Learning From My DME Experience: Turning A Negative Into A Positive

  It is easy to focus on the negative; we all do it from time-to-time. However, the goal of this article is to take a negative personal experience and turn it into positive information for Today’s Wound Clinic’s busy readers. Durable medical equipment (DME) is needed to help treat many medical conditions. However, insurances loathe paying for DME, even though research has shown that DME saves much more than it costs in avoided charges. For example, providing oxygen so that the patient can stay in their own home, avoids much more expensive care in a nursing home. Properly prescribed wheelchairs, seat cushions, and possibly support surfaces as well as teaching patients proper self care can also prevent physical complications related to poor posture and pressure ulcers and help the person to be independent and productive. But it is often very difficult to find knowledgeable and competent clinicians and providers to prescribe or recommend appropriate equipment and to fill out the necessary paperwork properly, bird-dog the order, and deliver the equipment in a timely manner.

  In addition, when a patient has a wound, care is given over to the wound care clinician who may not be schooled in DME and may not have a network of professionals to call on who are educated in this area. Added to this lack of knowledge is the reimbursement conundrum. Seating and equipment specialists may not be reimbursed for their evaluation time and paperwork time. The patient is the one who loses, and the wound can win the battle against the patient.

Personal Experience

  Trying to acquire durable medical equipment to assist with a medical condition became a frustrating experience for me this past summer. While I have been on the manufacturing, recommending and prescribing end for many years, this was my first experience with requiring quick access to DME for personal needs and being completely hampered by insurance requirements.

  I have had T-12 paraplegia for more than 30 years and in July 2011 had to undergo my first flap procedure for a recurring ischial wound complicated by osteomyelitis. After 3 weeks in the hospital I was on a limited sitting schedule of 4 hours per day and ready to be discharged, but my surgeon required me to have a seating evaluation. The result of this evaluation that consisted in large part of pressure mapping was the prescription for a new, expensive wheelchair cushion.

The Wheelchair Cushion

  Most would agree that a wheelchair cushion is an important piece of DME for a full-time wheelchair user who has just had major surgery on the sitting surface of the body. However, it took me more than 6 weeks to acquire this wheelchair cushion through my private medical insurance. It entailed working only with the approved providers. The representative for the first provider that I spoke with—a very large national company—clearly had no knowledge of wheelchair cushions other than the generic foam slab cushion … that she read about on her computer screen and cheerfully promised to send out immediately. It took nearly 2 weeks for this provider to tell me that they could not supply the prescribed cushion. The second provider specializes in wheelchairs and DME, and was much more knowledgeable about my needs and insurance requirements. They took the order but never called me back to let me know where my request was in the process. When I contacted them nearly 3 weeks later their response was “No news is good news, we only contact you when the product is rejected by your insurance or has been delivered”. The cushion finally arrived 2 weeks later because it was delayed by correspondence between the provider, the physician, and the manufacturer … even though I had a valid signed prescription and a seating assessment.

A Frustrating Process

  The time before delivery of this cushion was nerve-racking, as the only cushion I had did not pressure map well at all. I knew that I was potentially putting my new surgical site in danger by sitting on this cushion. Yet I was ready to start sitting up and getting back into life. Loan closets are non-existent due to liability issues and costs.

  Public funding such as Medicare and Medicaid are often excoriated for lack of payment for needed services. However, private insurance does not guarantee timely acquisition of needed equipment or services, either. Working with a knowledgeable DME provider was a key factor, as was a dedicated physician who was timely with his responses. So was persistence in follow-up on my part to find out what stage of process the order was in and to keep things moving forward.

If That Wasn’t Enough

  The first delivered cushion was a much smaller size than was ordered. Exchanging it for the right size took several more weeks.

Turning A Negative Experience to Positive

  How can the busy wound care clinician in an outpatient setting who is not expert at DME help their patients with the DME experience.

  First, know knowledgeable and competent DME providers in your local area. Start by looking for certified professionals at www.RESNA.org. Network with your local rehabilitation centers and DME providers. Talk with other wheelchair users in the area who may have already vetted therapists and providers and can give you first hand information. Bringing a DME expert—therapist or provider–onto your wound care team is an excellent and needed service for whole patient wound care.

  Second, work with these providers to learn more about DME. You don’t have to be an expert, but you can have more than passing knowledge of DME and information about where your patient can go to see or try equipment that might help their condition. DME providers can provide the best choices in many DME categories. For example, bathroom grab rails are carried in big box stores, but a DME provider will ensure that the rails are sturdy, screw into the wall securely, and are textured for better grip. Whenever possible try to move your patient into the hands of someone who can explain the difference in DME and provide installation or placement services.

  Third, learn the requirements for letters of medical necessity for various types of equipment – support surfaces, cushions, bathroom equipment, etc. – and have them ready to be modified to fit a particular patient’s needs. A knowledgeable provider can help you with the criteria that third party payors look for when approving a piece of equipment.

  Fourth, Users First is a grass-roots nonprofit organization operating under the umbrella of United Spinal Association. This organization is dedicated to educating and advocating for disabled consumers, motivating users to speak out for themselves, and guides the consumer to qualified professionals.

  Learn and network, make the time to provide whole-patient care for your patients who require DME, and deserve it.

Laurie M. Rappl, PT, DPT, CWS is currently an employee of Cytomedix, Inc. Laurie is a physical therapist, a certified wound specialist, and a consultant in wound care. She has a spinal cord injury at T-12 incurred in 1980, and has the unique perspective of both personal and clinical experience dealing with pressure ulcers and seating problems. She is a passionate advocate of those with SCI. For more information email Laurie at lrappl@cytomedix.com.