MDS Alert

But does it really work ... and will Medicare pay for it?

Proof, pricing and payoff - that's what nursing home providers want to know about new ultrasound technology for detecting pressure-induced damage lurking beneath the skin.

So just how evidence-based is the ultrasound scanning for detecting pressure ulcer risk? A study performed last year on healthy medical students demonstrated how pressure induces edema. "The volunteers had their heels weighted on a board for an hour," reports Paul Quintavalle, DPM, a podiatrist in private practice and director of Longport Inc., which owns the patent on the technology. The researchers did ultrasounds of the subjects' heels before and at 15-minute intervals after the hour-long application of pressure. "The edema was less after the pressure was relieved but then increased and peaked at 45 minutes and began to subside." On average, resolution of the edema required 90 minutes.

In an additional study that involved creating friction ulcers, "researchers found that ultrasound can distinguish friction from pressure ulcers," adds Quintavalle. "Friction ulcers demonstrate edema directly under the epidermis, whereas pressure ulcers begin in the subcutaneous tissue and spread toward the surface."

Medicare Payment on Horizon

Medicare doesn't currently pay for the scans in nursing homes, but Longport is applying to the American Medical Association for a CPT code for the procedure and will approach the Centers for Medicare & Medicaid Services for coverage. "Longport will probably ask for payment for performing scans on beneficiaries with certain levels of risk for pressure ulcers, such as a certain score on the Braden or Norton in concert with identified comorbidities," says Connie Phillips-Jones RN, MSN, director of clinical support for Longport.

But even if Part B ends up paying for the procedure, the SNF PPS will probably include the service as part of the all-inclusive Part A rate, experts predict. Even so, the scanner can pay off in other ways, which is what Little Flower Manor in Wilkes Barre, PA, discovered after it bought the scanner from Longport three years ago for approximately $40,000. Use of the scanner improved the facility's skin care outcomes - and lowered its skin care costs by about $30,000 in the first year of use, says Nancy DeFranco, BSN, RNC, who is director of nursing for the facility.