This author shares her observations on a market reset pushing wound care toward a hybrid model: clinic-centered, mobile-capable, clinically diversified, and supported by more than one economic engine.

Key Takeaways

• Shifting reimbursement conditions are exposing the vulnerability of wound care models that depend heavily on a single product, payer, or revenue stream.  
• Emerging models may combine a clinic-based hub with mobile and remote care, allowing practices to maintain access while centralizing equipment, staff, inventory, and complementary services.  
• This author feels that diversification should reflect the needs of the practice’s patient population and may include adjacent clinical services and carefully selected cash-pay offerings without creating a new form of single-stream dependence.  

Over the past year, wound care conversations have centered on cellular and tissue-based product (CTP) reimbursement, Centers for Medicare and Medicaid Services (CMS) policy, and the impact on both patient access and practice sustainability. Those issues deserve attention, but they are also accelerating a broader transformation: the wound care business model itself is changing.

Across the practices I work with and organizations entering the space, the same signals keep appearing. We see dependence on a single reimbursable product giving way to diversified revenue. Mobile-first models are reconsidering physical locations. Practices are adding services that address conditions surrounding the wound, and cash pay is entering conversations that historically focused almost exclusively on reimbursement.

Taken together, these are not isolated trends. They point toward a different kind of wound care practice.

Mobile Care is Recalibrating

Mobile wound care expanded for good reason. Patients with chronic wounds are often older, medically complex, and mobility-challenged. Bringing care into the home, assisted living community, or skilled nursing facility removed a significant barrier to treatment.

The need remains. The economics have changed.

Under the CY 2026 Medicare Physician Fee Schedule (PFS), CMS changed payment for skin substitute products used as part of covered application procedures, treating the products as incident-to supplies and establishing a single payment rate for 2026.¹ A national survey conducted shortly after implementation, representing approximately 12,000 wound patients per week across 36 states and Washington, DC, found that 45.4% of respondents reported an actual or planned closure of a wound care practice or service line. Notably, 57% of reported practice locations represented home-based, assisted living, or mobile/portable care.²

Those figures should not be interpreted to mean that 45% of mobile practices nationwide have closed. They do, however, reinforce what is becoming visible in the market: a mobile model heavily dependent on CTP economics is considerably more vulnerable today than it was a year ago.

We do not feel that the next model eliminates mobile care. Instead, it uses it more intentionally. A clinic can serve as the operational and clinical hub, while mobile teams extend care to homebound patients and other populations for whom transportation remains a genuine barrier.

The Clinic Becomes the Platform

The shift toward physician-office wound care actually predates the current CTP disruption. Medicare data show physician-office wound expenditures increased from approximately $3.0 billion in 2014 to $4.1 billion in 2019, while hospital outpatient wound expenditures declined from $10.5 billion to $2.5 billion.³

What is different now is what can happen inside that office.

The emerging wound clinic has the opportunity to combine wound treatment with services such as vascular assessment, ankle-brachial index (ABI) testing, fluorescence imaging, lymphedema and compression management, durable medical equipment (DME), nutrition, chronic care management, and remote patient or therapeutic monitoring. Not every practice needs every service, but the strategy is important: build around the clinical needs already present in the patient population.

This also changes the economics of brick-and-mortar care. Equipment can be centralized, providers can see patients more efficiently, inventory is easier to manage, and additional service lines can share staff and infrastructure. Mobile clinicians can operate from the same hub rather than functioning as an entirely separate business.

The building stops being simply an expense. It becomes an asset that supports multiple ways to deliver care and generate revenue.

The Wound Becomes the Front Door

A chronic wound rarely exists in isolation. The same patient may also be managing diabetes, obesity, vascular disease, neuropathy, lymphedema, impaired mobility, poor nutrition, sarcopenia, or other chronic conditions that influence healing and recurrence.

Yet wound care has traditionally built its business model around the wound itself.

That, I feel, is the larger opportunity ahead. Instead of asking, “What else can we bill for this wound?” practices can ask, “What does this patient need to heal, stay healed, and live better? And, which of those needs are we equipped to address?”

That question creates very different practice models. A clinic with a large population with venous disease might build around vascular diagnostics, compression, and lymphedema. A patient population with diabetes may support nutrition, metabolic management, remote monitoring, and coordinated chronic care programs. A practice serving a heavily homebound population may keep a larger mobile component supported by a smaller clinical hub.

Diversification should not start with a Current Procedural Terminology (CPT^®) code. It should start with the population.

Cash Pay Creates a Second Economic Engine

Cash pay is moving closer to the center of the independent practice model.

U.S. out-of-pocket healthcare spending reached $556.6 billion in 2024, an increase of 5.9% from the previous year.⁴  Meanwhile, the percentage of physicians working in private practices fell from 60.1% in 2012 to 42.2% in 2024. Among physicians whose practices had been acquired, better negotiating payment rates, improving access to costly resources, and managing payer regulatory and administrative requirements were identified as important reasons for the sale.⁵

Wound care has traditionally participated very little in the consumer-pay side of healthcare. That is changing.

Now, I am seeing practices beginning to explore medically supervised weight management, metabolic health, GLP-1 therapy, hormone optimization, peptides, nutrition, and other wellness or longevity services where clinically appropriate and legally permissible.

These services should not be bolted onto a wound clinic simply because patients will pay for them. The stronger strategy is to look for logical intersections between clinical need and consumer demand. A practice treating a significant population dealing with diabetes and obesity has a different opportunity than one specializing in venous disease or limb preservation.

The strongest independent models will increasingly have 2 economic engines: reimbursed clinical care and thoughtfully selected patient-paid services. The objective is not to replace insurance revenue. It is to avoid allowing any single payer, product, or reimbursement methodology to determine whether the practice survives.

Diversification Cannot Become the Next Gold Rush

There is a lesson in the current disruption that wound care should not miss. Replacing CTP dependence with chronic care management (CCM) dependence, remote patient monitoring (RPM) dependence, GLP-1 dependence, peptide dependence, or any other single revenue stream simply recreates the same vulnerability.

Before adding a service line, practices should be able to answer 4 questions:

Does our existing patient population need it?  

Can we deliver it exceptionally well?  

Does it share infrastructure with what we already do?  

And does it make the practice less (not more) dependent on a single source of revenue?

Those questions will produce different answers in different markets, which is exactly the point. There is no single blueprint for the next wound care practice.

There is, however, a common strategy: stop building the business around the wound and start building it around the population you serve.

What Comes Next

Demand is not the problem. In 2021, approximately 10.8 million Medicare beneficiaries (16.1% of the Medicare population) were diagnosed with at least one type of wound. Mid-range estimates placed Medicare wound care expenditures at $26.3 billion that year, up from $24.7 billion in 2019.⁶

The patients are still there. What is changing is the infrastructure we build around them.

The next generation of wound care will be brick-and-mortar centered, mobile capable, clinically diversified, and supported by both reimbursed and cash-pay services. The clinic becomes the hub. Mobile care extends its reach. Remote care maintains the relationship between visits. Diagnostics identify barriers to healing earlier. Adjacent services address the conditions contributing to the wound, and diversified revenue creates a more resilient independent practice.

The first era of modern wound care focused on treating the wound. The next became heavily influenced by the economics surrounding the wound.

From my point of view, the next era will be about building sustainable practices around the person who has the wound.

We are not waiting for that model to arrive. Its pieces are already being built.

Nikki Johnston is a healthcare operator and strategist. She is the CEO of Loden Health Partners and Founder of Kindling Consulting.  

References

1. Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). 2025.  https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare….

2. Tettelbach WH, Armstrong DG, Tucker T, et al. Early reported effects of the 2026 CMS Physician Fee Schedule on patient access to CAMPs in wound care: a national clinician and practice survey. J Wound Care. 2026;35(Sup7a):S5-S14. https://doi.org/10.12968/jowc.2026.0290  

3. Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE. Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: changes between 2014 and 2019. J Med Econ. 2023;26(1):894-901. https://doi.org/10.1080/13696998.2023.2232256

4. Centers for Medicare & Medicaid Services. NHE Fact Sheet: Historical NHE, 2024. https://www.cms.gov/data-research/statistics-trends-and-reports/nationa…. Accessed September 20, 2026.

5. Kane CK. Physician Practice Characteristics in 2024: Private Practices Account for Less Than Half of Physicians in Most Specialties. Policy Research Perspectives. American Medical Association; 2025. https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf. Accessed September 20, 2026.

6. Carter M, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife C. EE229 The Effect of COVID-19 on Care for Chronic Wounds Among Medicare Beneficiaries Using Medicare Claims - 2019, 2020, and 2021. Value Health. 2023;26(6):S101. https://doi.org/10.1016/j.jval.2023.03.530 

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