The 2014 HME Handbook: CPM
How to Ensure Optimal Outcomes for Patients with CPM Devices
Today’s healthcare environment emphasizes optimal patient outcomes at an optimal cost, and one of long-standing piece DME that was designed with that in mind is the continuous passive motion (CPM) device. Designed to help post-surgery patients start moving limbs intermittently, CPMs aim to preserve joints and help promote healing. However, because a patient coming out surgery can’t exercise his or her own joints for hours at a time, CPM devices were created to help them move passively; instead a machine does all the work.
Physicians that elect to use CPM machines are looking to promote the healing and regeneration of joint cartilage. The aim is to control pain and reduce inflammation, while providing motion in a specific plane of movement in order to protect any tissue that is healing. Also, the motion increases blood flow and nutrition to the injured site wile moving the limb or joint, prevent stiffness and soreness, reduce pain and swelling, reduce scar tissue formation, and increase range of motion and flexibility.
Since their genesis, there have been CPMs designed to help move most of the major joints of the upper and lower extremities. Two very popular applications for CPMs are for patients coming out of knee replacement and ACL surgery. When considering how providing CPMs can help optimize patient outcomes, here are some core concepts:
Timing and Funding
Depending on he surgery and the patient, CPM is typically used for two to three weeks after discharge from the hospital. Most CPM therapy actually begins in the hospital and then continues at home, with the CPM machine used on a rental basis. Medicare and most private payor insurance carriers will rent the CPM after the surgery for total knee replacement and ACL repairs, while CPM use for other surgeries will be covered on a case-by-case basis. So, providers will want to verify insurance coverage and ensure that their documentation is complete prior to establishing service. Also make sure patients are fully informed of their coverage, as well.
Part of supply CPMs is helping to act as an agent of the physician, so understand the doctors protocols regarding the use of CPMs — and those protocols might vary from doctor to doctor and surgery to surgery. So for example, one doctor might start a knee replacement patient at 0 to 60 degrees at set-up and increase flexion 5 to 10 degrees per day, using the CPM machine two to three times per day for one to two hours per session. Protocol for ACL surgery would differ slightly with the starting range, somewhat lower at 0 to 40 degrees to start and then progressing similar to the progression in the regimen for a total knee replacement. The more you advance the physician’s protocols, the more you’ll help optimize outcomes.
Of course, the provider can’t always be there, so education patients is fundamental in ensuring success. Typically the hospital will have an education program that they give to patients on the use of their CPM, but the provider should be actively involved from the get-go. Provide physicians with your own education materials that they can hand out to patients before the surgery even begins. When setting up the patient at home, again the provider should be providing hands-on education and leave-behind materials to help the patient get going and continue with their CPM treatment.
That education should include a range of very basic, but very important points that the patient should fully understand before the provider leaves. This includes:
- Use the CPM device as frequently as possible per physician’s instructions during the day and, if convenient, while sleeping.
- The CPM device’s settings should only be adjusted in accordance with the instructions provided by the doctor, therapist or provider.
- The patient should stop using the CPM device if unusual pain or discomfort occurs. The patient should immediately notify the doctor, therapist or provider.
- When using the lower limb CPM unit, it should be firmly positioned on the bed or floor.
- Use the CPM unit in a clean, dry place, and don’t allow children near the machine.
Follow-ups are critical in CPM therapy success. Patient education is one thing, but the onus is on the provider to return to the patient’s home and ensure that the patient is complying with therapy, that correct adjustments have been made per the physician’s protocols, and that nothing is amiss. Weekly follow-ups should check on how often the patient is using the device, if they are attending the required physical therapy, if there is any pain, that the device is properly adjusted, and what is the full active vs. passive range of motion.
Points to Remember:
- Continuous passive motion is used for a variety of joint surgeries, with knee replacement and ACL surgery being two key procedures.
- CPM use often starts in the hospital, so it is critical for providers to ensure patients have proper funding and that the device is approved prior to procedures.
- Providers must understand physicians’ specific protocols on CPM use.
- Patient education on CPM use both pre- and post-surgery is critical to success since the device is used in the home.
- Providers must follow-up regularly to check on patient use, ensure compliance and help adjust the device per doctor protocol.
- The history of the development and use of continuous passive motion is an interesting one. Learn more about CPM and the people and companies behind its origins at continuouspassivemotion.org.
This article originally appeared in the June 2014 issue of HME Business.