I made phonecalls to Hills ROM to see if the Clinitron bed would be ordered for
home discharge for my friend going home with stage IV decubitus ulcers (sacral,
heel, other). I was met with a surprise. No was the answer, because he does not
qualify. I let them know he already had a Clinitron bed at home when he left
Kessler (paid for by Medicaid?) back in 2007. He has been on a Clinitron bed
for a good portion of the time, although not at first at the community hospital
he is now at and his wounds worsened.
Anyway, they told me they would have to fight it out with Medicare. The rules
state he qualifies as a group III for the air-fluidized. But their regulations
require for a patient to go to a lower quality group II, and see if the
patients wounds get worse on a regular air mattress for 30 days. If his wounds
worsen (beyond stage IV? how could they even worsen?), then they would agree to
a Clinitron. I told them he coded several times at this hospital, had sepsis,
mrsa, bone infections, and now they are going to send him home with the least
quality mattress? (not to mention he does not have a regular bed at his
mother's home, so would have to purchase a bed, to put the mattress on, which
would make him worse, etc.). Then I am told they have an option to say he does
not meet all their requirements, and to make a case to Medicare so they (Hill
ROM) will get paid for providing the Clinitron bed.
Can you imagine? My friend is a quad, severe contractures, has been through a
huge nightmare at this hospital. Even last week I called a wound specialist to
come see him, and the hospitalist blocked him, stating he did not know he was
coming, so would not allow him to see him. Then blamed the patient,(of course).
My guess is the real reason is his doctors do not want another doctor from the
outside seeing his wounds and the care he received there.. so blocking access.
He needs an advocate and good legal advice. I feel his rights are being
violated at the hospital. His mom cannot bring him home until they have all the
electric means organized too- with a generator. I never heard of having to have
a generator before a patient is discharged on a Clinitron. I am not sure what
information the mom is getting...but he is not going to be able to see home for
Christmas. He has been in a hospital or LTAC and nursing home for over two
years.
Below is the excerpt of what was sent to me from HILL-ROM regarding the
regulations for prohibiting a patient from receiving a Clinitron at home unless
they have a 30 day trial on a lower quality mattress. Anyone else have this
trouble? And if so, what did you do to help?
LCD for Pressure Reducing Support Surfaces - Group 3 (L5069)
An air-fluidized bed is covered only if all of the following criteria are met:
1.The patient has a stage III (full thickness tissue loss) or stage IV (deep
tissue destruction)
pressure ulcer (ICD-9 codes 707.23-707.24).
2.The patient is bedridden or chair bound as a result of severely limited
mobility.
3.In the absence of an air-fluidized bed, the patient would require
institutionalization.
4.The air-fluidized bed is ordered in writing by the patient’s attending
physician based upon a
comprehensive assessment and evaluation of the patient after completion of a
course of
conservative treatment designed to optimize conditions that promote wound
healing. The
evaluation generally must be performed within one month prior to initiation of
therapy with
the air-fluidized bed.
5.The course of conservative treatment must have been at least one month in
duration
without progression toward wound healing. This month of prerequisite
conservative
treatment may include some period in an institution as long as there is
documentation
available to verify that the necessary conservative treatment was rendered.
Conservative
treatment must include:
a.Frequent repositioning of the patient with particular attention to relief of
pressure
over bony prominences (usually every 2 hours); and
b.Use of a Group 2 support surface to reduce pressure and shear forces on
healing
ulcers and to prevent new ulcer formation; and
c.Necessary treatment to resolve any wound infection; and
d.Optimization of nutrition status to promote wound healing; and
e.Debridement by any means, including wet-to-dry gauze dressings, to remove
devitalized tissue from the wound bed; and
f.Maintenance of a clean, moist bed of granulation tissue with appropriate
moist
dressings protected by an occlusive covering, while the wound heals.
In addition, conservative treatment should generally include:
g.Education of the patient and caregiver on the prevention and management of
pressure ulcers; and
h.Assessment by a physician, nurse, or other licensed healthcare practitioner
at least
weekly, and
i.Appropriate management of moisture/incontinence.
