Getting Comfortable

Ever since CMS adopted a new set of codes for seat backs and seat cushions in 2004 — which included creating 20 new “K” codes based on skin integrity features, positioning features, product dimensions and other defining criteria — both manufacturers and providers have focused on working with the new codes and on how they can best apply the products in them to their customers' needs.

There are some positives under the new structure, points out Bruce Shapiro, director of therapeutic support services for Medline Industries. For example, he notes, any patient who is physically compromised and qualifies for a wheelchair also qualifies for a pressure-reducing cushion.

But Michael Wright, Invacare Corp.'s product manager for seating and positioning, says some confusion still exists. “There is still a lot of confusion regarding reimbursement, especially around the new codes. The providers that really understand the codes and the implications of the reimbursement are going to figure out which combination of products will keep them profitable,” he explains.

A Push for Prevention

What holds true is the fact that preventing decubitus ulcers — the focus of seating and positioning products — is more cost-effective than treating them.

Estimates of the surgical cost to repair these lingering wounds range from $40,000 to $125,000, which leads one to question why any payer would not spend a few hundred dollars on appropriate seating and positioning products to prevent such an astronomical expenditure.

“In seating and positioning, we really do have two unique dynamics. Through the proper application of assisted technology, we can reduce the nation's health care spending and improve the quality of life and medical conditions of those who use wheelchairs,” says Tom Whelan, Sunrise Medical's vice president for seating and positioning. “That's a powerful thing.”

And according to Shapiro, within the home care community, “there is more awareness that [prevention] is an issue that needs to be addressed more vigilantly.”

“These products are not merely comfort-based products — they are very important to lifestyle and to health, and the system needs to recognize that it's not just the cheapest product that is going to do the job,” adds The Roho Group's Tom Borcherding, senior vice president of global medical sales.