Taking It Lying Down

Key considerations when providing beds and mattresse

Beds and support surfaces represent a cornerstone of DME. From bariatric patients to mobility-impaired patients, there is a multiplicity of home care customers that need special beds and mattresses.
Likewise, there are a number of things a provider must consider when offering beds and support surfaces to patients. Here are some key factors to keep in mind:

Assess Patient Circumstances

A good place to start in providing beds is to go to the patient’s home and conduct a walk-through. This is especially important in working with bariatric and mobility-impaired patients who might have special requirements when it comes to negotiating their homes.

The visit to the patient’s home will help the provider ensure the area is clear and uncluttered and can properly accommodate the bed that a patient should be using, says Duane Siz, COO of Delcrest Medical Services in Ivyland, Pa., which has been selling bariatric beds for roughly 15 years.

A site visit might be a real eye-opener, says Dr. Kevin Huffman, a board-certified bariatric physician and member of the American Society for Metabolic & Bariatric Surgery. Huffman says he’s often discovered patients who had previously been sleeping on floors or in recliners.

Sites visits offer an opportunity to educate patients about the type of bed they should be using and why, as well as answer any questions they might have. Moreover, providers get the additional opportunity to assess the home to see if patients need grab bars, rails or a trapeze to get in and out of bed.
Other medical conditions also can shape the decision for what kind of bed or support surface a patient might need. For instance, issues such as oxygen and nutrition could impact the healing of a pressure wound, and thus the effectiveness of a mattress, says Dan Anderson, vice president and co-owner of Ft. Worth-Texas provider Woundkair Concepts Inc. Poor nutrition could consequently result in poor wound healing.

Product Options

Where beds and mattresses are concerned, there are a host of options, and that means a provider must either specialize or provide a broad range of expertise.
For instance, when it comes to beds, patients could have bariatric needs, or require adjustability or beds that prevent wandering at night, such as those needed for people with autism.

Bariatric needs are perhaps the most complex. To begin with, bariatric patients often require treatment of other co-morbidities. A bed that articulates to help treat those other conditions, such as raising the legs in the case of edema or changing the position to aid a respiratory condition, might be required.
Safety is also a key piece of the puzzle. A poor choice of bed can result in injury, which is why bariatric beds should not only fit the correct weight category for the patient, but also should have a low enough deck height that the patient can get in and out of the bed without risking a serious fall. Suffice it to say, if the wrong choices are made, the provider could be liable.

Patient safety isn’t the only consideration. Helping a patient up from a bed or even providing care while the patient is in the bed could result in injury. For instance, if a caregiver has to get up on a stepstool to dress a wound or help a patient clean up, because the bed is too high off the ground, that presents an unsafe situation, Huffman says. “We’ve got to keep the caregivers in our thoughts when we recommend a bed for the patient,” he adds.

In general, beds should meet Occupational Safety and Health Administration and FDA requirements that they test to the UL 60601-1 and IEC 60601-2-38 standards for hospital beds. These requirements can be particularly important when it comes to powered and non-powered adjustable beds, which have more points of failure than a standard bed.

But don’t just look for the testing labels. Providers should do their homework and work with established suppliers that the provider knows to produce quality DME that will last them and their patients over the long haul.

Mattresses have an equal number of variations that must be tailored to the patient’s needs, especially since most of them are geared for treating or preventing pressure sores. (See “Pressure Wound Stages” to read more about the types of pressure wounds.)
There are two main types of mattresses available: standard low air loss mattresses and alternative pressure mattresses. There is also a third type of mattress that uses three-cell technology.

Usually, alternating pressure mattresses have A and B cells that alternate in pressure. When the A cells inflate, the B cells deflate. A third-cell mattress adds a C cell to the mix so that when the A and B cells are inflated, the C cells are deflated, which allows the patient to “bridge” across the cells to relieve more pressure.

The more severe the pressure wound, the more complex the mattress that will be required. A patient with a single stage 2 sore or less might simply need a gel overlay, while a patient with multiple stage 3 or 4 wounds might need a three-cell mattress.

As with beds, reliability is an important element in selecting the right mattress. Foam mattresses can break down and blower motors can overheat and fail. Make sure to look at blower motors and pumps that can hold up to a 24-hour use. Also, motors that use air that is already in the cells, rather than those that circulate outside air into the mattress, won’t have to work as hard.

Longevity needs to be an element in the reliability calculation as well, says Dikran Tourian, executive vice president of sales and marketing for support surface manufacturer Anodyne Medical Device Inc. One way Anodyne is doing that is by offering its ReactiveAir Pro mattress, a combination powered and non-powered air and foam support surface. The ReactiveAir Pro converts between powered and non-powered, which means it can still have therapeutic value in the event of a power outage.

Think Hard About Funding

Other important factors are funding and finances. According to Anderson, cost is a “huge consideration” when it comes to providing support surfaces. A mattress that is designed to treat a serious pressure wound can cost as much as $3,000. While Medicare or private payor insurance will cover the mattress, that’s a rather large expense to have sitting on the books while the funding gets sorted out.

Moreover, with funding cuts being caused either directly by competitive bidding or indirectly by its delay (see “Competitive Bidding Delay Set in Stone,” page 8), providers are wisely becoming more cost-conscious, both for their own sake and the patients’ sake. DME, such as support surfaces, can make an impact on the patient end of the financial spectrum. For instance, an air mattress with a motor will not only consume its own share of electricity, but if it runs hot, it will ratchet up that electricity bill even more by causing the air conditioning to come on more frequently, Anderson says.

Also, don’t forget the Centers for Medicare & Medicaid Services (CMS) rental caps, which mean it’s not just the provider that is feeling the financial bite.
“At the end of 13 months, it’s (payment) capped,” Tourian says. “What we’re experiencing now is that the patient is the one who is getting hurt. If they’ve had a surface for 20 months and it malfunctions, they’re calling the manufacturer, instead of the provider, and they’re having to come out of pocket.”
Remember that bariatric beds are charged on the same group II support code, E0277, which means that even though they cost more than a standard size mattress, those beds will receive the same level of funding. “Bariatric surfaces cost two to three times as much as standard support surfaces cost,” Tourian says. “That’s a safe statement to make. And the provider only gets to bill the standard E0277 code.”

Don’t Forget the Back End

Warehousing costs can and should be an important consideration when providing beds and mattresses. Beds clearly come with considerable warehousing requirements. They are large equipment with equally large storage footprints. Plus, each type of bed comes in a variety of sizes. These variations can quickly start to dominate a warehouse.

Likewise, mattresses can sometimes take up an equally large amount of space. Air mattresses often roll up, taking up less space, but a more standard mattress, or a foam mattress, might require some dedicated space. Also, some mattresses are adjustable, so a provider might be able to get away with one mattress for a range of beds. For instance, Blue Chip Medical’s

Power-Pro VW elite, a low air loss/alternating pressure mattress for bariatric patients, can be scaled to fit 37-. 42-, 48- and 54-inch bed frames. That adjustable approach cuts down on storage space consumption and budget.

In addition to hard assets, such as warehouse space, additional software assets, such as specialty expertise, could prove useful in the case of providing beds and support surfaces. That could be especially true from a marketing standpoint. While software might not necessarily be needed, if a provider’s business begins to grow, having on-staff expertise could become a good way to attract and serve referral partners.
“As providers grow in this segment, a lot of times they will add a wound care nurse,” Tourian says, “but it’s more to provide a service to their referral source, then it is to educate. They’re saying, ‘If you use us for your support surfaces, we’ll have our certified wound care nurse help your patients.’ It’s definitely an advantage, but it’s not cheap.”

Points to Take Away:

• Consider patient circumstances. Besides patient condition and funding, providers also should consider the patient’s home environment to ensure it will accommodate the correct bed or mattress. Site visits are a great way to make this determination, factor in additional equipment needs as well as educate the patient.

• Know the product options. Both beds and mattresses entail a variety of product types and options tailored to suit specific patient needs or therapeutic environments.

• Factor in funding. Beds and mattresses are expensive pieces of DME. Think about how they will impact your bottom line, how you will ensure they get funded and how they might impact your patients’ financial situations.

• Think about impact on your operations. Beds and mattresses can take up a lot of space. The required space and warehouse staff costs can quickly rack up. Likewise, you might want to have additional specialist staff on-board, such as a wound care nurse, as a service to key referral partners.

Learn More

• HME-Business.com’s Beds and Support Surfaces Solution Center, http://hme-business.com/mcv/sc/bedssupport — We provide a deep backlog of articles, columns and news items about beds and mattresses. Start your online research at our Web site.

• Medical Equipment Compliance Associations, http://ulmedical.com — MECA helps medical equipment companies with safety certification, compliance and regulatory adherence, and its Web site provides a good deal of information on safety testing requirements, such as IEC 60601-2-38 and UL 60601-1.

• National Pressure Ulcer Advisory Council, www.npuap.org — This organization provides a variety of pressure wound resources, including its detailed would staging guidelines, which were updated in 2007.

This article originally appeared in the August 2008 issue of HME Business.

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