CTP Policy Changes, Mobile Wound Care, and Rural Patients: A Frontline Perspective

As sweeping changes to cellular and tissue-based product (CTP) regulations roll out, mobile wound care providers are bracing for major disruptions in patient access, clinical continuity, and financial sustainability. In this CTP News Desk interview, Amber Metoyer, MSN, APRN, FNP-C, and Lance McNeill, MBA, MPAFF share candid insights into how these policies are already affecting the patients who depend on advanced therapies delivered in the home. 

The skin substitute landscape is changing rapidly. As mobile wound care providers, what immediate effects are you seeing—or anticipating—on patient access and continuity of care? 

Amber Metoyer, MSN, APRN, FNP-C: We’re already experiencing some of the impact. Every patient we see has a chronic wound; they’ve often been dealing with it for months or even years. They come to us because they cannot access a wound care clinic. Many live an hour or more from the nearest center, lack transportation, or have mobility limitations that make leaving home impossible. 

When we lose the ability to provide advanced therapies (like CTPs) in an outpatient, in-home setting, their outcomes can deteriorate quickly. We’ve seen patients end up hospitalized with sepsis because the wound hasn’t healed appropriately. 

And while we’re committed to doing right by patients, these changes also affect our ability to operate. You can’t run a service if the economics make it unsustainable. 

Lance McNeill, MBA, MPAFF: Exactly. Some have said these patients can just go inpatient, but that’s not realistic. Many physically cannot get out of their homes. Some need to be seen multiple times a week. 

Patients are generally more adherent to treatment plans and heal better at home. Suggesting inpatient care as the default solution ignores the real-world limitations and preferences of this population. 

Metoyer: Mobile wound care isn’t just about the wound itself. When we’re in the home, we often discover broader gaps; no follow-up with primary care, difficulty accessing specialists, unmanaged comorbidities. Patients aren’t avoiding care; they’re unable to reach it. Eliminating their access to advanced in-home therapy has ripple effects across their entire health picture. 

What day-to-day challenges are these new CTP policies creating, and how are your teams working to ensure patients don’t fall through the cracks? 

McNeill: The economics are the biggest challenge. In Central Texas, sending a nurse practitioner or physician assistant to a rural home visit, potentially an hour away, costs more than we’re reimbursed. Medicare pays about $130 for that visit. You can’t even get a plumber to your house for that amount. 

Historically, appropriate use of skin substitutes helped offset these losses, allowing mobile wound care to remain viable. We grafted fewer than 10% of our patients and did so conservatively and compliantly. But fraud elsewhere in the industry brought heavy scrutiny, and now compliant providers are squeezed by policies that remove the ability to stay financially sustainable. 

If we can’t offset the losses, we simply cannot drive an hour for every visit. Patients in rural areas will lose access first. 

Metoyer: We’ve always tried to support patients, even when it wasn’t profitable; checking in for home health teams, helping patients who had nowhere else to go. But with these changes, we’ll have to limit our radius, reduce visit frequency, and decline cases we previously took on to prevent patients from falling through gaps in care. 

Our patient population is largely geriatric with chronic conditions. For them, small delays quickly become major setbacks. Reduced access will directly impact outcomes. 

How might these changes disproportionately affect mobile providers compared to facility-based clinics?  

Metoyer: Mobile providers face higher operational costs: travel time, mileage reimbursement, and the limitations of working in a patient’s living room with only the equipment we can carry. Clinics have immediate access to supplies and infrastructure. 

Mobile wound care will be hit harder because the cost to physically reach patients isn’t being offset in reimbursement. Clinics may face overcrowding and staffing burdens, but they won’t face the same cost-to-care imbalance we do. 

On top of that, clinicians will become hesitant to graft at all. With the likelihood of denials and the financial risk involved, many providers simply won’t pursue CTPs, and patients’ wounds will worsen as a result. 

McNeill: I read a piece recently where a physician said he plans to stop using skin substitutes altogether and instead send patients for surgical debridement. That’s heartbreaking because these products work. The issue was economic manipulation, not clinical inefficacy. 

Our own case studies, 18 of them, showed healing rates that matched or exceeded randomized controlled trials. 

Now with the WISeR prior authorization program coming to Texas, we expect AI-driven denials, human reviewers incentivized to rubber-stamp those denials, and appeals processes that can drag on for more than a year. 

This will force many small practices out of the market and lead to significant consolidation. 

With CTP access tightening, where do you see innovation fitting in? How can outcomes be preserved? 

Metoyer: Innovation will be critical. We’ll need to maximize the few advanced therapies compatible with mobile wound care. These are beneficial, but I don’t feel they match the outcomes of grafting. 

We may need to restructure staffing—certified wound and ostomy nurses taking on more frequent visits, advanced providers spacing their visits differently. But that still has cost limitations. 

Documentation will also need to be more detailed and explicit to justify treatment choices in the face of prior authorization scrutiny. We’ve searched for alternative therapies, but we have not found anything equivalent to grafting that’s easily deployable in the home setting. 

McNeill: Remote patient monitoring has potential, but, in our experience, too often the technology companies—not providers—see the greatest financial benefit. 

We’ve evaluated many advanced therapies, and some are sold to providers at a cost higher than the reimbursement rate. Providers can’t operate at a loss. Innovation must account for economic sustainability—not just technology. 

As you look ahead, what do you want policymakers, clinicians, and payers to understand about the real-world consequences of these changes? 

Metoyer: This has been a severe overcorrection. Yes, there was fraud—there were providers applying grafts unnecessarily or excessively. But many of us followed strict criteria and only grafted after exhausting standard care options and confirming the patient was an appropriate candidate. 

We shouldn’t punish patients who truly need these therapies. For some, grafting is the only path to wound closure and to preserving their overall health. 

McNeill: Policymakers need to recognize their role in the pricing problem. CMS allowed pricing manipulation to escalate for years without intervention, then abruptly cut payments. On paper, that reduces spending. In reality, it collapses access. 

When you eliminate a major portion of a provider’s revenue overnight, many won’t survive. And when patients lose mobile wound care, they shift to inpatient care, which will cost Medicare far more. 

A middle-ground solution, like the reasonable price caps proposed by Senator Cassidy, or a gradual adjustment period, would have preserved access. Instead, we now face a situation where patients and small providers will bear the brunt of abrupt policy shifts. 

Lance McNeill is President of MacMor, LLC, a management services organization. 

Amber Metoyer is a nurse practitioner with Victory Wound Care.