're going to pull it back. We're going to put it back out there, public comment. We're going to change it. Here it is. Same thing with the CMS. So we've known this was coming. We just didn't want to acknowledge it because it was not tasteful, right? We didn't like it. It's here. So I think the pivot to diagnostic decision support is absolutely going to be driving some significant gains. You've got to be smarter with your resources. You've got to use tools that are going to give you information that otherwise you don't have. If you are applying, it’s no longer a high dollar ASP, but if you are applying, you know, CTPs and high volume and you're basing that on the fact that the wound stalled because you took a picture with your phone using a paper ruler, you're going to have challenges with the audits that you are going to go through. Remember, audits can go back 6 years. So you could be 4 years from now being audited on things you did 2 months or a year before the LCD took effect. So what are you doing now to really put yourself in a position to defend the decisions? It's all about justifying why. Why did you apply this and not that? Why did this patient, if every patient is needing skin substitutes at the maximized pricing, it's whack-a-mole, and you’re firmly putting in your head right in the middle to be visible. So I think the pivot to diagnostic decision support, it's in process, but it's still slow. You know, I think these technologies that are not new, were still new to people. So I think that's something that I expect to see. 

And then, you know, really double down on evidence in real world. So what are you, what's the data? What are you really showing? What is your performance metric? I think as wound care is continuing to evolve, the providers are really needing to show kind of, you know, why, why is this my treatment? And as I'm advertising to patients, we tend to focus a lot on mobile, but even as wound care centers, which have mobile extensions of them, how do I reach the patients and ensure that I’m providing the right care for the patients. Now I’m marketing to the patients. I need to provide them confidence in why to choose me. You know, health care in general is becoming much more of a direct-to-consumer model. We’re not quite doing the pharma ads, TV ads, and I hope we don't, but, you know, we're definitely doing a lot more marketing directly to the patients, and patients are becoming much more engaged and much more informed. You know, I think, you know, the things that the industry is should be doing is, you know, building prior auth and documentation services into their commercial offering. 

Several of the skin sub companies have been doing that for the last probably 2 years. You know, they've been implementing, you know, big systems where they're automating kind of the supply chain mode, but they're building into their offering as a service in addition to the products they provide, you know, that prior auth and documentation. I know several large distribution companies, which are really no longer distributors, they're almost quasi-providers as they're growing into much larger entities. And so they're putting forward, you know, prior auth documentation services. So, you know, I think they're going to, you know, as an industry, it's how do we streamline the process? Break it down to the basics. If I'm a provider treating a patient someplace, what is it that I'm doing? And how do I just make this effortless where as a provider I'm simply providing care? The tools can help get to that point.

And that's where I think the industry needs to continue to shift, where if I'm industry, and I should be putting things forward that just make it so easy to use me as a provider because I'm offloading that. And I think industry is continuing to kind of move toward more of a service offering. It's not a lot of historically, especially in wound, we've been very transactionally focused. I need 14 things. So I talk to 14 people. I take 14 steps, and I talk to the patient 14 times. And I think that day is gone, because we can't afford the efficiencies that we need or the inefficiencies that brings. 

So, you know, I think we're going to be saying, you know, pivot to diagnostic decision support. I think we're going to continue to see a lot more evidence-based and the LCDs are driving that. Whether the LCDs happen or not or happen differently, I think that bar has been set that you're going to need data and evidence. So I think that's going to continue. Prior auth documentation, whether it's the provider doing the prior auth, whether partnering with a third party, if it's the supplier that they're purchasing product from that does that, all that should be, it can and should be automated.

I'm a product marketer by, you know, I mean, I, you know, commercial sales and marketing, but I'm a product marketer. I love developing, launching products. You know, that is one of the most fun things. We don't need as many as we have, right? So I think if we've, you know, there's going to be some product rationalization and pricing flexibility across, whether it's from the supplier to the provider, the provider to the patient, I think we're going to all get a little more flexible in how we at the end of the day take all these dots and connect them to the patient point-of-care treatment, looking back at driving healing, you know, I think, you know, commercial focus, you know, we talk, you know, non-CTP revenue streams, I think is going to be one. That's the role I plan, right?

So I'm a SaaS-driven wound imaging monitoring. So, you know, how do we get flexible? That's one of the things that we're pivoting on my world is, yeah, we're not a capital device looking to charge a high dollar. It’s how inexpensive can I be to get you started in a platform that's going to drive efficiencies. So, you know, I've got an enterprise-wide wound management solution that will, you know, calculate depth. It'll calculate the wound image. It'll give you rigor toward better chart notes and documentation. It'll give you a solid back-end portal. And by the way, it's not a purchase, right? This is a SaaS model. So we're bringing a new model into the industry that is atypical, and we're all figuring it out together, but it gives you a chance to just a low cost. It's like Netflix. So let's try something different to bring efficiencies in a different way. 

And then I think we all need to prepare. I'm a market analyst industry geek and I love the finance, right? I've got the wound care fund. I've got the below-the-knee. I'm excited because I think we're going to see, expect to see an uptick in M&A and kind of align, you know, strategic alliances and get back to some investment. You know, the soapbox I've been on for a while is, you know, CTPs is a relatively small percentage of the patient care continuum. It is the only thing we talk about. And the chaos of the result of probably just a very few people that have crossed some lines. And I think we're past that, but it scared the investment community off. And so I think we've seen some strong market constriction, or contraction rather, you know, I mean, I can measure very accurately what market cap loss that we have seen from the public companies that are timed to very specific press releases, news articles, CMS decisions. You know, I can look at what the average annual investment for it, whether it be venture capital or private equity over the last 5 years, we've seen a pullback of that. And then forward looking, if we look at where the world would have been, should this have been, you know, as an industry, we've lost over $10 billion. And so now I hope that, yes, this is painful, because change is painful. But this change is going to bring stability. For an investor, they want confidence. And so I think we're going to see M&A pick up. I think some of the key strategics, they've been, you know, quietly sniffing around for a while. So I think we're going to see, you know, the consolidation drive, M&A activity, the large strategics I think are going to move into some new spaces. And I think we’re going to have the opportunity to also see some new players outside of wound enter the wound care space through acquisitions, through the consolidations. So, you know, to me those are some of the trends that I would expect to see potentially, you know, as we’re here in Q4 of 2025 and definitely in early 2026.