Reduce Your Medical Costs With Durable Medical Equipment

Durable Medical Equipment Often Overlooked for Cost Containment

 

Self-insured employers who are trying to control the cost of medical care within their workers’ compensation program will often use medical triage, nurse case managers and pharmacy benefit managers, but overlook durable medical equipment (DME).  Durable medical equipment is reusable medical gear or reusable medical products necessary for the injured employee to function at home or away from a medical facility.  Durable medical equipment must be prescribed by a doctor and most DME will have no benefit to a person who does not have an injury or occupational illness.  The need for durable medical equipment is closely related to the severity level of an injury — the higher the level of severity of an injury, the greater the probability that an injured employee will need DME.

 

 

Can Be Expensive, However Cheaper Than Hospital

 

Depending on the nature of the DME, it can be very expensive adding considerable medical cost to the workers’ compensation claim.  Examples of DME that can add substantially to the claim cost include:

 

  • Oxygen tents

 

  • Hospital beds

 

  • Motorized wheelchairs

 

  • Power operated vehicles

 

  • Lift chairs

 

  • Continuous positive airway pressure (CPAP) machine

 

  • Iron lungs

 

  • Traction equipment

 

  • Prosthetic limbs

 

  • Transcutaneous electronic nerve stimulators (TENS units)

 

  • Air beds or fluid beds

 

 

While some DME can be expensive, it is always much cheaper for the injured employee to be at home using DME than it is for the injured employee to be in a hospital room, nursing home or other type of  convalescent facility.  The cost of medical care supplied away from the home can range from 100% to 1000% higher than the cost of medical care at the injured employee’s home with DME.

 

In some liberal jurisdictions the range of DME has been expanded to include such items as:

 

  • In-home spas

 

  • Whirlpools

 

  • Hot tubs

 

  • Orthopedic/specialty mattresses

 

  • Air conditioners

 

  • Dehumidifiers

 

  • Hearing aids

 

 

Prescription Written by Doctors Should be Verified

 

Prescriptions for these types of items are normally only written by doctors chosen by the employee’s attorney.  If the employer is confronted with a prescription for specialized DME of this type, an independent medical examination of the injured employee can be completed to verify the need for the specialized DME.  An alternative is to have a utilization review or a peer review of the prescription to verify the medical necessity. A different approach is to have the request for specialized DME reviewed by the workers’ compensation board or industrial commission for their concurrence or denial.

 

 

Claims Adjuster Should Arrange for Purchases

 

If it is determined the specialized DME is necessary, the claims adjuster or the nurse case manager should arrange the purchase of the specialize DME.  This will allow the adjuster or nurse case manager to obtain the necessary equipment, but restrict the purchase to what meets the doctor’s prescription, but does not exceed it.  For example – the doctor writes a prescription for a Tempurpedic mattress and the industrial commission rules it must be provided.  If the claimant is left to select and order the mattress, the claimant will select the $6,000 version, while if the adjuster is responsible for obtaining the mattress, the adjuster will select the $3,000 version that meets the requirements of the doctor’s prescription.

 

Some DME is not expensive and is commonly provided to injured employees.  Examples of less expensive DME includes:

 

  • Commode chairs

 

  • Walkers

 

  • Canes

 

  • Crutches

 

  • Nebulizers

 

  • Non-motorized wheel chairs

 

 

Hold Durable Medical Equipment Costs Accountable

 

If the state medical fee schedule includes DME (some state fee schedules do include DME while others do not), and if there is no question in regards to the medical necessity of the DME, it should be submitted to the medical fee bill review service for control of the cost of the DME.

 

In the states where the state fee schedule does not address DME, the self-insured employer should make arrangements with a company that specializes in DME to provide all necessary DME.  A pre-arranged pricing agreement for the DME items listed above will reduce the cost of DME.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Speak Your Mind

*

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de