Unlocking the Durable Medical Equipment 'Black Box'

By Ted Smith, Vice President of Sales at Apricus, an Enlyte company

In science and computing, a black box is defined as a device, process or system, whose inputs and outputs are known, but whose internal workings are often not well understood. Durable medical equipment (DME) has traditionally operated as a black box of sorts for claims adjusters in the workers’ compensation space.

As a specialized area, DME’s inner workings are complex. There is a wide range of equipment. Within each category, there’s a significant number of products that vary in nuanced ways, with many products offering slightly different functions. As a result, costs run the gamut, and coding gets complicated with a “miscellaneous” code used for products that aren’t easily categorized.

From the adjusters’ perspective, the DME black box has known “inputs” and “outputs,” but whose “inner workings” can often be shrouded in mystery. Inputs into the DME black box such as referrals sent from treating physicians and needed timing are known and understood; however, the outputs are not as clear.

When adjusters receive DME orders, most of the time they pass them on to the specialty service provider to fulfill. However, if the inputs aren’t great to begin with and the vendor doesn’t have a stellar internal process, then the resulting outputs could vary significantly in terms of quality, patient satisfaction, cost, and other outcomes.

Adjusters want and need education on DME, but they often don’t have the time or bandwidth to research different products in the midst of an injured employee being discharged or in the middle of managing a claim. Instead, they need to rely on a specialty service provider with deep expertise across a wide variety of DME products and who has the knowledge to review orders on their behalf to bring any concerns to their attention.

Here are a few things to look for in a specialty provider:

• High-Level Customer Service: A specialty service provider should offer both customer and patient-focused delivery of DME products.
• Broad Network: Have a national network of credentialed DME and supply vendors offering prompt delivery, convenience, and significant savings.
• Continuum of Care: A specialty service provider should work in close collaboration with nurse case managers to ensure clinical oversight is applied to specialty service needs.
• Patient Satisfaction: The specialty service provider should contact the injured employees to ensure they’ve received their DME products, have obtained proper training (if needed), and are generally satisfied with the equipment. 
• Efficiency: Injured employees should receive their DME product in a timely manner, so they can begin to use it when they most need it.
• Costs: By containing DME expenses, a specialty service provider contributes to medical cost containment.
• Recovery and Return to Work: When and where possible the specialty service providers should look for and present any and all opportunities to help improve recovery times and return-to-work results.

Specialty service providers like Apricus are striving to fulfill adjusters’ DME needs, while also turning around the traditional black-box situation. With a black box, you can’t see what’s inside, but by unlocking and revealing the inner workings of the DME process, it can operate with greater transparency—and in the end, better results. To find out more about the key factors that make up the internal workings of the DME process so they can be tracked and monitored to ensure a better end result, read the full white paper at www.apricusinc.com/unlocking-dme-black-box. 

About the Author

Ted Smith is senior vice president of national sales for Apricus. With more than 10 years of experience in the workers’ compensation industry, Ted is an expert on managing specialty services, including diagnostics, durable medical equipment (DME), and home health services.

www.apricusinc.com

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