There are hundreds of rehabilitative mattresses on the market,all addressing specific issues. However, most workers' compensationmattress scripts are limited to a couple of manufacturers andmodels. This is partly due to physicians' familiarity only withbrands used in hospitals and partly to durable medical equipment(DME) companies' limited access to manufacturers anddistributors.

With long-term disability claims comprising more than 11 percentof the workers' compensation medical dollar, mattresses areimportant cost considerations.

Consider the Alternatives
Doctors often script the critical-care hospital beds withoutrealizing that less expensive and more practical alternatives forhome use exist. Complex workers' compensation injuries requirecustomized bedding solutions. Does the wound require acritical-care mattress for a period of time? How long? In a recentcase, a paraplegic patient with mild pulmonary issues wasdischarged with a prescription for a critical-care hospital bedrental. After reviewing the file, the case manager approached thedoctor with a cost-saving recommendation to purchase a $13,000 homemodel instead of renting the prescribed bed for $5,000 permonth.

Do pulmonary problems require patient rotation? The wrongmattress can worsen those problems, lead to pneumonia, create skinbreakdown, or exacerbate a wound. In the case described above, thepurchase of the appropriate bed produced additional savings byeliminating nightly visits from the home health aide to rotate theclaimant.

Wounds, which cost thousands of dollars to treat, are createdfrom pressure, moisture and heat. Low loss air mattresses, whichhave a series of vertical or horizontal chambers that rotate airpressure over time, help prevent and heal wounds. The direction,timing and pressure can be set to address the claimant's specificinjuries. Some can be used to reduce fluid in the lungs, assistingpulmonary patients.

A claimant prone to sweating should not use a "therma-pedic,"zero-pressure type mattress that keeps the body warm and allowsmoisture to build. In one case, a physician prescribed aconsumer-quality therma-pedic style bed for a paraplegic. Withinthree weeks of sleeping on the new mattress, the patient developedwounds from sweat moisture. The carrier ended up having to purchasea mattress with breathable foam.

Sadly, if the carrier had bought the rehab mattress in the firstplace, it would have prevented the wounds. Plus, it only cost$1,000 more than the commercial-grade one the carrier already paidfor and now had to discard. The carrier ended up spending $20,000on mattresses and incurred the cost of wound care -- all because ofthe wrong mattress.

Specialty Services Offer Wider Choices
Many carriers outsource DME, supplies and home health services tocompanies that use local providers. These DMEs serve Medicaidpatients and usually have contracts with a small group ofmanufacturers for a limited variety of products catering to thatpopulation.

However, there are thousands of rehab products designed fordifferent conditions, and it pays to use a specialty service thathas relationships with all the manufacturers and access to all theproducts. Specialty managed care (physical therapy, pharmacybenefit management, expert physician networks) has long been shownto provide true workers' compensation medical savings, and the sameholds true in complex home health care services and products forworkers' compensation.

A specialty supplier will send a rehab technician to theclaimant's home to investigate its space constraints andenvironment, the claimant's condition, and the social supportsystem. Queries about the claimant's age, weight, the length oftime since the injury, lifestyle, cleanliness of the home,co-morbidities and other complications go a long way to ensuringthat the right mattress is selected. A personal home visit educatesthe claimant about new technologies and how they will help hisparticular condition. In addition, the personal touch of havingsomeone show up and show concern for the claimant goes a long wayto soothing an anxious claimant.

Home visits bring other things to light as well. In one case,the payer could not understand why the 250-pound woman claimant wasalways breaking her bed. It was designed to hold more than herweight, yet the wheels kept breaking and the mattress wasconstantly sliding and breaking down. The visiting specialistswiftly identified the problem: The husband weighed at least 350.The bed was not designed to handle the combined weight.

Bedding down with the right specialty managed care company withexpertise in home health care products and services and complexworkers' compensation cases will bring more rest to the claimantsand to the payer.