CMS, I am Going to Hold Your Hand When I Tell You This....

CMS Is Slowly Suffocating Wound Care, and Patients Will Pay the Price

Wound care is not collapsing because clinicians stopped caring or because operators failed to innovate. It is collapsing because the system meant to support it is quietly choking it out.

Over the past several years, policy decisions coming out of the Centers for Medicare & Medicaid Services have created a perfect storm for wound care providers, particularly those operating in outpatient and mobile settings. What we are watching now is not reform. It is erosion.

The introduction of the WISeR model was positioned as progress. In practice, it has introduced confusion, administrative drag, and prolonged submission and approval delays that many clinics simply do not have the resources to withstand. Teams are spending more time chasing approvals than treating patients. Cash flow uncertainty has become the norm, not the exception. Clinics that once ran lean and effective operations are now forced into survival mode.

At the same time, reimbursement for skin substitutes has been slashed to levels that no longer reflect the cost, complexity, or clinical value of these therapies. Products that once supported limb salvage and faster healing are now financially untenable for many providers. The math does not work, and pretending otherwise does not change that reality.

Mobile wound care has been hit especially hard. These models were built to meet patients where they are, in homes, long term care facilities, and communities where access is limited. They filled a gap the traditional system could not. Today, many mobile providers are asking a painful question: do we keep pushing forward, or do we walk away before the losses become irreversible?

This is not a business problem alone. This is a patient access crisis unfolding in slow motion.

As wound care clinics close or scale back, patients do not disappear. Their wounds worsen. Infections progress. What could have been managed proactively now ends up in urgent care centers and emergency rooms. Hospitals absorb the burden, already strained systems stretch further, and costs rise across the board.

The most devastating consequence is one we are already seeing more frequently: amputations. When timely wound care is delayed or unavailable, limb salvage opportunities vanish. Amputation is not an endpoint; it is often the beginning of decline. Mobility decreases. Complications multiply. Mortality rates climb. These are not abstract outcomes; they are predictable and preventable.

Clinicians feel this deeply. Operators feel trapped. Patients feel abandoned. Yet policy continues to move forward with little acknowledgment of the downstream damage being done.

This editorial is not a rejection of oversight or accountability. Wound care, like all healthcare, should be responsible, evidence based, and appropriately regulated. But regulation that ignores operational reality is not stewardship, it is harm by design.

If this trajectory continues, wound care will become something only large hospital systems can afford to offer, and even then, access will be delayed and fragmented. Communities will lose local providers. Mobile models that once extended care will vanish. Patients will suffer quietly until they show up in crisis.

There is still time to change course. That requires listening to the providers doing the work, understanding how policies play out beyond spreadsheets, and recognizing that cost containment without access is not savings, it is displacement.

Wound care is not dying on its own. It is slowly being poisoned by the system that is in place to protect it.

Wound care clinicians and operators are resilient, but resilience should not be mistaken for infinite capacity.

If nothing changes, access will continue to shrink, costs will rise elsewhere, and patients will suffer in ways that could have been prevented.

— Nikki Johnston

Founder, Kindling Consulting