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

With long-term disability claims comprising more than 11 percent of the workers' compensation medical dollar, mattresses are important cost considerations.

Consider the Alternatives
Doctors often script the critical-care hospital beds without realizing that less expensive and more practical alternatives for home use exist. Complex workers' compensation injuries require customized bedding solutions. Does the wound require a critical-care mattress for a period of time? How long? In a recent case, a paraplegic patient with mild pulmonary issues was discharged with a prescription for a critical-care hospital bed rental. After reviewing the file, the case manager approached the doctor with a cost-saving recommendation to purchase a $13,000 home model instead of renting the prescribed bed for $5,000 per month.

Do pulmonary problems require patient rotation? The wrong mattress can worsen those problems, lead to pneumonia, create skin breakdown, or exacerbate a wound. In the case described above, the purchase of the appropriate bed produced additional savings by eliminating nightly visits from the home health aide to rotate the claimant.

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

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

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

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

However, there are thousands of rehab products designed for different conditions, and it pays to use a specialty service that has relationships with all the manufacturers and access to all the products. Specialty managed care (physical therapy, pharmacy benefit management, expert physician networks) has long been shown to provide true workers' compensation medical savings, and the same holds true in complex home health care services and products for workers' compensation.

A specialty supplier will send a rehab technician to the claimant's home to investigate its space constraints and environment, the claimant's condition, and the social support system. Queries about the claimant's age, weight, the length of time since the injury, lifestyle, cleanliness of the home, co-morbidities and other complications go a long way to ensuring that the right mattress is selected. A personal home visit educates the claimant about new technologies and how they will help his particular condition. In addition, the personal touch of having someone show up and show concern for the claimant goes a long way to 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 was always breaking her bed. It was designed to hold more than her weight, yet the wheels kept breaking and the mattress was constantly sliding and breaking down. The visiting specialist swiftly 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 with expertise in home health care products and services and complex workers' compensation cases will bring more rest to the claimants and to the payer.

Special Reports /

Resting Easy: Mattresses Make a Difference in Complex Comp Care

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