CODE Webinar 5. Documentation tips for justifying elevated vacuum. Molly McCoy, L/CPO McCoy Consulting, LLC CODE SPS

Transcription

1 CODE Webinar 5 Documentation tips for justifying elevated vacuum Molly McCoy, L/CPO McCoy Consulting, LLC

2 Overview The Policy The Case The Documentation Side note: Getting more & better information from your patient Review

3 Cigna s Policy Detailed Section specifically about Vacuum Suspension Evidence Based Several studies referenced Conclusion: The published evidence does not support clinical utility for this technology compared to conventional socket systems and overall effectiveness has not been clearly established In 2003: Washington state dept. of labor & industries concluded that the published literature does not substantially support the devices effectiveness for maintaining limb volume

4 Burden of Proof Policy says: High tech Expensive Less durable(?) Not enough research Small scale Uncontrolled Low statistical power Can t be generalized Why won t conventional work?

5 Burden of Proof Does your template gather enough detail? Policy asks for extreme detail Do your notes explain your choices? What is the problem? How does vacuum solve the problem? Why doesn t conventional solve it? Does the patient understand why they need this? Patient is their own advocate Do you understand the medical issues? What medications? Ask doctor if you don t understand

6 53 yr. old male Avionics Technician Motorcycles Boating R, T.T. amputation 9/12/10 Tumor very short residual limb Current prosthesis, 3 years old, vacuum suspension Not holding vacuum The Case Pump re-built once already Liners & sleeves worn out

7 Wear & Tear Replacement in 3 years 3 months What is damage? Leaking socket Worn out sleeves and liners CAUSE of damage? Boating? Work? Motorcycles? How will you prevent similar damage in future? Heavy duty components? Protective cover? More frequent service?

8 The Documentation Prove: Effectiveness for THIS patient Work requirements Activity level Clinical utility over conventional for THIS patient Short residual limb Xarelto Limb volume maintenance for THIS patient Past use & success

9 Effectiveness Customizing prosthetic devices with enhanced features is not medically necessary if ADL s can be met with standard devices -Cigna Avionics Technician US Dept. of Labor O-net website ( perform physical activities that require: o climbing, lifting, balancing, walking, stooping, handling materials ability to keep or regain balance when in an unstable position twist, reach, with arms, legs, and body

10 Clinical Utility Over Conventional Device Very short residual limb Skin breakdown in the past Distribute forces over entire limb Eliminate shear and socket movement Xarelto Side effects: bruising, skin blisters, collection of clotted blood in tissues Does doctor feel there would be a skin issue if socket were loose?

11 Limb Volume Maintenance Not an issue for this patient He has used vacuum in the past and had success Arguments for other patients: Counteract volume change from medications Counteract volume change due to high activity Track daily sock changes Specific problems with other suspension systems

12 Side note How can you get more information from your patient? About prosthetic use Without adding time to the appointment About prosthetic issues Without adding stress to the patient

13 Describing Prosthetic Issues Prosthetic Evaluation Questionnaire (PEQ) Validated (insurers like that) Helps patient verbalize issues Helps patient discuss issues with doctor Use for clinical decision making Send to patient ahead of appointment Drawbacks: Long o Can be broken down into useful sections Hard to score o Easier after 1 st time Tricky to photocopy o Follow instructions

14 Describing Prosthetic Use Questionnaires Gather info without time constraint Patient can take their time Patient can talk to family/friends Send before appointment or take at 1 st appointment and return it at 2 nd Validated and official is good If it doesn t fit the situation or you can t explain the results no good Unofficial but tailored to the patient is good, too The goal is not to confirm choices you ve already made The goal is to gain info to make choices

15 Review The Policy Gives CLINICAL details about what information you need to gather The Case Understand what the patient needs & why In DETAIL The Documentation Address the requirements of the policy Give needed information NOT just more information

16 Thank you! And thanks to SPS for making the CODE program and these webinars possible!

17 Questions? Comments? Ideas? Molly McCoy, L/CPO Ext. 5