Durable medical equipment and Medicare

With costs of the most common durable medical equipment reaching upwards of $1,200, the need for payment by Medicare is substantial. This increased cost of medical equipment forces elderly persons to look to Medicare and the rules governing what is covered are often confusing and time consuming. Find a durable medical equipment supplier and rely on their expertise, experience and guidance.

Durable medical equipment is a health care device that helps the elderly and/or disabled person do daily activities easier, and includes such items as wheelchairs, walkers, oxygen tanks, and hospital beds. Even items such as mobility aids, medication dispensers, convalescent care products, rehabilitation equipment and more. Also, Federal housing agencies want to make a difference to the lives of elderly and disabled persons by providing financial assistance to homeowners and landlords to carry out home adaptations.

Medicare covers certain types of durable medical equipment under certain circumstances.

Under Medicare Part B, the supplementary medical insurance program, rental or purchase of durable medical equipment is covered. However, certain restrictions are set out which elderly persons need do be aware of when considering purchasing durable medical equipment through a medical provider.

These restrictions can cost the elderly person thousands of dollars if they are unaware of the restrictions governing coverage of durable medical equipment by Medicare.

Aiding the elderly person in pre-purchase determinations of what durable medical equipment Medicare will cover can result in substantial savings. For example, the most common denials include oxygen and hospital beds, and coverage is not available to residents in skilled nursing homes.

Consumers, attorneys, and providers of durable medical equipment should be aware of these restrictions as they can result in different purchasing plans for the elderly consumer.

Quality, dependable Medical Equipment is an important component of every medical practice. It can’t be overstated that while the practice of medicine is an art, Medical Equipment is the science behind the implementation of that art.

Increasingly, patients are becoming more sophisticated in their understanding of the medical supplies and Medical Equipment that is being used to treat them. This means that a health care provider needs to know and understand not only how their equipment operates, but also have confidence that the Medical Equipment they use is of the highest quality.

Your Medical Equipment needs to be reliable and of a high quality.

The tools of your profession, whether it’s a stethoscope or a nebulizer, can now all be ordered online over the internet, generally at substantial savings. This means an easier approach to Medical Equipment management.

Both the professional and home health consumer are now ordering many of their Medical Equipment and medical supplies right from their computer. Prices are low and the quality is excellent. If you work in the health care field you’ll need medical supplies to help you with your work. Quality products that you know you can depend on will give you greater confidence during stressful situations.

Dale[R] Tracheostomy Tube Holders from Dale Medical Products replace twill ties and provide comfortable, controlled support of tracheostomy tubes. Dale’s exclusive use of a section of stretch material accommodates a resident’s cough reflex or edema, and ensures precise tube positioning. The product employs quick-fastening closure tabs for fast, easy, secure application to any tracheostomy tube. The tube holders have a soft cotton-lined neckband to prevent excoriation of the neck.

Dale[R] Foley Catheter Holders are designed to minimize the risk of infection caused by meatal irritation or accidental catheter pull-through. Two-inch wide surgical stretch material provides a comfortable, secure fit to patients of all sizes without the danger of blood-flow restriction. The catheter holder is easily secured without the time and cost associated with traditional tape application.

An important initiative at the U.S. Navy Medical Information Management Center (NMIMC) in Bethesda, MD, has been to empower its healthcare community by pioneering the virtual organization. This entails securely sharing a substantial amount of medical information, such as medical benefits, newsletters and e-mails, with more than 100,000 users worldwide, across every, conceivable technological environment.

Due to the size, cost and complexity involved in this project, NMIMC had to look beyond traditional VPN and secure extranet solutions. “Security was an absolute priority and every solution we looked at was reliable in this aspect,” says Lt. Rick Nickerson, head of security at NMIMC. “The real difficulty was to find a secure remote-access solution that could effectively work for this many remote users with unpredictable PC configurations. These users are generally not very technical and have minimal or no technical support.”

NMIMC manages a large volume of medical information–used to plan, coordinate and provide cost-effective information management throughout the world for Navy personnel and their families. Information is accessed through a variety of means, including e-mail, files, Web applications, terminal applications and traditional client-server applications. Recent efforts have been made to centralize, standardize and simplify access to more of this data using standalone or centralized Web servers.

The scale and nature of this secure remote-access problem demanded unique features beyond just high security to protect sensitive military and medical data. The widely dispersed, unpredictable and often unsupported PC configuration of remote users meant the solution could not assume anything about the client beyond the existence of an Internet connection and a browser. In addition, the sum of all direct, hidden and on-going costs had to remain reasonable, while scaling with tens of thousands of users.

NMIMC briefly considered traditional VPNs, with proprietary clients often using IPSec to securely communicate over insecure networks like the Internet. “We didn’t need or want all the functionality of traditional VPNs, and the cost and complexity involved made them unworkable,” says Nickerson.

A traditional extranet was NMIMC’s next choice. A basic Web portal-based extranet could eliminate most of the technical barriers of the traditional VPN client.

“Extranets can be complex, costly and time-consuming to build and maintain,” suggests Nickerson. “We already had the data and applications we wanted to share on our existing network and didn’t have the time or the resources to build another extranet network. All these additional systems, servers and clients just add more cost, failure points and management headaches for us.”

NMIMC eventually chose the Secure Extranet Appliance (SEA) solution from SafeWeb of Emeryville, CA. The solution integrates traditionally disparate standalone extranet technologies within a simple plug-in network appliance. By reducing the entire “extranet” to an appliance, there is no significant network reconfiguration, nor additional hardware and software required.

A secure extranet is built with the SEA in four broad steps. First, it is connected to the network and configured like any other network device, with information like the IP address and network gateway. Second, either internal or external authentication directories are defined to determine user and group access.

Third, internal resources like e-mail, file and Web servers are defined with granular access rules. Finally, the administrator determines which user has access to which resources via a customizable dynamic portal.

The SEA enables companies to set up a complete, secure extranet within a day, instead of months or years. The solution was implemented at NMIMC at a onetime cost of $90,000, with no annual license or other additional fees required.

“Our old system proved far too difficult to implement, manage and use. It didn’t provide us with centralized auditing capabilities or allow us to easily control user access,” says Nickerson. “The SEA has greater functionality and allows us to extend our service to all Navy medicine personnel without compromising security.”

NMIMC’s SEA currently gives secure remote access to more than 55,000 naval reservists in a high-availability, fail-over configuration, in conjunction with RadWare, a SafeWeb partner. This project is being extended to more than 100,000 active and reservist Navy personnel to provide them access to additional medical benefits and related information.

MERIDIAN Medical Technologies Inc., a developer of drug-delivery technology and innovative cardiopulmonary diagnostics, said that the Army has received approval from the Food and Drug Administration for Meridian’s automated assembly and filling production line for the Antidote Treatment Nerve Agent Auto-injector, or ATNAA. The company began manufacturing the ATNAA in January.

A joint research effort between the U.S. Army Medical Research and Materiel Command and Meridian resulted in FDA approval of the assembly and production line, company officials said.

The ATNAA offers significant advantages to the Army over currently used auto-injectors, they said. It’s easier to use, less bulky and reduces antidote administration time.

The ATNAA uses multichambered auto-injector technology to deliver two antidotes in a single injection while keeping the two drugs separate in the injector. The auto-injectors are prefilled, spring-loaded, pen-like devices that, when activated and pressed against the body, deliver precise dosages of medication quickly, safely and easily.–Meridian Medical Technologies

Automation is a critical component in the progress and evolution of any medical laboratory. But automating a laboratory and all of its processes is not simply a matter of plugging in a few machines and watching samples line up for testing. Managers need to know what automation entails and how it fits in with their own circumstances. Because of the complexities inherent in the automation process, an explanation of those and a “how-to list” for the preparation of, transition to, and implementation of an automation line follows.

Automation can help alleviate the pending labor shortage due to fewer students. The shortage of medical technologists (MTs) is becoming more significant every year as fewer students enter the field. Annually, only 4,000 people nationwide are graduating in the field. Schools are graduating 30% fewer MT students than 10 years ago and 56% fewer MT students than 20 years ago. The shortage is so severe that it has caught the attention of the U.S. Congress: Rep. John Shimkus recently re-introduced the Medical Laboratory Personnel Shortage Act–a bill intended to encourage more students to pursue medical laboratory careers by providing financial assistance.

Automation can help alleviate the pending labor shortage due to retirement. Current professionals are reaching retirement age in disproportionate numbers. Forty percent of medical laboratory employees are between the ages of 46 and 66 according to the American Society for Clinical Pathology, and nearly half of the current workforce will be ready for retirement by 2010. The U.S. Department of Labor’s Bureau of Labor Statistics estimates that 13,800 medical laboratory professionals will be needed each year through 2012 to fill vacant positions.

Automation can help respond to the increased demands that will accompany an aging population. The aging baby boomer population will soon create increased demand for medical testing. By 2040, 26% of the U.S. population will be at least 60 years old, up from 16.3% in 2000, according to the Center for Strategic and International Studies.

Automation optimizes the functioning, effectiveness, and accuracy of a laboratory. Laboratory automation allows for more testing in a shorter amount of time. It optimizes workflow processes to provide rapid, accurate, and cost-effective test results. Workstation consolidation, which reduces the amount of manual testing that is necessary, typically results from automation.

Automation can produce a more dynamic and robust laboratory. Automation typically frees up medical technologists to spend more time on the difficult cases that require careful analysis and assessment. Automation can also help a laboratory move from being viewed as an expense into being viewed as a revenue-generating resource. With an increased capacity for testing, a laboratory can expand its client base by serving outside healthcare facilities in addition to accommodating in-house needs.

Considering the possibilities

The need for automation is growing, and the benefits are compelling. Still, automating a laboratory is a significant undertaking and one that requires dedication and preparation. Labmanagers should fully understand what they need as they begin the process.

The first step is to make sure that the staff will energetically champion the effort, because the desire for automation must be strong. As with any significant change, the decision to automate may be met with reluctance and hesitation–whether from management wavering over costs or from veteran technologists wary of change.

Even the most enthusiastic advocates for automation should ensure that taking such a momentous step is justifiable. Consequently, the lab manager must assess future needs as well as current requirements. The medical laboratory should already be conducting a sufficient number of tests to justify the initial expense, although future demand may be near enough and strong enough to offset current shortfalls. Today’s medical laboratory that performs 400 hematology tests a day may soon be called to perform 1,000 a day. Will the new automation system be able to handle the increased workload? Also, if a laboratory is located in a geographic area with seasonal demands, these requirements should be built into the initial assessment. For example, laboratories in Florida and Arizona experience enormous surges in capacity demands during the winter months.

The impact of transitioning

Experience has shown that the transition to automation impacts the laboratory in profound ways. Perhaps most importantly, an automated system reduces the amount of manual testing required and produces a corresponding improvement in test-result accuracy. If stringent rules and algorithms are put in place, fewer slide reviews or manual differentials may be necessary, and there will be less need for further manipulation of samples. Less sample manipulation means fewer opportunities for error.

Ultracell Medical Technologies manufactures a complete line of nasal and sinus packing products, including an 8.0-cm anatomic pack available both with and without an airway. Ultracell material has a continuous open pore structure, giving it both strength and softness.

The 8.0 cm is the size most commonly used after septal, turbinate, and rhinoplastic surgery, as well as other intranasal procedures. The specially designed anatomic shape follows the contours of the nasal cavity and allows for equal pressure while absorbing postoperative fluids. PVA sponge packing is superior to other fibrous packing materials, such as cotton and gauze. Contact the company for free samples or more information.

Lone Star Medical Products, Inc., offers a line of new lightweight, reusable Aluminum Retractor Rings, Model 1104 and Model 1107, suitable for use in a wide variety of surgical procedures.

The new Aluminum Retractor Rings feature the same positive-locking-hinge design as the company’s single-use retractor rings and can be used with any of the Lone Star Retractor Hooks. The ring design features significant weight reduction in a reusable retractor ring, along with improved ergonomic design for easier stay attachment and readjustment.

The Aluminum Retractor Rings weigh only ounces more than Lone Star’s single-use Noryl[R] Retractor Rings. They are constructed of anodized aluminum with surgical-grade stainless steel hinge screws and threads.

Model 1104 measures 12.7″ (32.2 cm) by 7.2″ (18.4 cm) and is packaged singly, nonsterile. Model 1107 measures 14.2″ (36 cm) square. These products can be resterilized using any generally accepted procedure.

Another acquisition involves the Roche health care group and medical device supplier Disetronic, the world’s second-largest maker of insulin pumps. Roche offered Disetronic shareholders two Roche non-voting equity securities and $489 for each Disetronic share. Based on mid-February exchange rates, the deal was worth some $1.2 billion.

Roche will be able to offer comprehensive diabetes management solutions, from blood glucose meters for self-monitoring to programmable insulin pumps that allow patients to administer insulin doses continuously according to their individual needs. However, Roche reported it would resell Disetronic Injection Systems to Disetronic’s founder and chairman Willy Michel for $306.6 million.

The American metalworking industry thrives on complexity. As the designs of modem products and systems become more sophisticated, the value of precision in manufacturing processes and resource management increases substantially. The growing demand for highly complex parts not only narrows the competitive field, but it also places a greater premium on maintaining close contacts between manufacturers, suppliers and customers. Because the human body is much more complex than any of the manufactured mechanisms that support modern civilization, these factors are particularly applicable to the business of medical machining.

Producing medical parts is a demanding business that requires strict control of machining processes and a substantial amount of outsourcing. This heightens the importance of maintaining a network of reliable, specialized suppliers to provide services such as plating, heat treatment, electropolishing, passivation and laser marking. To support their continually evolving processes in the shop, manufacturers of medical components also must forge strong partnerships with machine tool suppliers and distributors.

Omni Components Corporation (Hudson, New Hampshire) is an ISO 9001:2000 organization that manufactures parts for various markets including the medical, optical, instrumentation, communications, electronics and commercial high-technology industries. Founded in 1978, the company originally operated cam-type Swiss screw machines, producing components for Braille typewriters. In 1984, as it expanded to serve other clients in New England, Omni purchased its first CNC Swiss-type lathe. Today, Omni provides a full range of multi-axis machining services. In addition to discrete parts, the company also produces various types of turnkey assemblies.

In the past, the telecommunications industry had provided a larger portion of the firm’s business than it does today. Due to poor economic conditions, this segment of Omni’s business declined significantly during the past 2 years. Responding to this situation, the company has simultaneously boosted the percentage of work that it produces in other markets, particularly its medical work. As a result, medical-related parts now represent more than 20 percent of Omni’s overall business.

The impact of this transition has been quite positive for the company. In 2002, while manufacturers in other industries were scaling back or closing, Omni recorded the most successful year in its history. Pursuant to this strong growth, the firm recently consolidated the operations of two separate facilities by relocating to a 32,000 sq. ft. facility in Hudson.

Turning Process Into Profits

Most of the medical parts that Omni manufactures are surgical instruments and bone screws that are machined from bar stock. Dominated by 25 CNC Swiss-style lathes served by bar loaders, Omni’s new production facility has the appearance of a high-tech screw machine shop. The Swiss lathes include B-, F-, L- and M-Series machines supplied by Marubeni Citizen-Cincom Inc. (Allendale, New Jersey).

Besides some waterjet cutting operations and deburring or cleaning of finished parts, the majority of Omni’s medical components are completely machined on the Swiss-style lathes. Equipped with Citizen-Cincom CAV and IEMCA VIP magazine-type bar loaders, the Swiss lathes can operate unattended for extended periods.

“For medical customers, our typical part runs range from 300 to 1,500 pieces,” says Sean Duclos, Omni’s manufacturing manager of turning operations. “We use the Swiss machines’ macro programming capabilities to make changeovers more efficient within families of parts’ Typically, Omni’s most complex parts are run on the newest Swiss lathes because they provide substantially faster cycle speeds. But the shop’s wide range of machines gives Mr. Duclos considerable flexibility in production scheduling. Despite the lathes’ continuous operations, Omni maintains a very clean shop environment by exhausting contaminants through a Trion Air Boss air cleaning system.

Two key elements in Omni’s machining processes are crucial to the company’s productivity. First, Omni uses targeted, high-pressure coolant to provide better chip evacuation, tool durability and surface finishes. Because the Swiss-style lathes perform multiple functions including stop-spindle operations, the positions of parts and the resulting demands for coolant continually change.

Omni’s machine tool distributor, Brook-dale Associates Inc. (Agawam, Massachusetts), has provided a solution to this challenge by developing a high-pressure coolant delivery system known as the Cool Blaster HD. Omni’s system provides up to eight independent coolant delivery lines for a single machine. Each coolant line is activated as needed via programming codes during machining. Besides improving cycle times and part quality, this system also reduces tool consumption.

Deep-hole drilling and gundrilling are also required for a significant portion of Omni’s work. In some cases, the company’s drilling applications involve depths as great as 25 times the diameter of the hole. In these high-speed drilling applications, high-pressure coolant delivered through the tools is particularly valuable for chip control and accuracy. Instead of producing long, continuous chips that form “bird nests” around the machine spindles, high-pressure coolant causes the chips to break into small pieces that are readily flushed away.