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Goals of providing urological supplies
Now let’s review the goals of providing urological supplies. First and foremost, quality of care is an important feature of matching treatment and supplies to the patient-specific condition and needs. Assuring the provision of quality care and positive clinical outcomes, including a reduced risk for complications, are important goals for care and treatment as well as the provision of appropriate urological supplies. Following guidelines and appropriate documentation for urological supplies, particularly for coverage of labor and supplies, will impact a patient’s liability for costs and overall financial outcomes. Patient satisfaction is commonly based on patient perception of their care and caregivers. Included in patient satisfaction is their evaluation of the appropriateness, costs, and outcomes of care. Patient-centered care and considerations in providing urological supplies is important to supporting a return to a normal and healthy lifestyle.
Urological supplies Indications and appropriate use of catheters and other urological supplies that support adequate bladder drainage have been defined under new Medicare guidelines for suppliers of medical equipment and supplies that were issued in 2008 and took effect in 2009. These standards included prevention of fraud and the promotion of quality care. It is helpful to look at the Medicare guidelines because they have been established according to evidence-based reviews and expertise. Some research has suggested that carefully following the guidelines and documentation recommendations can contribute to positive clinical, financial, and patient satisfaction outcomes. The guidelines outline a set of appropriate uses that justify the specific types of urological supplies that may qualify for reimbursement. First, appropriate products are designed for people who have urinary incontinence or retention and need the assistance of these products to remove urine from the body. The reasons may include blockage in the urethra, nervous system problems, and others. The supplies that are considered appropriate (and may be covered) include catheters, drainage bags, and irrigation and insertion trays with related supplies (often in the form of a kit), and other related supplies. The types of catheters will vary according to medical need and the quantities may be limited during a billing cycle, with each product having a different limit level. According to CMS, under urology specialty, urinary catheters accounted for 40% of the allowable amounts for DMEPOS or more than $56 million of the total more than $142 million Medicare Allowed Amount.
Catheter indications Now let’s review some guidelines for urological supplies, including indications and documentation requirements. According to the American Urological Association, “knowing when to place a catheter is just as important as utilizing proper technique for its insertion”. A quality control effort that compared catheter complications with guidelines for appropriate catheter indications in an emergency department concluded that the best way to avoid complications is to avoid unnecessary insertion of catheters and removing them when they are no longer necessary. Many of these lessons can be transferred to other settings, such as inpatient, outpatient, and home care. Guidelines suggest indications for documentation and appropriate use of urological supplies, including catheters. This list shows many of the indications for catheter use. As we discussed before, acute urinary retention is considered urgent, while chronic retention may develop over time. Chronic retention is associated with urinary frequency, overflow incontinence, or impaired kidney function. Retention due to a clot and hematuria may be the result of a bladder tumor, prostate enlargement, or trauma in previous catheter insertions. Urosepsis accompanied by incomplete emptying and high voiding pressure from prostate obstruction or neurogenic bladder may require placement of a catheter. A bedbound patient who cannot use a commode/urinal/bedpan with altered levels of consciousness, or skin ulcerations with incontinence that requires dryness for healing, may indicate the need for a urological catheter. In cases of long surgeries that risk bladder distension and damage, a catheter placement should be considered. Other conditions that require strict measurement of inputs and outputs, if the measurement could not be reliably completed by other means may indicate the need for a catheter and associated supplies. The most common contraindication for the use of a catheter is not having an appropriate indication that justifies its use. Other contraindications include urethral injury, artificial urinary sphincter (which would require deactivation before catheterization), and urinary incontinence by itself.
Knowing when to place catheter is as important as proper technique
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