Operational Observations in a New CTP Regulatory Environment

1. Revenue pressure is exposing operational gaps. The decline in skin substitute revenue has uncovered weaknesses in documentation, workflows, and denial management that were previously overlooked. Practices are now feeling the financial impact of every missed or delayed reimbursement.
2. Diversification is no longer optional. Reliance on a single modality like skin substitutes is no longer sustainable, pushing practices to adopt a broader, more holistic approach to wound care. This shift represents a long-term reset toward more balanced and standardized treatment strategies.
3. A return to fundamentals is critical. Success now depends on strong clinical fundamentals—comprehensive assessment, appropriate modality use, and consistent documentation—paired with honest self-evaluation and team support. Practices must elevate both clinical and operational rigor to remain effective.

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. 

Nikki Johnston:

Now that CPT revenue has kind of taken a backseat to where we were previously, let's talk about some of the things that this scenario has exposed in a lot of these practices.

Kati Kaushal, DNP, FNP-C, CWS:

Yeah, absolutely. I think it's definitely exposed the underlying deficiencies with charting and with denials that are coming out of not having accurate charting. The workflows that we're following now maybe aren't supporting that need for really good documentation either.

Nikki Johnston:

Yeah. I think that what we're seeing too is we were okay previously maybe not having all of the revenue come through because the skin substitute revenue was so expansive and it covered so many of our just everyday expenses that we could survive off of the skin sub-revenue. But now that we don't have that revenue coming in, I think we're really seeing an insurgence of identifying those inefficiencies. We're seeing where maybe we were getting denied on a lot of the things that we probably shouldn't have been denied on. And like you mentioned, having proper documentation, really understanding do our workflows work properly now, every dollar counts. And so we have to be super diligent about scheduling and routing and patient flow and making sure that that documentation is proper on the front end so we don't have the delays. We can't afford delays any longer.

Kati Kaushal, DNP, FNP-C, CWS:

Yeah, absolutely. When we used to be able to be okay with a couple denials here and there, because most of them were coming back approved and we were getting reimbursed on, now we feel every single denial. Every single missed opportunity to capture that revenue hurts the practice.

Nikki Johnston:

And even if it doesn't on the front end, we're now also bogged down with Wiser and the pre-authorization process that's taking place in the states that have rolled it out. So now we have an extra layer of extra work that has to go into getting the ones that we do want to use approved prior to even application.

This is absolutely a permanent reshaping of the space. This is where we as an industry have the opportunity to really button up, standardize and introduce the proper advanced modalities for these patients and not solely rely on one advanced modality to do the heavy lifting of everything that we've been doing in the clinic space.

Kati Kaushal, DNP, FNP-C, CWS:

We absolutely have to diversify when practices used to rely solely or majority on skin substitutes in that grafting to heal a patient. Now we need to look at everything from the very first visit when we see the patient all the way through until closure, what can we deploy and use on the patient outside of just a skin substitute, which really is standard of care. We should be doing that anyways in order to give really good holistic wound care.

Nikki Johnston:

I think we lost sight of that with the expansive reach of the skin substitutes. We lost sight of needing to really drill down and understand what is the patient coming in with, what is the proper treatment plan for that patient, and then reevaluating along the way. So this does give us an opportunity to press the reset button. We get to start over. We get to reevaluate, restructure, really button up what we're doing from not just a clinical, but also an operational perspective and introduce maybe some of those other advanced modalities that we were not necessarily needing to introduce because what we thought we had was working well.

Kati Kaushal, DNP, FNP-C, CWS:

The one thing that I hope that clinicians and practices take away from any of these changes in new implementations is that we really need to get back to the basics. We need to identify the wound, what is the underlying comorbidity, what do we need to overcome in order to treat that wound and then treat the wound with the modalities that we have. Use everything in your toolbox, not just bits and pieces of the toolbox. And then being able to take on a leadership role and identify where when you see that patient on visit one, how what you do then and plan to do through their whole cadence of care affects their whole healthcare directory and their healing trajectory and looking at it also from an operational standpoint where we need to make sure that our documentation, our implementation of all of those modalities is really strong and teed up and buttoned up.

Nikki Johnston:

And I would love to add into that, that I think we need to have really honest conversations with ourselves about where are we? Where are we at? What is our skill level? Do we have areas of opportunity? Because right now the growing consensus is that only about 50% of all practitioners really understand how to utilize those products and those tools in a way that is both financially beneficial to the practice, but also clinically beneficial to the patient. So being open and very honest and truthful with ourselves on what is our practice really doing right now and what do we need to do to help pivot and introduce, maybe like you said, diversify and grow into a different version of ourselves and be open to that change. Not everybody is always open to looking in the mirror and seeing kind of where you're at from a realistic standpoint.

So really hyper focused on standard of care, getting back to basics, making sure that your team has the support because we're doing more with less now. And so making sure that your team understands that you're there to support them and making sure they have all the tools and products that they need to be incredibly successful.