Manufacturers Under Pressure, Patients at Risk: The Real-World Impact of CMS Reimbursement Cuts

This speaker contends that CMS's changes on CTP reimbursement do negatively impact the ability to support providers and patients, saying he sees an "access crisis" in which some providers are no longer able to provide care. 

• CMS (US) — 2026 skin substitute payment at ~$127/cm²: Manufacturers face pressure to cut costs by ≈93%, prompting concerns about product downsizing, pricing strategies, and exploitation of a loophole allowing large minimum product sizes (e.g., ≥44 cm²) for small wounds (3–5 cm²).
• Market and reimbursement impact: Lower reimbursement may shift market share toward products meeting physician cost needs, especially in mobile care environments, unless legislative action closes the size-based utilization loophole.
• Access concerns: Providers delivering care in nursing homes, assisted living facilities, and home settings report inability to sustain services under >90% reimbursement reductions, contributing to clinician attrition, practice closures, and reduced patient access.

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 I think that we’re adjusting market strategies to reflect the changes that are being made with CMS in ways that others are also pursuing. How can we deliver a product for 93% less than what the average product is being delivered for today? And how can we still provide good clinical value? 
 
So all manufacturers are now struggling with those realities in terms of how they can get their costs of good sold down and their sales and general administrative expenses. It's just not an easy thing to do. So there are some new loopholes that have popped up out of that that could perhaps become very problematic for CMS as well. 
 
I think that products that can best hit the price point for physicians where they’re not losing money to treat their patients, especially in the mobile environment, would gain market share. And so perhaps those products that had a smaller size that meets their expectations—and what I mean by that is if you've got your smallest size at, say, 44 square centimeters, and most of your wounds are 3 or 4 or 5 square centimeters, CMS allows you in a current loophole in their intention, against their intentions to cut costs to use that product. So at a flat rate of $127, if the smallest product made by your company is 40-something, you're going to be wasting a lot of products. So I think that some of those folks who have adopted that strategy, like it or hate it, will gain market share unless something is done legislatively to fix that loophole. 
 
So I feel like the CMS changes really do negatively impact our ability to support providers and patients, specifically those providers who are trying to see patients that cannot get to a traditional wound care center owned by a hospital or a hospital outpatient department, HOPD. The government has really picked winners and losers here. The costs borne by a provider going to see a patient where they're at in a nursing home in an ALF, assisted living facility, or even in their home, which was necessitated first during the COVID pandemic, but has continued to prove more broadly needed by patients all over the country, cannot be supported with the reimbursement rates on these products going down 90-plus percent. 
 
So we're facing an access crisis because many or the providers we’re talking to are simply not able to provide services anymore. Some of them are leaving the practice, many of them are, many of them are trying to sell their practices but there really aren’t any buyers. And others are retreating to other care environments where they can have their cost structure protected to or like working back at the hospital again. So it's really a disservice to patients when we really get down to the nuts and bolts of it.

John Schroeder is President and CEO of Venture Medical.