January 2014

The Centers for Medicare and Medicaid Services (CMS) recently issued new rules that include increased reimbursement and the new use of a level II HCPCS code for single-use/pocket-sized negative pressure wound therapy (NPWT) system.

   The final rules incorporate an increase in mean reimbursement from $209 in 2013 to $276 in 2014, according to the CMS. The increase in existing reimbursement applies to the Ambulatory Payment Classification 0016 and HCPCS G-codes. The CMS announced that these new rules were effective beginning on January 1, 2014.

   Kazu Suzuki, DPM, CWS, is pleased with the ruling and hopeful about what this could mean for future single-use NPWT system implementation.

   “It is rather rare to get an increase in reimbursement in anything in today’s healthcare climate,” explains Dr. Suzuki. “I’m hoping that this reimbursement increase will facilitate faster implementation of these single-use NPWT systems as the treatment cost is one of the major factors in using disposable medical devices.”

   In his practice, Dr. Suzuki says he regularly uses both the PICO (Smith & Nephew) and SNaP (Spiracur) single-use NPWT systems. Additionally, he sometimes uses Prevena (KCI) for incisions and notes that patients have given positive feedback for this device in terms of comfort.

   Dr. Suzuki mainly uses single-use NPWT systems on elderly patients who may find traditional NPWT “too heavy and cumbersome.”

   “(The single-use NPWT system) is a nice alternative for traditional battery-operated NPWT, which is sometimes too heavy for some of my frail and elderly patients,” adds Dr. Suzuki, the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles.

   Dr. Suzuki will also utilize the single use device as a transition between VAC therapy and a conventional wound dressing. However, the single-use devices are somewhat limited in their draining suction capacity in comparison to larger NPWT devices, explains Dr. Suzuki.

   According to Dr. Suzuki, when using single-use NPWT systems over traditional battery-operated NPWT systems, practitioners will need to purchase single use units ahead of time and keep them on stock in their facility. Secondly, Dr. Suzuki notes that one must change the single-use NPWT systems once or twice a week, which differs from traditional battery-operated systems that require changing three times per week.

   “I was hesitant and skeptical at first, but I found out quickly that single-use NPWT work just as well as the battery-operated NPWT. The ‘negative pressure (suction force)’ is all the same, regardless of the manufacturer,” adds Dr. Suzuki.

Can Hallux Valgus Surgery Improve Balance And Gait In Older Patients?

By Brian McCurdy, Senior Editor

A new study in the Journal of the American Podiatric Medical Association has concluded that in older patients, hallux valgus surgery may have positive effects on gait and balance.

   Researchers obtained gait and static balance data from 40 adults. There were 19 patients with preoperative hallux valgus, 10 patients who recently had successful hallux valgus surgery and 11 control participants. Authors note that despite similar age and body mass index, post-op patients exhibited 29 percent and 63 percent less center of mass sway during double-and single-support balance assessments respectively in comparison with pre-op patients. The patients’ overall gait performance was similar among the groups, except that post-op patients experienced lower speed during gait initiation in comparison with the preoperative group.

   Study co-author Lowell Weil Jr., DPM, FACFAS, notes that the study population consisted of older adults so researchers are not necessarily certain how bunion surgery will affect balance control in those over 65. He says the mean age for the hallux valgus post-op group was 50 ± 9.4.

   “We are not advocating bunion surgery for the sole purpose of restoring or improving balance,” clarifies Dr. Weil, the President of the Weil Foot and Ankle Institute. “The indications for bunion surgery, we believe, should still be foot pain and the inability to ambulate productively and/or comfortably regardless of patient age.”

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