Continuous passive motion (CPM) devices help patients regain their range of motion after a surgery that affects a joint. The goal is to help patients recover more quickly so that they can return to their daily lifestyles and livelihoods.
Moreover, a quicker recovery will also hopefully reduce the costs of their care, since patients most likely will not have to undergo physical therapy for an extended period time. In fact, the psychological benefit for a patient to see his or her limb moving — possibly the moment they wake up after surgery — can be immeasurable.
This is where the HME provider comes into play. With such a clear-cut therapeutic benefit, CPMs represent an attractive business for HME providers looking to help post-surgical patients. What do they need to do to get started?
How long are CPMs used? Physicians typically prescribe a CPM to be used for between 14 and 21 days on average. The Medicare guidelines generally cap CPM usage at 21 days, unless the physician specifies that the patient needs to continue with the therapy. Typically, a physician starts out with a small range of motion and then ramps up a small amount, perhaps 5 or 10 degrees more, each day, until the patient reaches a point where the doctor feels he or she no longer needs the device.
A couple factors impact the length of usage: patient tolerance of the device, and the nature of the surgery. For instance, was it a total knee replacement or anterior cruciate ligament repair? Those factors will be the main determinants in how long the patient is on a CPM and how well they tolerate it.
CPM funding and costs. If the patient is billing through Medicare, the HCPCS code for CPMs is E0935, and Medicare specifically covers CPMs for knee replacement. The state-by-state fee schedule for daily CPM rental ranges between $23.87 at the ceiling and $20.29 at the floor. If the patient is not covered by Medicare, the provider will most likely be billing through a private insurance or workers compensation.
While CPMs are essentially self-contained units there is a soft good — a removable pad that is swapped out between each patient — that is a regular cost. The Medicare fee schedule includes the cost of the soft item, but with private insurance and workers compensation, a lot of providers can recoup the cost of the pad by billing as a miscellaneous DME supply or accessory.
Credentials. Providing CPMs requires no certification or specific credentials from the business or staff. If a provider has a physical therapist or athletic trainer on staff that can help patients with the devices, it would be a plus, but it is not required.
Medicare stipulates that a patient must be put on a CPM post knee surgery within 48 hours. So, if a patient is in the hospital post surgery for three days, the physician will already have them on the device. If the provider wants to pick that business up, it must get that device into the hospital within that 48 hours.
Start networking with physicians. Naturally, the physician is a key relationship. Obviously, the provider can’t give the equipment to the hospital and then ask for the referral when the patient is sent home, as that would be inducement, so the provider must shop local physicians ahead of time. When the physician is ready to write a prescription, the provider must be at the front of his or her mind.
While most doctors might not know the difference between one CPM or another, many believe they are a key element in post surgical care. Reach out to local hospitals and doctors and see if they do or not, and if they do, see if they need a supplier. If they already have a supplier, don’t stop. Start start sizing up that competition to see how you can differentiate from them, and ultimately win that physician’s business. Likewise, make sure that you have a good relationship with physicians’ office managers and assistants so that they will remember you as a key partner.
Discharge planners. Another key set of professionals that the provider should work with are discharge planners since they coordinate patient needs after they leave the hospital. You want to make sure you are on their list of key providers.
Estimate usage. It is critical for providers to understand what the utilization rates of their equipment will be when working with a new physician. How many surgical procedures is a physician conducting a week? If they are working with a group, how many in the group use CPMs in their post-surgical care and how many patients? This will help the provider determine how many CPMs it must have in its inventory to accommodate patient needs, as well as cover any devices that break down in service and need replacing.
Also, don’t forget that patients aren’t always going to be responsible when it comes to notifying the provider when they are done with their CPM, so keep careful track of when therapies are supposed to be coming to an end, so that they can cycle equipment back into the flow. Otherwise a provider risks getting stuck with no CPMs. A lot of the time that means checking with the office manager, so, again, have a good relationship with physician staff.
Points to take away:
- CPMs are prescribed for usage between 14 and 21 days to help patients regain a range of motion.
- Medicare covers a daily rental rate for CPMs up to 21 days. The rates vary by state.
- Because CPMs must be prescribed within 48 hours after surgery per Medicare, providers must build solid physician relationships.
- Other key referral partners are physician’s office managers, assistants and hospital discharge planners.
- Ensure you have a solid estimate of device usage when working with new physician partners so that you can help them maintain continuum of care for patients.
CPMs are straightforward electro-mechanical devices that solve a common problem in regaining range of motion post surgery: it hurts. It can be very painful for a patient to repeatedly flex his or her muscles after a surgery in order to move joint. That’s where the “P” comes in. A CPM does all the heavy lifting, passively, in order to increase the joint’s range of motion. The patient literally doesn’t have to move a muscle, which is why a physician might even prescribe that a patient be put on a CPM right after surgery, before they go home.