Beds and Support Surfaces -- HME Business

Beds and Support Surfaces

Jul 01, 2005

In Shakespeare's time, mattresses were secured on bed frames by ropes. When you pulled on the ropes the mattress tightened, making the bed firmer to sleep on. Hence the phrase: "Good night, sleep tight."

Gone are the ropes and the archaic methods to make a mattress firm. Today's support surface and bed market offers such a diverse line of products that it can be challenging for an HME provider to know how to stock his or her store. Let's begin by taking a closer look at the types of support surfaces on the market.

According to Cynthia Fleck, R.N., B.S.N., E.T., a board certified wound care specialist for Medline Industries Inc., support surfaces exhibit five basic standards in technology and they offer relief from pressure, shear, friction and moisture. The five basic standards are as follows:

Surface Tension The ability of the body to sink in without tissue deformation.
Low Friction and Low Shear The product should be made of a material that produces little friction or shear against the skin.
Freedom of Motion The surface should move with the end user, tracking their constant movements.
Constant Restoring Force The surface does not exhibit a spring recoil effect. The surface should not push back against the user's tissue no matter how much she or he immerses.
Moisture and Heat Dissipation

Maintaining normal skin temperature and moisture levels may be important in certain people as excessive moisture is one of the four extrinsic risk factors for the development of pressure ulcers.

Support surfaces used to be referred to as "pressure reducing" or "pressure relieving." The terminology has changed to "preventative" and "therapeutic."

Bed Rails and Fall Prevention

Preventative Products

Preventative products include overlays, mattress replacements, full-bed systems and bariatric systems. All of these products utilize varying technologies and sometimes more than one. These technologies include: Non-powered advanced, low air loss, powered air, air fluidized and hybrid systems. Preventative products are typically used for lower stage pressure ulcers, acute or short-term needs. They reduce pressure but not below the level required to close capillaries.

Powered systems often have user-friendly control pumps and built-in alerts to notify the caregiver of power outages and low pressure.

Non-powered systems are typically constructed of foam or a foam-base including air bladders with release valves.

Therapeutic

Most therapeutic support surfaces are prescribed by a physician as they are products used to treat higher stage or multiple pressure ulcers. They are a better choice for chronic or longer-term use because of their durable construction," Fleck said. "These products typically reduce interface pressure below capillary closing pressure.

Compliance and product acceptance by clients are other crucial factors to consider when matching a product to a client. According to Fleck, this is probably "one of the most important, but least contemplated criteria for choosing a support surface." The client needs to be comfortable lying down on the system and the product should be user-friendly for both the client and the caregiver.

Another overlooked problem is power consumption, power failures, and blackouts (read: California!) When a powered product is provided, an additional expense relating to electrical consumption is incurred by the patient, sometimes What happens in a power failure? An important aspect of the client's wound care can be interrupted.

Continuity of care is a significant issue for clients in need of support surfaces. "The client may be protected by a quality support surface overlay or mattress only to start rehabilitation and begin getting out of bed to sit on an easy chair, wheelchair or recliner; but 66 percent of pressure ulcers occur on the pelvis. A support surface or therapeutic cushion is just as important as the recumbent support surface," Fleck said.

Reimbursement

Resnick recommends that dealers work closely with their referral sources on the reimbursement of support surfaces. Sometimes a client in need of a support surface has an entire multidisciplinary team working with them including wound care nurse, physical and occupational therapists and discharge planners.

"Many dealers can increase their cash sales by selling full-, queen— and king-sized pressure-relieving toppers for their home beds. They also can sell therapeutic pillows," Resnick said.

Beds

Like support surfaces, there are a multitude of beds for HME providers to choose from including adjustable, electric (both semi-electric and full-electric), bariatric, manual and multi-height. The shift away from long-term hospital stays — to reduce costs — and the desire of many clients to remain at home are factors that make the bed market a growing commodity. There are several beds designed to take the strain off back muscles and are benefits for arthritis sufferers. Some beds have enclosure systems specially designed to prevent clients with Alzheimer's and dementia from wandering.

Adjustable beds are typically designed with comfort and durability in mind. Other features to look for include quiet motors, ergonomic designs, a durable frame and massage options.

For bariatric beds, look for features that apply both to the client and caregiver such as accessibility, user-friendly set up, weight capacities and quiet operation.

Some manufacturers offer beds with a multiple features designed to extend the products' lifecycle.

Bed Rails and Fall Prevention

Some HMEs have incorporated fall prevention products such as bed rails into their product mix. "This is especially helpful with patients who have been diagnosed with Alzheimer's, dementia and other neurological disorders," said Ron Resnick, president of Blue Chip Medical, Suffern, N.Y.

Assistance Level 1. Minimal

User can stand up or transfer on their own, but need some support for safety. A bed rail is used mainly for in bed mobility or additional stability during standers and transfers. This user may require the use of a cane.

Conditions might include:

General fatigue and weakness

Suggested product:

A standard rail for home beds

Assistance Level 2. Moderate

User requires firm or solid support to be able to complete standing or transfers. He or she can stand on their own, but will likely benefit from learning support. A cane, walker or scooter is part of their mobility needs.

Conditions might include:

Arthrtis, muscle capacity loss, dizziness and balance issues when standing, early stages of M.S. or Parkinson's.

Suggested product:

A bed rail that unlocks and pivots open to provide learning support in front of the user, minimizing forward falls and improving the transfer process.

Assistance Level 3. Maximum

Bed rails and transfer devices are an essential part of the users' mobility needs. He or she will likely depend on a walker or wheelchair to get around. A user will require leaning and resting support and may not be able to perform standing and transferring without assistance. User might also expect support needs to evolve over time.

Conditions might include:

Paraplegic with good upper body strength, mid-stages of M.S. or Parkinson's, recovering from knee or hip replacement surgery and recovering from a stroke.

Suggested product:

A quarter length fixed bed rail and a horizontal bar that pivots and locks into multiple positions to allow for optimal positioning and support during transfers. This product should also reduce caregiver strain by allowing users to make use of their strength while a caregiver supervises and aids the user in the transfer.

Ian Crawford of Healthcraft Products contributed this information.

Staging of Pressure Ulcers

Stage I — Non-blanchable erythema of intact skin (reddening)

Stage II — Partial thickness skin loss involving epidermis and/or dermis (partial skin loss and reddening)

Stage III — Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia (more damage including muscle tissue but not down to bone)

Stage IV — Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting

Group I Patient Criteria

There are seven criteria associated with qualifying for Group I support surfaces, they are:

Patient is completely immobile
Patient has limited mobility
Any stage pressure ulcer on the trunk or pelvis
Impaired nutritional status
Fecal or urinary incontinence
Altered sensory perception
Compromised circulatory status

In order for a patient to qualify for a Group I support surface they must:

Meet criteria number one or
Meet criteria number two and at least one of the criteria number four — number seven or
Meet criteria number three and at least one of the criteria number four through seven.

CMS Codes For Group I Products

E0180, E0181, E0182 — Powered pressure reducing mattress overlays (APP's)
E0184: Foam Mattress
E0186: E0187, E0196: Air or water or gel mattress
E0185: Gel Overlay
E0188: E0189: Sheepskin and lambs-wool pads
E0197: Air mattress overlay
*E0198: Water Mattress overlay
E0199: Foam mattress overlay

Group II Patient Criteria

There are six criteria associated with qualifying for Group II support surfaces, they are:

Multiple Stage II pressure ulcers located on the trunk or pelvis
Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate Group I surface.
The ulcers have worsened or remained the same over the past month.
Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis.
Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the last 60 days).
The patient has been on a group II or III support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days).

In order for a patient to qualify for a Group I support surface they must:

Meet criteria number one, two and three or
Meet criterion number four or
Meet criteria number five and six

CMS Codes For Group II Products

E0277: APM's, Low Air Loss Mattresses
E0371: Non-Powered Pressure Reducing Mattress Overlay
E0372: Powered Pressure Reducing Mattress Overlay (Low Air Loss, Alternating Pressure, etc.)
E0373: Advanced Non-Powered Pressure Reducing Mattress