A 4-month rental pays HME providers about $1,700 a month, but Medicare is watching, and previous wound care experience is highly recommended.  

What do you do when a patient's wound will not heal, despite the use of various types of wound care dressings and therapies. When confronted with these difficult-to-heal wounds, clinicians often turn to negative pressure wound therapy (NPWT). HME providers who rent these devices to patients at home receive about $1,700 per month for the rental, and sell the accessories for about $27.

HME dealers who already provide wound care supplies and therapeutic surfaces to various groups may want to seriously consider NPWT, especially if they have enough appropriate patients. Once again, criteria for coverage are key.

According to the Medicare policy, NPWT is covered in the presence of:
• chronic stage 3 or 4 pressure ulcers;
• neuropathic ulcers;
• venous or arterial insufficiency ulcers;
• chronic ulcers of mixed etiology lasting at least 30 days; and
• a complete wound therapy program has been tried or considered as described by the policy and ruled out prior to application.

In addition, the medical record must reflect: 1) documentation of an evaluation; 2) measurements by a licensed medical professional; 3) application of dressings to a moist wound environment, and 4) debridement of necrotic tissue. “All these things have to be evident in the record in addition to provision for adequate nutritional status,” says Georgie Blackburn, president of the Pennsylvania Association of Medical Suppliers (PAMS) and compliance director/privacy officer for Blackburn’s Physicians Pharmacy, Tarentum, Pa. “I can’t think of any other product where it is more important to qualify the patient by requesting the medical record. Providers also must have in the record that compression bandages or garments have been consistently applied and that leg elevation and ambulation have been encouraged if treating a venous insufficiency ulcer. …According to Region A-B policy, you have to prove in the medical record that you have tried a number of other things and each of those demonstrated a need for something more.”

“Documentation is definitely extensive, which, under the circumstances, it should be,” adds Tom Oliver, COO of National Wound Care, a DME provider specializing in beds and support surfaces in Champaign, Ill. “And it can be burdensome just obtaining all the information, because it has to be documented before you ever got involved.”

At first glance, NPWT may sound like a good business, but—be warned—CMS is paying attention. “I do know from talking with Dr Hughes [Paul J. Hughes, MD, medical director of the Region A DMERC] that Medicare is watching this very closely,” says Blackburn. “Right now ,the payment is high and you can rent NPWT out for only 4 months. If additional months are required, you will have to provide extenuating circumstances before Medicare will allow additional payment.”

Typically, an HME provider will deliver the device according to the physician's order, and in most cases through a wound clinic. Home health care nurses are sent out to monitor wounds on behalf of the physician. These nurses treat the wound, tend to it, and debride it when necessary. Reporting back to the doctor periodically is a critical part of this job. “The home health agency is independent and is ordered onto the case by the physician to treat the patient and report back so the physician can monitor the wound,” says Blackburn. “NPWT is usually for a wound that is not responding to anything else.”

The Future
While NPWT currently makes up only a tiny part of most HME wound business, it could get a lot bigger in the years to come. NPWT device manufacturers at Medtrade, who declined to be named, reported that booths were “slammed for 3 days” at Medtrade. As with other medical products, the demands of an aging population will likely reach the NPWT market. “I would sense that this market may grow,” says Blackburn. “I don’t have a crystal ball, but I do think the prevalence of diabetes and an expanding older population with secondary conditions may cause the problems that eventually warrant NPWT.”

Will those complicated documentation requirements stop providers from getting into the field? “I don’t think it will discourage them from trying it,” says Oliver. “However, if they do, and they end up with quite a few problems getting paid because they don’t have the proper documentation, then you might find some that say it’s not worth what they’re putting into it.”

Ultimately, experience with other wound care products and modalities will serve the new provider well. “I would hope that only those providers who handle wounds already—by providing either wound care supplies or group 2 and 3 surfaces—would see this as an ordinary augment to what they are doing,” warns Blackburn. “If any provider thinks, ‘Oh, this pays a lot of money per month, I’m going to jump into this,’ I believe, upon research, he would think twice, because this policy is very specific, and that is the type of attitude that breeds fraud and abuse.”

Greg Thompson is the editor of Home Health Care Dealer/Provider. He can be reached via e-mail: gthompson@ascendmedia.com.

What is NPWT?
Negative pressure wound therapy (NPWT) is the controlled application of subatmospheric pressure to a wound using an electrical pump to intermittently or continuously convey subatmospheric pressure through connecting tubing to a specialized wound dressing—which includes a resilient, open-cell foam surface dressing, sealed with an occlusive dressing that is meant to contain the subatmospheric pressure at the wound site, and thereby promote wound healing.

—Definition courtesy of Paul J. Hughes, MD, medical director, Region A DMERC