This article is a part of your HHCN+ Membership
Demand for wound care in the home is intensifying, and investors and providers alike are zeroing in on the service line’s potential, drawn by high Medicare reimbursement rates and growing emphasis on value-based care.
Integrating specialized wound care into in-home services is emerging as both a clinical imperative and a strategic business opportunity, allowing providers to tap into new referral pipelines, improve patient outcomes and unlock additional reimbursement potential. But the rewards come with significant risks, and some providers are hesitating to expand their wound care services.
Wound care in the home health sector is evolving, according to Christian Rodriguez, CEO of Woundtech. As risk delegation and vertical integration increase within the care ecosystem, care models are shifting toward a more proactive and preventative approach to wound management, rather than just reactive treatment.
Another significant trend is the increasing focus on interdisciplinary collaboration.
“We’re observing more integration between a provider model, like ours, and home health nursing models,” Rodriguez told Home Health Care News. “This is especially important as we consider factors like long-term care coordination to achieve better patient outcomes and reduce the financial burden, usually borne by our health care systems and patients.”
Woundtech, located in Hollywood, Florida, is a home-based provider specializing in wound care and the management of chronic wounds.
Rodriguez said he expects to see the demand for home-based wound care to grow, driven by the increased prevalence of chronic conditions like diabetes and obesity, both of which often lead to complex wounds.
Expanding wound care offerings
For many home health agencies and primary care provider groups, home-based care is becoming central to their efforts to drive vertical integration.
“Quite frankly, there is no better care setting than a patient’s home,” Rodriguez said. “We can observe the environment, social determinants of health and the whole person far more effectively than a physician can in an inpatient or clinic setting.”
With that said, Rodriguez issued a reminder that these are complementary, not competing care settings.
“When you add to the mix a provider-driven model that enhances the nursing model in areas like order management, the care delivery becomes cohesive, holistic and supportive of primary care providers,” he explained.
An expanded wound care service line makes home-based care providers more appealing to referral sources, referring providers, primary care providers and those who see a burden of costs for caring for these patients in their practice, according to Kathleen Corcoran, associate vice president of CenterWell Home Health’s wound care program.
Care transitions coordinators seeking care for patients transitioning from a hospital or long-term care facility may focus on finding a home health solution that meets the patient’s needs and provides a level of care that reduces the risk of rehospitalization, Corcoran explained.
“Then there’s an area of advanced wound care that exists in outpatient care,” Corcoran told HHCN. “(These providers) look for partners in home health to care for their patients between patient visits to their wound centers, and they look for an even higher level of skill and expertise because they provide advanced care.”
Humana’s CenterWell brand includes home health care, primary care and pharmacy services. Its home health segment has over 350 locations, over 9,000 clinicians and serves more than 350,000 patients annually.
While a dedicated wound care service line offers strategic benefits, some agencies are hesitant to expand their wound care services, according to Shari Courtney, vice president of leadership at Rebirth Advanced Healing.
“Home health agencies are already stretched thin,” Courtney told HHCN. “Adding advanced wound care can feel risky. The supplies are expensive, the certifications are specialized, the requirements are stringent and the patients can require a high level of ongoing care.”
Rebirth Advanced Healing is an advanced mobile wound care company based in Traverse City, Michigan.
Courtney pointed out that patients with complex wounds tend to stay longer on an agency’s census, which can lead to hospital readmissions and negatively affect an agency’s star ratings and financial results.
“That’s why we recommend a hybrid approach,” Courtney said. “Agencies should become true experts in standard wound care and then collaborate with trusted partners for advanced cases.”
Courtney explained that Rebirth Advanced Healing partners with home health agencies across more than 20 states, working closely with them to manage patients with complex wound care needs.
“Our teams coordinate with the agency’s clinical staff to ensure patients receive the needed care without overburdening resources,” she said.
She also emphasized the broader perspective: as the population ages, chronic wounds are expected to become more prevalent.
“Agencies that want to stay ahead must think proactively about managing wound care. Having the right partnerships in place makes this much more sustainable,” she said.
Risks and liabilities
While the benefits of home-based wound care are significant, it is essential to identify and actively address the inherent risks associated with this approach. The primary concerns focus on two interconnected areas: liability and patient safety.
Wounds carry a risk of worsening, infection or hospitalization that can lead to amputations or even death. This creates challenges when designing a program to reduce risks or ensure patient safety. The program must meet patients’ needs and identify when they develop issues.
In the home environment, providers work in a setting that is less controlled than a hospital or clinic, which can have several implications for patient safety, according to Rodriguez. For example, maintaining optimal sterility can be a challenging task.
“We’re not in a surgical suite; we’re often in a living room, so ensuring proper wound hygiene and preventing cross-contamination requires strict protocols and careful practice from our clinicians, as well as education for the patient and their family,” he said. “Environmental factors like pets, dust or overall cleanliness can affect wound healing or increase infection risk. We need to assess these factors and teach families how to create the safest possible environment.”
Beyond the physical environment, there is a significant risk of miscommunication or inconsistent, inaccurate monitoring, especially if the patient or their informal caregiver isn’t properly trained or fully engaged, according to Rodriguez. These gaps must be addressed as care visits are scheduled between home health, wound care providers and primary care providers. Having a connected health care ecosystem can help ensure alignment between home health, wound care and primary care providers, Rodriguez said.
From a liability standpoint, these patient safety risks directly lead to professional and organizational liability, according to Rodriguez. Inadequate documentation, failure to follow the latest best practices for wound assessment and treatment, or breakdowns in communication with other health care providers can all create significant legal exposure. This highlights why ensuring proper, thorough documents, strictly sticking to evidence-based best practices and maintaining strong, ongoing training and competency programs for all clinicians are not just good practices, they are essential to reduce these risks and safeguard both patient well-being and the ability to provide future services, Rodriguez elaborated.
“There’s always the concern of making sure we’re meeting the requirements of our regulatory oversight,” Corcoran said. “In many cases, that has to do with documentation. Documentation has to be clear and concise. We have to ensure that we can demonstrate that there continues to be an ongoing skill need for the patient.”
Regulatory requirements
Regulations around reimbursement are relatively complex, according to Corcoran. Providers must have a clear understanding of what these regulations entail, as well as the documentation and coding requirements that accompany them.
“Think of them less as obstacles and more as the essential blueprints for creating effective and compliant care,” Rodriguez said. “They determine everything from the specific licensing requirements for our clinicians – defining exactly which level of skilled nursing professional can perform certain types of wound care – to the detailed, almost forensic, documentation standards we must follow. They also control the exact billing codes used for reimbursement, which directly affects our financial stability.”
Medicare and Medicaid guidelines outline specific coverage criteria for advanced wound care treatments provided in patients’ homes. Guidelines may change, and understanding the details isn’t just about compliance but about anticipating future changes.
“I expect further changes in the regulatory environment,” Rodriguez said. “There is a growing push for more value-based purchasing models, which could encourage even more focus on preventative care and outcomes in wound management. We are also closely monitoring how policy changes, such as the implications of V28 and other regulatory adjustments, are shifting more risk to home health agencies. This means agencies are assuming a larger role in managing complex patients, especially those with significant wound care needs, outside of traditional institutional settings.”
Rodriguez stated that this change fundamentally transforms the care ecosystem, placing home health agencies at the core of efficiently and effectively managing high-acuity patients.
Regulatory practices around state licenses are another key factor for providers, Corcoran said. Some clinicians practice in multiple states, and licensing limitations can impact staffing and make it difficult for providers to care for some wound patients.
Providing wound care at home aligns closely with value-based care models, according to Rodriguez. By preventing complications, reducing hospital readmissions and facilitating wound healing, providers are positively impacting key metrics.
“It’s about proactive management that avoids more costly interventions later,” Rodriguez said. “This approach not only improves patient health but also benefits the health care system by making better use of resources.”
Providers offering home-based wound care may be able to take advantage of innovative reimbursement and incentive opportunities such as risk savings or performance bonuses, Rodriguez said. There is also the potential for increased patient satisfaction scores, which are becoming more closely linked to reimbursement. Further, by successfully managing complex patients at home, providers demonstrate their capability and value, potentially leading to more favorable contract negotiations with payers.
Investor interest brings opportunity
Investors are making significant commitments to in-home wound care, according to Rodriguez, driven by several complex factors.
First, demographic tailwinds have increased investor interest. The aging global population, along with a rising prevalence of chronic diseases that often lead to complex, long-term wounds, creates a growing market for specialized wound care. Approximately 33% of home health patients have wounds, according to the VNA Health Group, and investors view the steady demand as a key driver.
Secondly, there is clear and proven cost-effectiveness in providing high-quality care at home compared to traditional institutional settings, according to Rodriguez. Hospitals and skilled nursing facilities can struggle to ensure continuity of care after discharge. Investors see the potential for strong returns by helping reduce costly hospital readmissions and prolonged stays in institutions, effectively “decompressing the more expensive parts of the health care system,” Rodriguez said.
Corcoran said investor success is a matter of investing in a program that includes a core group of clinical experts to determine escalation pathways when patients fail to improve, stall, or deteriorate.
“Challenges are going to continue to increase,” she said. “Reimbursement guidelines and regulations change constantly, so (investors) need to be aware of those changes.”
She also said that investors should be aware of technology and innovation trends, including smart technology and dressings, data collection and home health care delivery.
“We need to adapt to the evolving health care environment, especially as it continues to grow in the home health sector. Creating a successful, strong wound care program requires dedication, understanding and foresight,” she advised.
Rebirth Advanced Healing CEO and owner-physician Dr. Christopher Mason told HHCN that although investor interest in home-based wound care has grown significantly in recent years, it has not always been for the right reasons.
“There’s no question that advanced wound care, especially in the home setting, has attracted investors’ attention,” Mason said. “Medicare reimbursements are high, which makes the sector very appealing. However, this also creates opportunities for unethical actors.”
He said that new graft manufacturers and wound care providers are entering the market quickly, with what he described as “Wild West-like conditions and minimal oversight.”
“When private equity money gets involved, incentives start to shift. There is more pressure to grow fast, cut costs and push products, which can lead to ethical compromises,” he cautioned.
Rodriguez said he sees more opportunities than challenges in the future of at-home wound care.
“The increasing demand represents a huge opportunity in itself,” he said. “We’re witnessing a significant shift where home health agencies are increasingly assuming a primary role in the health care system, taking on more risk in managing complex patients with chronic conditions, especially those with wounds. The transfer of risk, driven by changes like V28, is fundamentally transforming the care delivery model. It allows home health providers to be central in managing these high-acuity patients efficiently and effectively in the most suitable settings.”
