Page 26 - Mobility Management, May 2017

ATP Series
Cushions: Showing Their Age
real time/real use. From an engineering/testing standpoint, you typically like to test a product to failure to fully understand how a product could fail. But that again may be overly extreme. If the test is too ‘easy,’ it may not adequately predict failure that could occur in three, four or five years of use, so such a test wouldn’t be beneficial, either. As a result, our committee — which consists of dedicated contributors from universities, clinics and industry — attempt to find the ‘sweet spot’ of testing that will give a reason- able prediction of durability, without being unduly aggressive, to better inform the user, prescriber and payor of how cushions can continue to benefit the user in the long haul.”
There’s also the challenge of ensuring that test results are accurately understood and applied by all stakeholders.
Said Cwiertnia: “The U.S. standards group working on this has been in a long debate regarding minimum testing protocols for cushion aging because we are concerned that the testing or information could be misconstrued by funding sources.”
EXTENDING CUSHION LIFE
As discussion continues regarding how tomorrow’s cushions might be defined and tested, there are practical ways to extend the life of cushions today.
“Keeping them clean and keeping dirt and debris out of the material will prolong the life and not accelerate the breakdown over time,” Rogers said.
“The best methods to prevent accelerated aging start with following the manufacturer’s recommendations for laundering, disinfection, storage and maintenance,” Cwiertnia added. “Sometimes putting the cushion cover in the dryer on too high heat will ruin it. I have also seen cushions ruined because
they were left in direct sunlight inside a hot vehicle during
the summer. Often, bleach isn’t recommended for disinfection because it can ruin cushion materials, so check to see which disinfectants are approved. Choosing the proper style of cushion to match the user’s needs and lifestyle is very important too.” m
Cushion Codes: Where We Stand Now
Wheelchair seat cushion testing, standards, codes and reimburse- ment are multiple sides of the same coin...if a coin had about a dozen different sides. Assigning appropriate codes to cushions is necessary for adequate reimbursement. Defining codes is neces- sary to understand which cushions belong within them. Testing cushions determines the codes they should have. Determining the standards cushions should meet, such as how many test cycles they need to survive, helps to define what clinicians, ATPs and consumers should expect from different cushions.
It’s a complex relationship with a long history, said Rita Stanley, VP of government relations at Sunrise Medical.
“New seating codes were implemented in 2004,” she said. “One of the primary goals at that time was to address the fact that there was a single code: E0192, Low Pressure and Positioning Equalization Pad. The SADMERC, a Medicare contractor prior to the \[current\] PDAC, requested new HCPCS codes to represent the high number of products in the E0192 and the myriad array of technology and varying efficacies for addressing skin injuries or positioning.”
Stanley said stakeholders spent years on the coding proposal.
“The Medical Directors (this project spanned more than one) worked with several experts and the RESNA product standards board to link product testing to the new codes with the goal of ensuring product quality and efficacy to the extent possible. There were limitations in terms of testing, and as hard as the RESNA board and researchers worked to establish tests to demonstrate a product’s ability to provide skin protection, time ran out.
“The codes were announced and implemented; the result was that a wide array of skin protection products remained grouped into one code, and the initial fee schedule was inadequate to allow access to fluid technology, the technology with a history
of reliability and what clinicians depended on for people at high
risk or with a history of skin injuries. The SADMERC and CMS promptly responded and created a distinction with the skin protection code for ‘adjustable’ and allowed products with the capability of adding or removing material after delivery.”
Stanley said stakeholders recognized this as “not the best solution, only the most expeditious one, and there was a commit- ment to continue to consider a way to define the important cushion materials and characteristics that would distinguish the various levels of skin protection technology. In addition, the SADMERC agreed to continue to work with researchers and RESNA to develop tests to demonstrate the abilities of cushions to meet any newly developed criterion.”
Then, the SADMERC lost the Medicare contract, and the cushion provision wasn’t included in the PDAC contract.
“Changes to the initial codes created in 2004 have not happened,” Stanley said. “As a result, the number of models that have been coded under E2603 (skin protection seat cushion, width less than 22", any depth) and E2622 (adjustable skin protection seat cushion, width less than 22", any depth) since these codes were implemented is approximately 1,700 and 1,400, respectively. Not all of these models are valid for billing under these codes today, but there are still a high number of products that are, and there is little meaningful code distinction between these models, while the actual technology differences and efficacy varies. Moreover, the coverage requirements are the same. This makes it difficult for inexperienced clinicians
or consumers of this technology to make educated decisions regarding the most appropriate technology in a given situation.”
So, inexact coding and inappropriate product assignments within cushion codes continue. “As efforts to control utilization and cost has become a priority for payors, having HCPCS codes, definitions and defined characteristics is more important than ever,” Stanley said. m
26 MAY 2017 | MOBILITY MANAGEMENT MobilityMgmt.com