2015 HME Handbook

How to Coordinate CPM Treatment with Referral Partners

The key for providers finding success in providing CPMs comes down to developing solid relationships with their physician referral partners.


Continuous Passive Motion (CPM) machines are based on the theory that if intermittent movement is healthier for both normal and injured joints, then continuous motion is better for healing. The concept was developed by Robert Salter, M.D., a Toronto orthopedic surgeon who saw that the immobilization of joints after injury or surgery was unhealthy. Since patients cannot be expected to move their own joints for hours at a time, Salter developed CPM machines with the idea that they could used for most of the major joints of the upper and lower extremities.

CPM machines are considered advantageous for post-surgical treatment to promote the healing and regeneration of joint cartilage. Specifically, they generate increased 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. Bearing that in mind, CPM machines are used post operatively after procedures such as total knee replacement and ACL repairs, and are sometimes used after micro-fracture surgery and other repairs.

Given that the application of CPM devices is post-surgical, and sometimes immediately after surgery, while the patient is in the hospital, the key for providers finding success in providing CPMs comes down to developing solid relationships with their physician referral partners to ensure quality care and service, and that the service meets the post-surgery needs of the physician. So, how can a provider start to create these relationships?

Stat with Physician Education

It’s not uncommon for some hospitals to use aging CPMs that have been around for a long time and don’t offer the features or technological advances that newer devices do. This presents providers with an excellent opportunity to offer state-of-the-art solutions for post-surgical care, and establish its expertise within the local healthcare community. Take time to educate local physicians are aware of the options they have available from your business, and that your team offers a solid level of expertise.

In addition to the product options, educate referring physicians about the entire process of offering CPMs, including funding. That’s particularly important, because some physicians are unaware that patients need to be put on a device within a certain time frame after surgery, or that Medicare will not fund the CPM.

In both regards, it is critical for the provider to develop staff knowledge of products and the various aspects of provisioning CPMs so that the team are truly experts in the category. Referring physicians will come to appreciate having people on whom they can depend for information. That will greatly differentiate your business from the competition.

Foster Solid Communication

Patients are usually put on CPMs right out of surgery, with treatment then lasting after they leave the hospital to heal at home. Because this treatment is such a high priority for patient and physician alike, it is critical that the HME provider establish solid communications with physicians so that the devices are properly deployed in one of the first post-surgical steps that patient’s treatment.

The provider will want to work with the physician to ensure that the correct frequency, length, range of motion, the right amount of progression, etc. is used for each patient. And it is important to not that not all doctors have the same CPM requirements for one procedure or another, so a provider serving different physicians must take care that each patient set up reflects these differences.

Understand Each Physician’s Protocols

As mentioned, CPM therapy can vary between doctors. Physicians prescribe CPM machines to be used in accordance with their prevailing protocol. For instance, it is likely that each physician serviced by provider will have his or her specific CPM protocol for a specific surgery, such as total knee replacement. One might start a 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. That doctor might then have a different protocol for ACL surgery, perhaps with a starting range at a slightly lower 0 to 40 degrees to start and then progressing as you would with the total knee regimen. The provider must pay strict attention to each physician’s guidelines for each patient.

Provide Flawless Follow-up

Once the patient is slated to be discharged from the hospital, the provider needs to follow up with the patient — often several times — after he or she returns home. Key goals are to ensure the patient is complying with therapy, isn’t having any difficulties, and if there are, that those difficulties are addressed. It’s important to have that follow-up continue through the CPM therapy, because it can last two weeks or longer.

Give patients the tools for sticking with their therapy. For instance, put together materials such as logbooks that help them track activities such as the frequency and length of their CPM use, post-surgery exercises, and how they feel their recovery is progressing.

And the provider isn’t the only person involved in that follow-up. Likely, there will be physical therapists involved in the patient’s post-surgical care, and that means that the provider will need to coordinate with those care providers. And of course, the provider will want to report back that follow-up to the physician so that any adjustments to the post-surgery can be made.

Points to Take Away:

  • CPM therapy often begins right after surgery, in the hospital.
  • Providers want to establish themselves as experts in the field of CPM use in order to stand out to their referral partners as reliable partners in patient care.
  • Providers need to coordinate with physicians through education and communication, and must understand each physician’s protocol for CPM therapy.
  • Providers also need to regularly follow up with patients and other care providers, including physical therapists, to ensure CPM therapy results in an optimal outcome.

Learn More:

  • Check out the latest news, features, columns, and product coverage on CPMs from HME Business at bit.ly/HMEB-CPM.

This article originally appeared in the June 2015 issue of HME Business.

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