Pressure Relief Meets PPS.

With the advent of the Prospective Payment System (PPS), administrators must learn to balance cost control and quality of care. Purchasing pressure relief products is no exception.

There's no question that there is a pressure relief product for nearly every resident's need. The difficulty for facilities lies in getting the most for their money. "Prior to PPS, pressure relief products were reimbursed on a cost-plus basis," says Barbara Tagliaferro, reimbursement specialist with Gaymar Industries, a manufacturer of medical devices in Orchard Park, NY. "Ancillary support surfaces (Group II or Group III products) could be reimbursed above the per-diem rate if the resident met the required medical criteria.

"Now that PPS is in effect," she adds, "all support surfaces are included in the per-diem rate. The nursing home is no longer able to receive additional reimbursement for these products.

This has had an impact on the pressure relief product industry and, ultimately, on providers, as well. "With the advent of PPS, there is a tremendous movement in nursing homes away from renting specialty beds," explains Thomas Stewart, PhD, president of Gaymar Industries. Instead of renting a specialty bed for $40 or $60 per day, he notes, it is much more cost-effective for facilities to buy low-cost, effective support surfaces. "Because facilities are not going to be able to pass along these high rental costs to the federal government anymore for reimbursement, it's going to give facilities the incentive to do a better job at prevention and find low-cost but effective support surfaces to prevent and treat pressure ulcers."

According to Dr. Stewart, the good news is that a number of low-cost and effective support surfaces are available that will save the government money and be good for the resident, as well. He admits, however, "There is no standard method used to measure pressure and shear." Dr. Stewart says that facilities can choose the right product for the needs of each resident by assessing each resident's risk for developing pressure ulcers, using various scales for risk assessment, such as the Braden Scale or Norton Scale. "Part of these risk assessment scales look at the resident's level of activity, mobility and level of sensory perception," says Dr. Stewart. "These are the three factors that you should hone in on to determine what the resident's pressure relieving needs are." Products can then be selected to meet those needs.

The different types of pressure relief products vary by level of prevention and therapy. The first line of defense, according to Dr. Stewart, is foam overlays or mattress replacements. The next line for prevention and therapy consists of air overlays, which can be static or alternating. Next are gel-filled overlays (although they can also be combined with foam or air), water-filled overlays and low-air-loss overlays, which help manage heat and moisture on the resident's skin.

Going up the chain of therapeutic benefit, powered mattresses can replace conventional mattresses. The most popular of these are alternating and low air loss. The next higher level therapy support surfaces are known as specialty beds, such as low air loss, air-fluidized, water immersion and rotational beds. The air-fluidized and water immersion beds can help manage the resident's body temperature, and the rotational beds provide pulmonary therapy for critically ill, immobilized residents. These might also be combined, for example, in a low-air-loss, rotational bed. Unfortunately, notes Dr. Stewart, though specialty beds provide versatility and precision in treatment, they are the ones caught in the PPS rental squeeze.

Industry has responded, however, and as an example, Dr. Stewart points to one of his company's recent products, a relatively low-cost support surface that is specially constructed to provide graduated pressure and shear relief without a power supply. [*] It is in a honeycomb configuration made of a soft, compliant gel arranged in columns that are linked together. When a person lies on the support surface, the sides of the columns give way and undergo the phenomenon called "buckling" for added pressure relief. According to Dr. Stewart, the pressure-relieving attributes of the gel and honeycomb structures combine to provide a "one-two punch" for pressure and shear relief, with no power assist.

"It's incumbent upon facilities to make sure they know how good any support surface is," says Dr. Stewart. "They should look to the manufacturers that provide clinical pressure relief studies and educational support for their products."

For now, as facilities struggle to accommodate PPS, nursing home residents might be the only ones feeling much relief from pressure relief products. But, as PPS continues to evolve, so will the cost-effective pressure relief products available.

*Patented and marketed by Gaymar as "Isoflex."