Simply choosing an appropriate support surface means that clinicians in the US have to navigate a minefield of confusing product modalities, classification groups, patient qualification criteria, manufacturer marketing materials and reimbursement code references.
The current equipment manufacturing industry landscape here has been shaped by these incongruous reference points, and to a large extent by the available medicare reimbursement dollars. These factors have driven product design specifications, raw material choices and price points, rather than allowing more clinically appropriate and advanced products to be developed outside of these constraints, utilizing new technologies, materials and clinically proven designs.
“as a decision maker for your facility, you can choose to act differently if you are truly going to raise your standard of care for pressure injury prevention and treatment”
Today’s Medicare product design specifications for group I support surfaces were developed over 30 years ago, when polymer, fabric and electronics were much less developed than they are nowadays. Patient qualification criteria are also over 30 years old and were designed with the available product technologies in mind at the time.
Group I mattresses were just slabs of foam with a nylon taffeta cover or innerspring mattresses with vinyl covers. This was because the emphasis in pressure injury prevention and treatment was not high, and the reimbursement codes were built around paying for these low end products Of course, these are still available today, because the reimbursement allowables haven’t increased enough to allow a better solution… so many DME dealers still choose these as the standard go-to mattress for all patients.
Over the last 30 years, product designs have been geared for home care patients and home care reimbursement, whereby a patient has to start off with minimally effective products, becoming progressively worse by developing multiple stage II pressure injuries on the trunk and pelvis before any truly effective products can be used. Prevention is not the key approach with this Medicare model… it is the the false notion of saving reimbursement dollars by avoiding higher end products until absolutely necessary. Of course, this is old fashioned thinking and is a backwards approach. It actually costs Medicare more in the long run, as it is much more expensive to heal pressure ulcers than it is to prevent them in the first place. As my grandmother always said, an ounce of prevention equals a pound of cure…
Add to this the fact that today, in order for any support surface to meet the medicare reimbursement criteria, it only needs to meet these 30 year old design specifications, but does not need to have clinical outcome evidence, and you have a recipe for disaster, with facilities selecting non clinically proven products that have been manufactured based on out of date coding, limited funding and old fashioned thinking.
“It is within your power, and incumbent upon you as a patient advocate, to think and act outside the box, and to ask your DME supplier to work with you to help raise the standard of care, with value-based, clinically evidenced solutions”
So where does this leave facilities who are looking to select appropriate products? Unfortunately, clinicians are often forced down product selection pathways where inappropriate products may be the only ones available in their supply chain. This is largely due to the fact that their DME suppliers are Home Care product focused, and only buy Medicare coded group I products, and that even outside of medicare patient product criteria, clinicians are still in the habit of referencing the product selection criteria progression of Group I to Group II. This is also old fashioned thinking in a new environment which is focusing more and more on evidence-based solutions instead.
But as a decision maker for your facility, you can choose to act differently if you are truly going to raise the bar in terms of pressure injury prevention and treatment. Start focusing on evidence based solutions.
Products like the Immersus Mattress have been designed with modern offloading concepts, and high specification polyurethane foams that just weren’t available 30 years ago. As such, they do not fall into the old Group I category because they have been manufactured without those design or cost constraints…in fact, the Immersus mattress was not designed with medicare coding or specifications in mind. Rather, it was created specifically to have design characteristics that would support fall reduction, and pressure injury prevention and treatment in elderly and end of life patients. As such, it has a 44 patient clinical outcome study, published in a peer reviewed medical journal…Ostomy Wound Management ( now called Wound Management and Prevention). This evidence show us that the product really does work to do the job it is intended for.
Clinicians need to demand clinically proven solutions instead of allowing old purchasing habits and legacy supplier and product choices to determine product availability for their patients. It is within your power, and incumbent upon you as an advocate for your patients, to think and act outside the box, and to ask your DME supplier to work together with you to help raise the standard of care, by supplying products that have bona-fide clinical evidence, and are proven to prevent and treat pressure injuries, and to prevent falls.
Call us at 855 994 4325 for more information on how you can raise your standard of care through value based purchasing and evidence based products.
