Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

WOUND CARE SUPPLIES:


OPERATION RESTORE TRUST DATA


p$ SERVICE3 

.# “G. 

q 

JUNE GIBBS BROWN $ 

2 Inspector General
 ‘2


%
 # ~++ OCTOBER 1995 ‘%d~~ > OEI-03-94-00792 
OFFICE OF INSPECI’OR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Semites’ (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by four OIG operating components: the Office of Audit Services, the 

Office of Investigations, the Office of Civil Fraud and Adminsitrative Adjudicationand the 

Office of Evaluation and Inspections. The OIG also informs the Secreta~ of HHS of program 

and management problems and recommends courses to correct them. 

OFFICE OF AUDIT SERVICES 

The OIGS Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIGS Office of Investigations (01) conducts criminal, civil, and administrative


investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of


unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions,


administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud


control units which investigate and prosecute fraud and patient abuse in the Medicaid program.


OFFICE OF EVALUATION AND INSPECITONS 

The OIGS Office of Evaluation and Inspections (OEI) conducts short-term management and 

program evaluations (called inspections) that focus on issues of concern to the Department, 

the Congress, and the public. The findings and recommendations contained in these inspection 

reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability, 

and effectiveness of departmental programs. This report was prepared in the Philadelphia 

Regional Office under the direction of Robert A. Vito, Regional Inspector General. 

PHILADELPHIA REGIONAL STAFF 

Robert A. Baiocco, ProgramAnaZyst


Linda M. Ragone, ProgramAnaZysi


Cynthia Hansford, ProgramAssistant


Emily Tseng, Intern


Neil Montovani, Intern


Won Jong Oh, Intern


HEADQUARTERS STAFF 

Stuart R. Wright, ProgramSpecialist 

Barbara Tedesco, TechnicalSupporl Staff 

Brian P. Ritchie, TechnicalSuppoti Staff 

Linda Moscoe, TechnicalSuppoti Staff 

To obtain a copy of this repo~ please call the PhiladelphiaRegional Office at (800) 531-9562. 
Depatiment of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

WOUND CARE SUPPLIES:


OPERATION RESTORE TRUST DATA


& #J ‘=--’’’&s”&a 

+ q 

w JUNE GIBBS BROWN 

$

$ Inspector General 

5

‘b 

%+--

# OCTOBER 1995 

‘~d3a > OEI-03-94-00792
EXECUTIVE SUMMARY


PURPOSE 

This report identifies questionable billing practices and describes supplier and nursing 

home practices that can lead to questionable payments under the Medicare Part B 

wound care benefit in the five States targeted by Operation Restore Trust: California, 

Florida, New York, Illinois, and Texas. 

BACKGROUND 

Wound Ckre Supplies 

Wound care supplies are protective covers or fillers that treat openings on the body 

caused by surgical procedures, wounds, ulcers, or bums. The Health Care Financing 

Administration (HCFA) reimburses for wound care supplies under Medicare Part A 

through its payments to nursing homes and home health agencies and Medicare Part 

B through its payments to suppliers. The HCFA broadened its coverage policy on 

March 30, 1994, allowing payment for secondary as well as primary dressings and 

expanding the procedures that require dressings to non-physician treatments. 

We selected claims for a 1 percent sample of beneficiaries who received wound care 

supplies between June 1994, the start of fee schedule reimbursements, and February 

1995. We applied proposed DMERC draft guidelines to these claims to identify 

questionable billing practices. We also collected data from a stratified random sample 

of 420 nursing homes from HCFA’S Online Survey Certification and Reporting system. 

O~ation Restore llust 

This inspection was conducted as part of Operation Restore Trust. Operation Restore 

Trust is a health care anti-fraud demonstration project developed within the U.S. 

Department of Health and Human Services by the Office of Inspector General, the 

Health Care Financing Administration, and the Administration on Aging. Its aim is to 

coordinate Federal and State resources to attack fraud and abuse in home health 

agencies, nursing facilities, and durable medical equipment, including wound care 

supplies in the five States with the largest Medicare expenditures. 

The general findings of our study are contained in two other reports which highlight 

questionable billings and potentially abusive marketing practices. In this report, we 

have compiled our data for the five Operation Restore Trust States. By reviewing this 

data, the Operation Restore Trust partners responsible for reviewing fraud and abuse 

in each of the five States may be able to determine what problem areas regarding 

supplier and nursing home practices exist in their State. 

1 
Over $22 &n of $65 &n in questibnublepaymentsfor wound care supplies 

between Jm 1994 and Febmmy 1995 wasfound in thejive O~ration R@ore ?hst 

States. 

Excessive utilization of wound care supplies was found in 62 percent of the total 

Medicare allowances in Operation Restore Trust States. Significantly higher costs per 

beneficiary was found in Illinois. For all States, $65 million of the $98 million in 

Medicare Part B allowances for wound care supplies exceeded the proposed DMERC 

guidelines. 

Wound care activityh Option Restore lhxst Stat@ is concentratedbyp&G suppk, 

andplizce of service. 

Hydrogel wound care products account for 41 percent of the questionable Medicare 

allowances for non-tape supplies. Almost half of the excessive payments in the five 

States were made to 9 suppliers, 6 percent of the sample. One supplier alone 

received 19 percent of the questionable payments. Over three-quarters of 

questionable wound care payments was made for beneficiaries who resided in nursing 

homes. 

N&g horns h OperationRestore tit Stites reportsimilarmarketingpractices by 

wound care suppi%m;huwevq in some Statesthe practices are more *pread 

Overall, among the five Operation Restore Trust States there were not significant 

variances in how nursing homes responded to survey questions concerning supplier 

marketing practices. However, the prevalence of inducement offers from suppliers 

did vary significantly among the ORT States. In addition, the degree of influence 

some suppliers attempt to have over the provision of wound care supplies to nursing 

homes differs among ORT States. 

We solicited and received comments on our draft reports from HCFA and other 

concerned organizations. The organizations that provided us with responses were the 

Health Industry Distributors Association (HIDA), the Health Indust~ Manufacturers 

Association (HIMA), and the National Association for the Support of Long Term 

Care (NASL). 

The NASL made the only comment that was directed specifically at this report. They 

stated that the fact that the five Operation Restore Trust States account for a high 

proportion of the wound care supplies is only logical since these are the States with 

the largest Medicare market. We agree. The purpose of this report was to provide a 

single document that would be useful to the Operation Restore Trust partners who 

are operating in the five States. This report is a compilation of information collected 

ii 
for two companion reports, Questionable Medicare Payments for Wound Care Supplies 

(OEI-03-94-O0790), and Marketing of Wound Care Supplies (OEI-03-94-00791). The 

remaining comments from HCFA and the outside organizations and our responses to 

those comments are presented in the companion reports. 

... 

111 
� 

� 

� 

TABLE OF CONTENTS


PAGE 

EXE~ s UMMARy . . . ...”””””””””””””””” ““””””””””””””””””””

.1


mODUmON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


.8


FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


8


Excessive utilization ofsupplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

. 10


Concentration of Medicare allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

11


Supplier marketing ofwound care supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . 

..13


CC)MMENTS . . . . . . ...”””””.””.””” . . . . . . . . . . . . . . . . ” ” ” ” ”....”.”” 

APPENDI= 

k
 Wound Care Supplies -Descriptions and Guidelines . . . . . . . . . . . . . . . . . . . A-1 

. B-1


Confidence Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Questionable Allowances by HCPCS and State . . . . . . . . . . . . . . . . . . . . . . . C-1 

B: 

c. 

D 

. . D-1


Nursing Home State Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
INTRODUCTION


PURPOSE 

This report identifies questionable billing practices and describes supplier and nursing 

home practices that can lead to questionable payments under the Medicare Part B 

wound care benefit in the five States targeted by Operation Restore Trust: California, 

Florida, New York, Illinois, and Texas. 

BACKGROUND 

Wound care supplies are fillers or protective covers that treat openings on the body


caused by surgical procedures, wounds, ulcers, or burns. Wound covers are flat


dressing pads. Wound fillers are dressings placed into open wounds to eliminate dead


space, absorb exudate, or maintain a moist wound surface. The Health Care


Financing Administration (HCFA) reimburses for wound care supplies under the


Medicare Part B program’s coverage for durable medical equipment (DME). The


coverage policy for these supplies is found in section 2079 of the Medicare Carriers


Manual. The HCFA contracts four DME regional carriers (DMERCS) to process


durable medical equipment claims including wound care supplies. The DMERCS issue


their own guidelines to clarify their coverage policy.


Medkare PartB Allowancesfor Wound Care Suppliks: 1990-1994 

There were significant changes in wound care activity between 1990 and 1994. 

Medicare Part B allowances were as low as $50 million in 1992 and peaked in 1993 at 

$132 million, an increase of 164 percent. The number of beneficiaries that annually 

received these supplies ranged from 86,600 in 1993 to as high as 273,300 in 1991. As 

a result, allowances per beneficiary varied from $199 in 1990 to $1,526 in 1993. 

Between 1993 and 1994 the number of Medicare beneficiaries that received wound 

care supplies increased 47 percent. 

In 1994, 61 percent of the average allowance per beneficiary was for specialty 

dressings. Medicare fee schedule amounts for specialty dressings are as high as $35 

for large hydrogel wound covers. Eleven of the specialty wound care products are 

reimbursed by Medicare at over $10. Prior to 1992, Medicare reimbursed for wound 

care supplies primarily in a single kit payment. These kits were a compilation of 

wound care supplies and were reimbursed at $8 each in 1992. Billing for kits was 

disallowed in 1992. However, component supplies contained in a kit can still be billed 

as individual products. Billing for kits was disallowed in 1992. As a result, the number 

of wound care supplies has increased over six times from 13 million in 1991 to 81 

million in 1994. The table on the next page summarizes surgical dressing activity for 

calendar years 1990 through 1994. 

1

Table 1. Wound Care SupplyActivity 1990-1994 

Allowances $53 million $87 million $50 million $132 million $98 million 

Beneficiaries 266,400 273,300 117,300 86,600 127,300 

Per Beneficiary $199 $317 $423 $1,526 $769 

No. of Supplies NI’A 13 million 45 million 69 million 81 million 

The HCFA Broadens its Covemge Policyfor Wound tire Supplies 

On March 30, 1994, HCFA expanded its coverage policy for wound care supplies. 

The new policy states that coverage is “...limited to primary and secondary dressings


required for the treatment of a wound caused by, or treated by, a surgical procedure


that has been performed by a physician or other health care professional.” Primary


dressings are therapeutic or protective coverings applied directly to wounds or lesions


either on the skin or caused by an opening to the skin. These include alginate, foam,


specialty absorptive, hydrogel, hydrocolloid, and composite dressings. Transparent film


and contact layers also serve as primary dressings. Secondary dressings serve a


therapeutic or protective function and typically are needed to secure a primary


dressing. Items such as adhesive tape, roll gauze, and bandages are examples of


secondary dressings.


The PiihrMidicare Covemge Poiky Was More Restrictive 

The HCFA national policy and the DMERCS’ policies prior to March 30, 1994 were 

more restrictive. Stringent requirements were placed on the type of dressings, length 

of treatment, cause of wound, type of provider, and medical documentation. The 

DMERCS’ policy before the expansion of the national policy covered only primary 

dressings resulting from a surgical procedure for usually no more than 2 weeks. This 

policy stated that “surgical dressings for closed incisions without drainage would rarely 

be medically necessary for more than 1 week” and “when an ulcer, traumatic wound, 

or burn has had sharp debridement, it will be considered a surgical wound for no 

more than 2 weeks from the date of debridement.” 

Prior to March 30, 1994, the HCFA national policy would allow dressings to be 

covered for treatment of wounds that resulted from sharp debridement (e.g., scalpel, 

laser) performed only by physician. The DMERC local policies stated that dressings 

for other types of debridement (e.g., mechanical, chemical, autolytic) were not 

covered. Wound care suppliers were required by DMERCS to submit a certificate of 

medical necessity to document the need for the products. After the policy change in 

March 1994, this was no longer required. The table on the following page compares 

the wound care supply policy before and after March 30, 1994. 

2

Table 2. Comparison of Wound Care Supply Coverage Policies 

Only primary dressings Primary and secondary dressings 

Time limits on medical necessity As long as medically necessa~ 

Dressings for sharp debridement only Any type of debridement I 

Limited to physician treatments Physician and non-physician treatments 

II

Certificate of Medical Necessity Certificate of Medical Necessity 

required not required 

Canier Romssing of Wound Care Supplk 

In June 1992, HCFAissued afinalrule designating four Durable Medical Equipment 

Regional Carriers (DMERCS) to process all claims for durable medical equipment, 

including wound care supplies. The four carriers are the MetraHealth Insurance 

Company (DMERC A), AdminaStar Federal (DMERC B), Palmetto Government 

Benefits Administrators (DMERC C) and Cigna Healthcare (DMERC D). Effective 

October 1, 1993, HCFA began the transition to the DMERC processing wound care 

supply claims. During 1994, 56 carriers also processed surgical dressing claims before 

the transition to DMERCS was complete. During the transition, these carriers did not 

utilize the DMERC policies; they carriers used their own local policies to process 

claims. 

l%e DME Reghal (hriem Implementa Fee Schedideand Introdke New Codks 

Starting in June 1994, reimbursements for wound care supplies were based on a fee 

schedule. The DMERCS introduced over 60 codes for wound care products to 

implement the fee schedule. Prior to June, less than 20 codes were used to identify 

and reimburse dressings. The DMERCS granted a grace period for all but two old 

codes submitted through October 1, 1994. During the grace period the DMERC 

would crosswalk the old code to the appropriate new code. 

l%e DMERC3 hue Dn@ Polity to Ckzr@ Wound Care Cinwrage 

Each DMERC, working with HCF~ developed a policy to clarify the coverage of the 

wound care benefit. Included in these guidelines are definitive utilization and medical 

necessity parameters. In addition, modifiers to the codes have been added to identi~ 

the number of wound sites being treated. In January 1995, each DMERC solicited 

comments on these guidelines. After reviewing the comments, the DMERCS issued 

revised policies to be effective October 1, 1995. See Appendix A for a summary of 

the utilization guidelines. 

3

This change was initiated in part as a response to organizations in the wound care 

community that expressed the need for clarification. For example, the Health Industry 

Distributors Association in cooperation with the National Coalition for Wound Care, 

the National Association of Retail Druggists, and the National Association for the 

Support of Long Term Care developed consensus recommendations for improving the 

Medicare wound care policy. These changes were recommended prior to the release 

of the proposed changes in January 1995. 

l%e GeneralAccounting @ice Dircloser SimihrrAbuses 

The General Accounting Office (GAO) issued a final report, Medicare: Excessive 

Payments for Medical Supplies Continue Despite Improvements (HEHS-95-171), in 

August 1995 concerning payment controls for Medicare expenditures of durable 

medical equipment with an emphasis on wound care supplies. The GAO found a 

“lack of system wide controls” which led to abuse in both Part A and Part B. For 

example, the number of dressings billed per beneficiary was, on average, nearly three 

times higher under 29 new wound care codes. They attribute this activity to the 

absence of a clearly defined policy. 

Opation Restore tit TargetsHealih CareAbuse in Five Stata 

Operation Restore Trust (ORT) is a health care anti-fraud demonstration project 

developed within the U.S. Department of Health and Human Services by the Office of 

Inspector General, the Health Care Financing Administration, and the Administration 

on Aging. Its aim is to coordinate Federal and State resources to attack fraud and 

abuse in home health agencies, nursing facilities, and durable medical equipment, 

including wound care supplies. The project’s initial focus will be in California, Florida, 

New York, Illinois, and Texas. 

METHODOIX)GY 

QuestiimableBUings 

To asses the nature of questionable billing practices, we interviewed DMERC officials 

including medical directors and fraud control personnel. Each DMERC responded to 

a questionnaire concerning wound care supply processing guidelines, the nature of 

questionable billing practices, and corrective actions taken. 

To determine the extent of questionable billing practices, we analyzed a 1 percent 

sample of wound care beneficiaries. These beneficiaries received supplies under one 

of 85 wound care supply codes in use between June 1994, the start of fee schedule 

reimbursements, through February 1995. These claims are maintained in HCFA’S 

National Claims History 100 percent Physician/Supplier database. Medicare Part B 

allowed $980,270 in wound care supplies for our sample of 1,205 beneficiaries for this 

9-month period. The five Operation Restore Trust States accounted for 727 

beneficiaries and $760,502 in Medicare allowances. Allowed payments include the 80 

4 
percent Medicare payment and the 20 percent coinsurance fee billed to the


beneficiary.


We applied the proposed DMERC draft guidelines to these claims to identify


questionable billing practices. Although these guidelines were not inforce during the


review period, they represent a consensus concerning wound care policy that couldbe


systematically applied and measured. We assumed the maximum allowable usage each


month for the month in which the supply was billed. We defined a questionable


billing practice as that amount in excess of the utilization guideline. We assumed each


type of wound cover billed represented a wound site. We reported Medicare


allowances above the tolerance levels by type of supply, DMERC, and number of


beneficiaries receiving supplies, and supplier. To determine if a link exits among


suppliers suspected of abusive billing practices, we reviewed data from the National


Supplier Clearinghouse (NSC). Under each provider identification number, the NSC


database includes the name of corporate officials, addresses, and provider aliases.


Claims for tape supplies (HCPCS A4454 and K0265) were analyzed differently. We


selected 101 beneficiaries from two groups of a stratified sample of 349 beneficiaries


that received tape. The first strata contained 31 beneficiaries that received $1,000 or


more in tape. The second, 318 beneficiaries that received between $25 and $999 in


tape. We selected all 31 from the first strata and randomly selected 70 beneficiaries


from the second. This sample of 101 beneficiaries represent $73,848.13 or 52 percent


of total allowed dollars in tape claims. The five Operation Restore Trust States


accounted for 50 beneficiaries and $28,822.54 in Medicare allowances from the sample


of 101 beneficiaries.


For each tape claim, we assumed that the beneficia~ used the maximum monthly


allowable usage for each primary and secondary dressing billed during that month


according to the proposed DMERC draft guidelines. The secondary dressing was


allocated the same amount of tape as the primary dressing. Dressings with an


adhesive border were not allocated tape.


We assumed dressings less than or equal to 16 square inches to be 4 inch by 4 inch.


We assumed a 6 inch by 8 inch size for dressing between 16 and 48 square inches and


8 inches by 8 inches for dressings greater than or equal to 48 square inches. We


allocated tsvo inches extra of tape for each side. Therefore, a 4 inch by 4 inch


dressing was allocated 24 inches of 1 inch tape. A 6 inch by 8 inch dressing was


allocated 36 inches and a 8 inch by 8 inch dressing, 40 inches. We applied the current


fee schedule price of $0.12 per 18 square inches to the tape allocated. Each 4 inch by


4 inch dressing used $0.16 in tape. A 6 inch by 8 inch dressing used $0.24 in tape,


$0.27 for a 8 inch by 8 inch dressing.


To quantify the potential impact of questionable billing practices, we projected our


findings, by multiplying sample results, i.e., Medicare allowances above the proposed


DMERC guidelines, by 100. Confidence internals for our projections are presented in


Appendix B.


5 
Ntig ~07?lt3 Swvey 

To determine how suppliers market wound care supplies and how nursing homes 

handle the provision of these supplies, we selected a stratified random sample of 420 

skilled nursing facilities and nursing homes from the Health Care Financing 

Administration’s Online Survey Certification and Reporting (OSCAR) system. The 

system contains every nursing home that is certified to receive Medicare or Medicaid 

funds. We decided to sample nursing homes from the OSCAR system that had a total 

size of 60 beds or more. This gave us a universe of 12,878 nursing homes from which 

we selected our sample. 

We selected a stratified sample so that we could provide more focused information on 

five States: California, Florida, Illinois, New York, and Texas. These States are 

curiently being targeted by Operation Restore Trust. We stratified our sample into six 

groups including the five States and all other remaining States. We sampled a total of 

420 nursing homes; the number of nursing homes from each stratum is shown in the 

table below. 

Strata Universe Sample Responding 

Universe 

California 931 60 636 

Florida 565 60 414 

Illinois 700 60 537 

New York 584 60 457 

Texas 964 60 723 

Other States 9,134 120 7,003 

Total 12,878 420 9,770 

We sent identical questionnaires to the administrators of the 420 nursing homes. 

Surveys were returned by 315 nursing homes giving us an overall response rate of 75 

percent. We chose to project responses only to the responding universe and not to 

the total universe of 12,878 nursing homes. Responses from the 315 nursing homes 

were weighted by stratum and projected only to the responding universe of 9,770 

nursing homes. The responding universe for each stratum in included in the table 

above. 

In order to accurately project responses to the total universe, we would have had to 

perform an analysis of non-respondents to evaluate the characteristics of nursing 

homes who chose not to respond. Because we knew very little about the nonresponding nursing homes, we decided to use the more conservative responding 

universe. 

6

For comparison purposes, data from the each of the fives States is presented along 

with data from the remaining 45 States in Appendix D. 

Reprt l%xentation 

This report is one of three reports concerning Medicare payments for wound care 

supplies. The second report, Questionable Medicare Payments for Wound Care Supplies 

(OEL03-94-00790) identifies questionable billing practices for wound care supplies 

under Medicare Part B between June 1994 and February 1995. A third report 

Marketing of Wound Care Supplies (OEI-03-94-00791) describes supplier and nursing 

home practices that can lead to questionable payments and examines issues concerning 

Medicare beneficiaries’ use of wound care supplies nationally. 

This inspection was conducted in accordance with the Quali~ Standards for Inspections 

issued by the President’s Council on Integrity and Efficiency and is part of Operation 

Restore Trust. 

7

FINDINGS


OVER $22 MILLION OF $65 WON IN QUESTIONABLE PAYMENTS FOR 

WOUND CARE SUPPLIES BETWEEN JUNE 1994AND FEBRUARY 1995WAS 

FOUND IN THE FIVE OPERATION RESTORE TRUST STATES. 

The five States targeted by Operation Restore Trust, California, Florida, New York, 

Illinois, and Texas accounted for $22 million in Medicare allowances for wound care 

supplies that exceeded utilization guidelines between June 1994 and February 1995. 

For all States, $65 million of the $98 million in Medicare Part B allowances for wound 

care supplies exceeded the proposed DMERC guidelines. 

Quatiouble billingpmcti= found in 62 pemnt of Medicare allowancesin O~ation 

Restore llu.st Stakx 

The $22 million in questionable payments in California, Florida, New York, Illinois, 

and Texas represent 62 percent of the $36 million in total wound care allowance for 

those States. Non-tape supplies account for over $18 million of the questioned 

payments, tape approached $4 million. These States had 39,200 beneficiaries that 

received wound care supplies. Excess utilization was found in 26,200 beneficiaries that 

received non-tape supplies. The table below summarizes the wound care activity for 

the five Operation Restore Trust States between June 1994 and February 1995. 

Table 3. Wound Care Activity Summary-5 Operation Restore Trust States 

Submitted $76,050,200 72,700 $1,046 36,313,600 

Allowed $35,640,150 39,200 $910 26,969,200 

Total Questioned $22,250,630 N/A N/A N/A 

Questioned - Non-Tape $18,552,330 26,200 $708 12,938,400 

Questioned - Tape $3,698,300 N/A N/A N/A 

Significantlyhighercosts per benejichq wasfound ti Illbwik. 

The submitted, allowed, and questioned wound care amounts per beneficiary were 

significantly higher in Illinois than the other Operation Restore Trust States. The 

wound care claims that were submitted for 68 Illinois beneficiaries in our sample 

averaged $2,421. The next highest average in the ORT States was found in New York 

at $1,612, no other ORT State exceeded $790. The Medicare allowed charges for 50 

Illinois beneficiaries averaged $1,515. California followed at $962 per beneficiary. 

Questionable payments were found in 33 Illinois beneficiaries that received non-tape 

8 

—. 
Iluu 

supplies. These payments averaged $1,176, almost double the $690 average of 

California beneficiaries. However, one Illinois beneficiary received questionable 

papents of$21,770, which represented 12percent of the ORT total. Questionable 

pa~ents fortheother 32 Illinois beneficiaries averaged $532. Thetable below 

summarizes the wound care activity from the sample of beneficiaries in each State. 

Submitted and allowed totals include tape, questioned amounts are for non-tape 

supplies only. 

Table 4. Wound Care Activity- Each Operation Restore Trust State 

c.. 

mlu w Uu I I 

17,189 Questioned - Non-Tape I 33 

California 

164,597 $2,421 

$75,765 $1,515 

$38,811 $1,176 

$141,612 $553 

$75,993 $962 

$43,467 $690 

$290,176 $1,612 

$119,867 $936 

$59,740 $629 

Submitted 

Allnmn=d -1” v. “/-

l==Questioned - IGn-Tape 

Submitted


Allowed


Questioned - Non-Tape


1=Submitted
 L 

u A“-wed M 

~ UG3 LIULIW- Non-Tape 

!,

,, 

4

Submitted 

A Iln.xh=d mlu w .-

Questioned - Non-Tape 

256 

79 

63 

180 

128 

95 

61,030 

46,731 

20,833 

New York 

151,335 

116,953 

62,782 

Florida — 

109 41,868 $86,152 $790 — 

67 36,602 $56,241 $839 — 

48 15,859 $30,712 $640 — 

Texas -l,, 

114 41,622 $77,965 $684 

68 26,143 $28,736 $423 , 

23 12,721 $12,793 $556 

9

QUESTIONABLE WOUND CARE PAYMENTS IN ORT STATES ARE 

CONCENTRATED BY PRODUCI’, SUPPLIER AND PLACE OF SERVICE 

The excessive payments for wound care products in California, Florida, New York, 

Illinois, and Texas was concentrated in a small number of products and suppliers. In 

addition most of these payments were made for beneficiaries that resided in Skilled 

Nursing or Nursing Facilities. 

Hjdiogel wound carep&ts accountfor 41pement of the quekmable Medicare 

alibwancesfor non-tape supphk 

In the five Operation Restore Trust States, questionable payments for hydrogel wound 

care products accounted for 41 percent of the non-tape supplies that exceeded 

utilization guidelines. Of the $185,523 in questionable non-tape payments in our 

sample, $76,277 was made for hydrogel products. We identified $44,356 in 

questionable payments for hydrogel wound filler alone. The data in Appendix C 

provides the Medicare allowances in our sample that exceeded the proposed DMERC 

guidelines for each wound care product, not including tape. 

Abnost half of the excessivepaymentsh the jive Stateswere made to 9 supph%, 6 

percent of the sample. One wpplier aknw 19pement of the questionablepayments. 

Nine suppliers received 49 percent of the non-tape payments for supplies that exceed 

utilization guidelines. They represent 6 percent of the 155 suppliers who provided 

wound care supplies in California, Florida, New York, Illinois, and Texas. The 

individual States show a similar concentration. In Illinois, one supplier received 57 

percent of the questionable payments, two others received a total of 19 percent, for an 

overall total of 76 percent. Two suppliers in Texas received approximately half of the 

questionable non-tape payments identified in that State. In California and Florida, it 

was three suppliers, in New York it was four. 

One of these suppliers appeared at the top in both California and Illinois and received 

19 percent of all questionable payments in the five States. Another supplier appeared 

at the top in New York and Texas and received 3 percent of all questionable 

payments in the five States 

Over three-quartemof questinuble wound carepqments was rnadkfor 54 penxmt of 

benejkiaries who residedSkilkd Nursingor N&g Facilitks. 

Over 77 percent of the excessive Medicare allowed payments for non-tape supplies 

was made for beneficiaries that resided in skilled nursing or nursing facilities. The 

beneficiaries in these locations accounted for 54 percent of all beneficiaries in 

California, Florida, New York, Illinois, and Texas. The remaining 23 percent of excess 

payments was made for the 46 percent of the beneficiaries that resided at home or a 

custodial care facility. The table on the following page shows the excessive payments 

10

for non-tape supplies by place of service. Nine beneficiaries appear in more than one 

place. 

Table 5. ExcessivePaymentsfor Non-Tape Wound Suppliesby Place of Service 

Skilled Nursing Facility 120 $125,597 

Home 123 $38,443 

Nursing Facility 27 $17,385 

Custodial Care Facility 1 $4,098 

NURSING HOMES IN OPERATION RESTORE TRUST STATES REPORT 

smALAR MARKETING PRACI’ICES BY WOUND CARE SUPPLIER% 

HOWEVER IN SOME STATES THE PRACTICES ARE MORE WIDESPREAD. 

Overall, among the five Operation Restore Trust States there were not significant 

variances in how nursing homes responded to survey questions concerning supplier 

marketing practices. This was true when comparing both the ORT States to each 

other and to the rest of the States in the nation. However, there were several supplier 

marketing practices where certain ORT States reported significantly different levels of 

occurrence. A copy of the survey instrument with individual State responses for each 

question is provided in Appendix D. 

l%e prevalence of indkement offeis from suppiiensvariedsignificantlyamong the ORT 

States. 

While 23 percent of Florida nursing homes and 22 percent of Texas nursing homes


reported having been offered inducements such as free gift or supplies from wound


care suppliers, only 4 percent of New York nursing homes report such inducements.


I.-ESSthan one-tenth of Illinois nursing homes (7 percent) reported supplier


inducement attempts. California’s nursing homes reported inducements at a rate of 15


percent which was similar to the 13 percent average of all other States.


llw digree of in.e some supphknrattemptto have over theprovkion of wound care 

suppliesto numinghomes ~izw among ORT States. 

Among the ORT States, nursing homes differ on whether it is their staff or the 

supplier representative that decides the number of wound care supplies to be 

delivered in a given month. Only 7 percent of California nursing homes had suppliers 

making this determination, while more than one-third of nursing homes in New York 

(34 percent) had suppliers performing this task. Eleven percent of nursing homes in 

Florida had suppliers determining the amount of supplies delivered in a month. 

While, Illinois and Texas had 24 and 22 percent respectively. Similar to Illinois and 

11

Texas, 24 percent of all other Statesreported that suppliersdetermined the number of 

supplies provided monthly. 

Nursing homes in the ORT States reported statistically significant differences in


suppliers’ provision of prescription forms to be filled out by the nursing home or


patient’s physician. New York facilities reported a high of 34 percent of suppliers


providing these forms. In addition, nursing homes in New York appear more likely to


also have suppliers fill out the prescription form and present it for the physicians


signature than other States. All of the ORT States reported higher percentages for


supplier provision of prescription forms than the 8 percent average reported by all


other States.


The ORT States also differ in the amount of access suppliers request to patient


medical records. Almost half of the nursing homes in New York (47 percent)


reported that supplier representatives have requested to review patient medical


records. This percentage was more than double the percentage of nursing homes


reporting this situation in non-ORT States (20 percent). The next highest ORT State


was Florida with 16 percent and Illinois, California, and Texas with 13, 12, and 11


percent.


12

COMMENTS


We solicited and received comments on our draft reports from HCFA and other 

concerned organizations. The organizations that provided us with responses were the 

Health Industry Distributors Association (HIDA), the Health Industry Manufacturers 

Association (HIMA), and the National Association for the Support of Long Term 

Care (NASL). 

The NASL made the only comment that was directed specifically at this report. They 

stated that the fact that the five Operation Restore Trust States account for a high 

proportion of the wound care supplies is only logical since these are the States with 

the largest Medicare market. We agree. The purpose of this report was to provide a 

single document that would be useful to the Operation Restore Trust partners who 

are operating in the five States. This report is a compilation of information collected 

for two companion reports, Questionable Medicare Payments for Wound Care Supplies 

(OE1-03-94-00790), and Marketing of Wound Care Supplies (OEI-03-94-00791). The 

remaining comments from HCFA and the outside organizations and our responses to 

those comments are presented in the companion reports. 

13

APPENDIX A


WOUND CARE SUPPLY UTILIZATION GUIDELIN= 

OCTOBER 1, 1995 

HCPCS WOUNDC4RE PRODUCX STANDARD 

K0196 Alginatedressingwoundcover,withoutadheaive,16 sq. in. or less llday


K0197 Alginatedressingwoundcover,withoutadhesive,>= 16 sq. in. <= 48 sq. in. llday


K0198 Alginatedressingwoundcover,withoutadhesive,more than 48 sq. in. llday


K0199 Alginatedressingwoundfiller,per 6 inches 21day


K0203 Compositedressingwoundcover,withadhesive,16sq. in. or less 3iweek


K0204 compositedressingwoundcover,withadhesive,> = 16sq. in. <= 48 sq. in. 3/week


K0205 Compositedressingwoundcover,withadhesive,more than 48 sq. hi. 3/week


K0206 Contactlayer,16sq. in. or less Mveek


K0207 Contactlayer,>= 16sq. in. <= 48 sq.in. l/week


K0208 Contactlayer,more than 48 sq. in. liweek


K0209 Foamdressingwoundcover,withoutadhesive,16sq. in.or less 3fweek


KO21O Foamdressingwoundcover,withoutadhesive,> = 16sq. in. c= 48 sq. ln- 3/week


K0211 Foam dressingwoundcover,withoutadhesive,more than 48 sq.in. 3iweek


K0212 Foamdressingwoundcover,withadhesive,16sq. in. or less 3fweek


K0213 Foamdressingwoundcover,withadhesive,>= 16sq. in. c= 48 sq. in. 3/week


K0214 Foam dressingwoundcover,withadhesive,more than 48 sq. in. 31week


K0215 Foam dressingwoundfiller,per gram llday


K0216 Gauzenon-impregnated,withoutadhesive,16sq. in. or less 31day


K0217 Gauzenon-impregnated,withoutadhesive,>= 16sq. in. <= 48 sq. in. 31day


K0218 Gauzenon-impregnated,withoutadhesive,more than 48 sq. in. 31day


K0219 Gauzenon-impregnated,withadhesive,16sq. in. or less lfday


K0220 Gauzenon-impregnated,withadhesive,>= 16sq.in. <= 48 sq. in. llday


K0221 Gauzenon-impregnated,withadhesive,more than 48 sq.in. llday


K0222 Gauzeimpregnated,withoutadhesive,16sq. in.or less ltday


K0223 Gauzeimpregnated,withoutadhesive,> = 16sq.in. <= 48 sq.in. llday


K0224 Gauzeimpregnated,withoutadhesive,more than 48 sq. in. I/day


K0228 Gauzeimpregnated,withoutadhesive,16sq. in.or less I/day


K0229 Gauzeimpregnated,withoutadhesive,>= 16sq. in. <= 48 sq. in. Iiday


K0230 Gauzeimpregnated,withoutadhesive,more than 48 sq.in. ljday


K0263 Gauzeelastic,alltypes,per linearyard sameas prima~


K0264 Gauzenonelastic,per linearyard sameas primary


K0266 Gauzeimpregnated,anywidth,per linearyard sameas primary


K0234 Hydrocolloiddressingwoundcover,withoutadhesive,16sq. in. or less 3iweek


K0235 Hydrocolloiddressingwoundcover,withoutadhesive,>= 16sq.in. <= 48 sq. in. 3/week


K0236 Hydroccdloid
ressingwoundcover,withoutadhesive,more than 48 sq. in. 3/week 

K0237 Hydrocolloiddressingwoundcover,withadhesive,16sq. in. or less 3/tmek 

K0238 Hydrocolloiddressingwoundcover,withadhesive,> = 16sq. in. <= 48 sq. in. 3Jweek 

K0239 Hydrocolloiddressingwoundcover,withadhesive,more than 48 sq. in. 3Aveek 

K0240 Hydrocolloiddressingwoundfiller,paste,per fluidounce 31week 

K0241 Hydrocolloiddressingwoundfiller,dryform,per gram 3/week 

A-1

HCPCS WOUND CARE PRODU~ 

K0242 Hydrogeldressingwoundcover,withoutadhesive,16sq. in.or less


K0243 Hydrogeldressingwoundcover,withoutadhesive,>= 16sq. in. <= 48 sq. in.


K0244 Hydrogeldressingwoundcover,withoutadhesive,more than 48 sq. in.


K0245 Hydrogeldressingwoundcover,withoutadhesive,16sq. in.or less


K0246 Hydrogeldressingwoundcover,withoutadhesive,>= 16sq. in. <= 4Ssq. in.


K0247 Hydrogeldressingwoundcover,withoutadhesive,more than 48 sq. in.


KOX8 Hydrogeldressingwoundtiller,gel,per fluid ounce


K0249 HydrogeI dressing wound filler, dry form, per gram


K0251 Specialtyabsorptive dressing wound cover, 

without adhesive, 16 sq. in. or less 

K0252 Specialtyabsorptive dressing wound cover, 

without adhesive, >= 16 sq. in c= 48 sq. in. 

K0253 Specialtyabsorptive dressing wound cover, 

without adheaive, more than 48 sq. in. 

K0254 Specialtyabsorptive dressing wound cover, 

with adhesive, 16 sq. in. or less 

K0255 Specialtyabsorptive dressingwound cover, 

with adhesive, >= 16 sq. in <= 48 sq. in. 

K0256 Specialtyabsorptive dressingwound cover, 

with adhesive, more than 48 sq. in. 

K0257 Transparent film, 16 sq. in. or less, each dressing


K0258 Transparent film, > = 16 sq. in. <= 48 sq. in.


K0259 Transparent film, more than 48 sq. in.


K0154 Wound pouch, each


K0261 Wound filler, not elsewhere classified,gel/paste, per fluid ounce


K0262 Wound filler, not elsewhere classified,dry form, per gram


A4460 Elastic bandage, per roll


K0265 Tape, all types, per 18 sq. in.


A4454 Tape, all types, all sizes


STANDARD 

llday 

l/day 

l/day 

3fweek 

3tweetr 

3/%wek 

3/month 

3/month 

I/day 

I/day 

I/day 

l/every other day 

I/every other day 

Vevery other day 

3/week 

3hveek 

3heek 

3/week 

I/day 

llday 

ltweek 

per wound cover 

per wound cover 

A-2

APPENDIX B


coI$n3m.NcE INTERVALS 

Wereported ourprojected totals by multiplying 100 bythepoint estimates in our 

samples. The point estimates represent the total allowance, number of supplies, or 

number of beneficiaries. The tables below include confidence internal columns. The 

number provided in this column is the semi-width of the confidence interval for each 

of the projected totals. The semi-width is the standard error of the projection 

multiplied by 1.96 when computing confidence intervals at the 95 percent level. The 

semi-width added to or subtracted from the estimated mean or total (projection) 

provides a 95 percent confidence interval. The table title numbers below correspond 

with the table numbers in the report. 

Table 1. Wound Cam Supply Activity 1990-1994 

Table3. Wound lMe Activity Summmy-50puation Restwe’Mst States 

+/-$288 $1,046 +/-2,075,430 36,313,600 

+/-$138 $910 +/-5,925,809 26,969,200 

IVA N/A N/A NIA 

+/-$204 $708 +/-3,263,443 12,938,400 

NIA NIA N/A NJA 

B-1

.. .

APPENDIX C


MEDICARE PART B NON-TAPE ALLOWANCES THAT EXCEEDED 

PROPOSED DMERC UTILIZATION GUIDELINES 

Alginate Dressings 

K0150 $0 $0 $0 $0 

KOl%/KO150KB $0 $1,386 $1,676 $292 

K0197K0150KC $0 .$0 $0 $0 

KO198/KO150KD $0 $0 $0 $0 

K0199 $4,747 $0 $638 $0 ,.. ,,:..,.....:...,.,, .. ,,.,.,,. . . . .. .; .,. ... . ... .: :.. 

..;:$j@&:: :,. ;.:~~,qlf;.:, ;:.,:: ,@z; 6;&:-$i~&ii:$4&$’ :.;;:;:;;;:;:’.:: :;:,””...:411%7‘;;:;: 

Foam Dressings 

K0151 $0 $0 $0 $0 

K02QWK0151KB $1,040 $3,979 $6,628 $2,507 

K0210/KO151KC $0 $1,136 $766 $747 

K0211/KO151KD $3,150 $0 $133 $929 

K0212 $1,920 $244 $1,644 $0 

K0213 $0 $636 $0 $0 

$0 $0 

$0 $3,354 

$0 $0 

$0 $0 

$0 $2,385 

. ., .:. . . . . . . . ,.,. ”. 

:.”: ?,’+J:.: , “,,..$5,F%” 

$0 $0 

$96 $14,250 

$511 $3,160 

$0 $4,212 

$245 $4,053 

$0 $636 

K0214 $0 $0 $0 $0 $0 $0 

K0215 $0 $0 $0 $0 $0 $0 

c-1 

I 
. .

.. . . . .

Gauze 

A4200 $59 $0 

A4202 $0 $0 

A4203 $0 $0 

K0216/A4200KB $918 .$752 

K0217/A4200KC $150 $891 

K02181A4200KD $6,215 $70 

K0219 $0 $0 

K0220 $0 $0 

K0221 $0 $0 

K0222 $59 $707 

K0223 $519 $380 

K0224 $0 $0 

K0228 $0 $1,649 

K0229 $489 $517 

K0230 $0 $0 

K0263/A4202KF $0 $0 

K02WA4203KF $0 $0 

K0266 $0 $0 

,..:; . ,,,.:..:. :. . ,,.,.., .,,.: .’:,:..,,..:..:..,. : 

+Y<.$swz ::xMw@: .... .. .. .. . .. . .,,,, . . .........

: 

Hydrocolloid Dressing 

A4204 $340 $680 

K0149 $74 $0 

K0234/KO149KB $99 $0 

Ko235/Ko149Kc $362 $398 

K02WK0149KD $0 $0 

K0237 $36 $0 

K0238 $0 $52 

K0239 $0 $0 

K0240 $0 $0 

K0241 $0 $0 

:kid - Mwii&iiiidii+iiiiti :: ‘:” : .’ “ “’““kill”: :.’; ‘“‘:$1:1% ; ‘ 

c-2 

$403 $57 $147 $666 

$0 $0 $0 $0 

$0 $0 $0 $0 

$4,316 $919 $869 $7,774 

$354 $1,880 $1,309 .$4,584 

$1,456 $6,246 $0 $13,987 

$0 $0 $0 $0 

$20 $0 $0 $20 

$0 $0 $0 $0 

$741 $325 $0 $1,832 

$260 $0 $0 $1,159 

$0 $0 $0 $0 

$0 $0 $0 $1,649 

$2,073 $5% $423 $4,098 

$0 $0 $0 $0 

$0 $0 $0 $0 

$0 $0 $0 $0 

$0 $0 $0 $0 

. . 

$1,535 $0 $13 $2,568 

$0 $0 $0 $74 

$82 $190 $200 $571 

$21 $0 $0 $781 

$0 $0 $0 $0 

$197 $0 $0 $233 

$0 $611 $0 $663 

$0 $0 $0 $0 

$0 $0 $0 $0 

$0 $0 $0 $0 

&,835””; : “:“;””ml i ;“;RW1$;” “’:’::~”~i~~~”” : 
.- ..-. I .. . ... . . . t’- 2 

Hydrogel Dressings 

A4205


K0148


K0242/KO148KB


K0243/KO148KC


K02JWK0148KD


K0245


KOW6


K0247


K0248/KO148KE


K0249


K0251 

K0252 

K0253 

K0254 

K0255 

K0256 

!ioti-i@cial&:*ti* 

A4190 

Ko257/A4190KB 

K0258/A4190KC 

Ko259/A4190KD 

$319 $0 $796 $637 $372 $2,124 

$0 $0 $0 $0 $0 $0 

$1,905 $292 $1,748 $250 $544 $4,739 

$2,963 $178 $5,649 $0 $269 $9,059 

$2,057 $0 $1,063 $11,388 $0 $14,508 

$0 $0 $39 $0 $0 $39 

$0 $94 $1,174 $0 $184 $1,452 

$0 $0 $0 $0 $0 $0 

$11,405 $12,979 $13,684 $2,528 $3,760 $44,356 

$0 $0 $0 $0 $0 $0 

Specialty AbsorptiveDressings 

$0 $30 $258 $0 $0 $% 

$60 $140 $1,165 $1,466 $194 $3,025 

$2,128 $86 $389 $1,798 $1,902 $6,303 

$240 $107 $0 $0 $0 $347 

$0 $191 $0 $0 $0 $191 

$0 $0 $0 $0 $0 $0 

:ti*j;&i: :::..~,,“. “.$*W,,,.,

: ‘“”,,: ., .,,,, .$5$+:{.’:,.’; 096.. “.”’’.,’. :$lb,js$

TransparentFilm 

$12 $0 $79 $174 $19 $M 

$39 $8 $126 $0 $33 $206 

$1,952 $230 $1,437 $.3,454 $360 $7,433 

$69 $0 $0 $0 $0 $69 

Other Supplies 

I 1 1 I I 1 

A4323 Saline Solution $2,828 $2,107 $7,166 $1,237 $1,346 $14,684 I 1 f I 

A4460 Elastic bandage $43 $0 $236 $0 $0 $279 

I , 1 ! 

c-3 
APPENDIX D


NURSING HOME STATE DATA 

Each nursing home inoursample wasasked tocomplete a48questionsumey. The 

questions for the survey were developed by reviewing information on wound care 

supplies produced by HCF~ the Durable Medical Equipment Regional Carriers, 

wound care suppliers, and professional organizations. 

For most questions, we report the percentage of nursing home responses to the 

question and the projected number of responses by the each of the five States. The 

percentages have been rounded to the nearest whole number and therefore will not 

always add up to exactly 100 percent. The projected numbers have been rounded and 

will therefore not always add up to exactly 9,770 nursing homes. In addition, for 

several questions respondents selected more than one answer. These questions are 

identified by an asterisk in the sample survey instrument that follows. In the several 

questions where respondents were asked to provide numerical data (e.g., number of 

beds or percentage of patients receiving incontinence supplies), an average number or 

percentage is provided. 

We also report the semi-width for each of the response percentages at the 95 percent 

confidence level. The semi-width is the standard error of the projection multiplied by 

1.96. The semi-width added or subtracted to the percentage provides a 95 percent 

confidence internal. The range of the 95 percent confidence interval is presented in 

the table following each question. 

Under each question, a table is presented that breaks down each response by State. 

For each State, the first number provided is the percentage responding, the second 

number is the semi-width, and the third number is the projected number of nursing 

homes. 

D-1

SURGICAL DRESSINGS AND WOUND CARE SUPPLIES 

NURSING FACILITY SURVEY 

This sumey is being conducted by the Office of Evaluation and Inspections within the 

U.S. Department of Health and Human Services’ Office of Inspector General. We 

are currently reviewing Medicare’s payments for surgical dressings and wound care 

supplies. We are also interested in learning about equipment suppliers’ marketing 

practices for wound care supplies. When we refer to wound care supplies, we mean 

supplies such as gauze, tape, specialty dressings, wound pouches, etc. that are used in 

the treatment of surgical openings or debrided wounds. 

Our review is focusing on Medicare Part B payment of wound supplies. Please keep 

this in mind when completing this survey. We are not at this time interested in wound 

care supplies or surgical dressings that are included in Medicare Part A cost reports. 

All information provided will be kept confidential. All data will be reported out in the 

~me~ate and the names of nursing facilities will never be identified to the Public. If 

you have any questions about this survey, please call Linda Ragone at 1-800-531-9562. 

Please return this surveyby March 27, 1995in the enclosed self-addressed,pre-paid 

envelope or if you prefer you can fax it to us at (215) 596-6987. We appreciate your 

cooperation and assistance. 

Pleaseprint the folknvinginforrnution(@wire kiitas the reqxmdent thepemon who 

answemthe survey quiwions): 

RESPONDENT: 

JOB TITLE: 

NURSING FACILITY: 

ADDRESS: 

TELEPHONE: 

D-2

GeneralInformation 

1. How does Medicare categorize your facility? 

Skilled Nursing Facility 76 70 43 89 22 33 

*13.1 *13.5 *14.3 *8.9 *12.1 *9.6 

483 290 231 407 159 2311 

Nursing Facility 2 0 26 6 27 17 

*4.3 *0.O *12.7 *6.8 *13.O *7.7 

13 0 140 27 195 1191 

Both Skilled Nursing 22 25 15 2 44 50 

Facility and Nursing *12.7 *12.8 *1O.3 *4.O *14.5 *1O.2 

Facility 140 104 81 9 318 3502 

Other (please speci~) o 0 15 2 4 0 

+0.0 *0.O *10.3 *4.O *5.7 *0.O 

o 0 81 9 29 0 

No Response o 5 0 0 2 0 

too *6.4 *0.O *0.O *4.1 *0.O 

o 21 0 0 14 0 

2. How many beds does your nursing facility contain? 

D-3

4. What percentage of your population is eligible for Medicare Part B Coverage? 

5.	 What percentage of your current patient population receive surgical dressings or wound care 

supplies (e.g. gauze, hydrogel or alginate dressings, wound pouches)? 

6.	 Are any of the surgical dressings or wound care supplies used for patients in your nursing 

facility billed to Medieare Part-B? 

Yes 54 50 48 57 49 57 

*15.3 *14.8 *14.4 *14.2 *14.6 *10.1 

343 207 258 260 354 3992 

I 

No 44 45 48 38 49 38 

*15.2 *14.7 *14.4 *13.9 *14.6 *9.9 

280 186 258 174 354 2661 

5 4 4 2 5 

~6.4 *5.7 *5.6 *4.1 *4.5 

+ 21 21 18 14 350 

D-4

. . .

7.	 Does your nursing facility directly bill Medicare Part B for wound care supplies or do you have 

at least one external supplier who bills Medicare Part B directly for these supplies? 

Nursing Facility is sole 49 23 20 4 27 33 

supplier *15.3 ~12.4 +11.6 *5.6 *13.O *9.6 

312 95 107 18 195 2311 

At least one external 37 36 48 70 40 45 

supplier *14.8 *14.2 *14.4 *13.1 *14.3 *1O.2 

235 149 258 320 289 3151 

Other (please specify) 10 23 24 23 24 18 

*9.2 *12.4 ~12.3 *12.O *12.5 *7.9 

64 95 129 105 174 1261 

No Response 5 18 9 2 9 4 

*6.7 *11.4 *8.3 *4.O *8.4 *4.O 

32 75 48 9 65 280 

8.	 Do you have a wound care supplier that provides wound care products only to the 

Medicare-eligible patients in your facility? 

.,.,,. ..:, .,..::.:.,:’:,,; .. ., 

Yes 

No 

No Response 

20 18 22 40 31 17 

*12.2 *11.4 *12.O *14.O *13.5 k7.7 

127 75 118 183 224 1191 

78 77 70 57 67 79 

t12.7 *12.4 *13.2 *14.2 *13.7 *8.3 

496 319 376 260 484 5532 

2 5 9 2 2 3 

*4.3 *6.4 58.3 *4.O *4.1 *3.5 

13 21 48 9 14 210 

D-5 
9. How did your facility become aware of the suppliers you use? 

Through supplier 10 14 9 4 2 22 

advertisements *9.2 *10.3 *8.3 *5.6 *4.1 k8.5 

64 58 48 18 14 1541 

Through supplier direct 5 9 4 2 2 8 

mail marketing *6.7 *8.5 *5.7 *4.O k4.1 *5.5 

32 37 21 9 14 560 

Through supplier 63 41 54 74 36 67 

representative/salesperson *14.8 *14.5 *14.4 *12.5 *14.O *9.6 

visit 401 170 290 338 260 4692 

Other (please speci@) 37 39 39 23 40 36 

*14.8 *14.4 *14.1 *12.O *14.3 *9.8 

235 161 209 105 289 2521 

No Response 7 20 13 4 27 

*7.8 +11.8 *9.7 *5.6 *13.O *4.O 

45 83 70 18 195 280 

~more than one answer was selected by some respondents 

D-6


4 
Use of Wound Care SuPPliea 

10. Who initially identifies that a patient has a need for wound care supplies? 

Family Physician 24 39 41 38 44 34 

*13.1 *14.4 *14.2 *13.9 *14.5 *9.7 

153 161 220 174 318 2381 

Medical Director of 7 2 9 11 7 9 

Nursing Facility *7.8 *4.1 *8.3 *8.9 *7.5 *5.8 

45 8 48 50 51 630 

Supplier Representative 2 2 4 2 0 1 

*4.3 *4.1 *5.7 i4.o *0.O *2.O 

13 8 21 9 0 70 

Director of Nursing 39 20 30 17 47 25 

*14.9 *11.8 *13.2 *1O.7 *14.6 *8.8 

248 83 161 78 340 1751 

Nurse/Nursing Facility 63 70 59 66 38 70 

Attendant *14.8 *13.5 *14.2 *13.5 *14.2 *9.4 

401 290 317 302 275 4902 

Wound Care Specialist 20 14 11 4 0 3 

Contracted by Nursing *12.2 *1O.3. *9.O *5.6 *0.O *3.5 

Facility 127 58 59 18 0 210 

Other (please specify) 17 20 20 23 11 11 

*11.5 *11.8 *11.6 *12.O *9.1 *6.4 

108 83 107 105 80 770 

No Response o 0 0 0 2 0 

*0.O *0.O *0.O *0.O *4.1 *0.O 

o 0 0 0 14 0 

more than one answer was selected by some respondents 

D-7

11. Who decides what specific supplies will be ordered for the patient? 

Family Physician 49 66 57 49 62 63 

*15.3 *14.O *14.3 *14.3 *14.2 *9.9 

312 273 306 224 448 4412 

Medical Director of 10 7 9 13 7 13 

Nursing Facility *9.2 *7.5 *8.3 *9.6 *7.5 *6.9 

64 29 48 59 51 910 

Supplier Representative 5 0 4 6 0 2 

*6.7 0.0 *5.7 *6.8 *0.O *2.9 

32 o* 21 27 0 140 

Director of Nursing 56 18 44 17 40 21 

*15.2 *11.4 *14.3 *1O.7 *14.3 *8.3 

356 75 236 78 289 1471 

Nurse/Nursing Facility 29 41 26 43 16 39 

Attendant *13.9 *14.5 *12.7 *14.2 *1O.7 * 10.0 

184 170 140 197 116 2731 

Wound Care Specialist 22 14 13 9 2 12 

Contracted by Nursing *12.7 *10.3 *9.7 *8.2 *4.1 k6.6 

Facility 140 58 70 41 14 840 

Inventory Supervisor 7 5 4 0 2 3 

*7.8 *6.4 *5.7 +0.0 k4.1 *3.5 

45 21 21 0 14 210 

Other (please specify) 15 18 9 30 11 18 

*10.9 *11.4 *8.3 *13.1 *9.1 *7.9 

95 75 48 137 80 1261 

No Response o 0 0 0 2 1 

*0.O *0.O *0.O *0.O *4,1 *2.O 

o 0 0 0 14 70 

more than one answer was selected by some respondents 

D-8

12. How are the wound care supplies initially ordered? 

.,+b”... .,”~.: .g+ ., *. “: “, 

Nursing facility contacts 78 91 76 85 69 80 

supplier +12.7 *8.5 *12.3 *1O.2 *13.5 *8.2 

496 377 408 388 499 5602 

Supplier is told of need 7 5 9 13 7 5 

when supplier *7.8 *6.4 *8.3 *9.6 *7.5 *4.5 

representative or delivety 45 21 48 59 51 350 

person visits 

Supplier suggests wound 7 5 4 2 4 3 

care supplies would be *7.8 *6.4 *5.7 *4.O *5.7 *3.5 

appropriate for certain 45 21 21 9 29 210 

patients 

Other (please speeify) 12 7 20 9 16 16 

*9.9 *7.5 *11.6 *8.2 *10.7 *7.5 

76 29 107 41 116 1120 

No Response o 0 2 2 7 2 

*0.O *0.O *4.O *4.O *7.5 *2.9 

o 0 11 9 51 140 

* more than one answer was selwted by some respondents 

D-9

.

..

. .

13.	 At which stages of a pressure ulcer, do you use Medieare-reimbursed wound care supplies on 

patients? 

L . . :‘Wqx&? : .“CA” *;’” .’ ‘K, m. m ..Cfl’HER .,. .

Stage I 2 7 7 4 4 11 

*4.3 *7.5 *7.4 ~5.6 *5.7 *6.4 

13 29 38 18 29 770 

Stage II 12 20 24 15 27 30 

*9.9 +11.8 *12.3 *1O.2 *13.0 *9.4 

76 83 129 69 195 2101 

Stage 111 76 64 52 36 60 63 

*13.1 +14.2 *14.4 *13.7 *14.3 *9.9 

483 265 279 165 434 4412 

Stage IV 59 43 37 60 38 48 

*15.1 *14.6 *14.O *14.O *14.2 *10.2 

375 178 199 274 275 3361 

Other (please specify) 12 18 28 36 13 20 

*9.9 *11.4 *13.O *13.7 *9.8 *8.2 

76 75 150 165 94 1401 

No Response 5 18 15 4 9 10 

*6.7 *11.4 *10.3 *5.6 *8.4 *6.1 

32 75 81 18 65 700 

* more than one answer was selected by some respondents 

SupplierMarketing Practices 

14. Have supplier representatives ever tried to market their wound care products directly to 

patients? 

“:: ,.,.~;:;~g&’:.; 

Yes 

No 

No Response 

! . ... .. ..... ,. ... ,., .,-i 

::;, ,, “.;:;: ,,, , ..... ~~ . ‘ “Q**’ “: *::;; “%:::::.‘:,“:iti”:’”.,“:N+,,.’“ ., ‘lx:., , “’

2 9 4 4 9 5 

i4.3 *8.5 *5.7 *5.6 *8.4 *4.5 

13 37 21 18 65 350 

98 89 93 96 89 95 

*4.3 *9.2 *7.4 *5.6 *9.1 *4.5 

623 368 499 439 643 6653 

o 2 2 0 2 0 

*0.O *4.1 *4.O *0.O *4.1 *0.O 

o 8 11 0 14 0 

D-10 
.. . ::.:. .... ..

15.	 Have supplier representatives ever helped you determine which patients in your facility qualify 

for Medimre reimbursement of wound care supplies? 

[“’ ,&s@l$~; “. ~ ~ c~ “ “ 

29 32 

Yes 

No 

NOResponse 

22 25 24 45 

*9.5 

*12.7 *12.8 *12.3 ~14.2 *13.3 

2241 

140 104 129 206 210 

78 73 76 55 69	 67 

*9.6 

*12.7 *13.1 *12.3 *14.2 *13.5 

4692 

496 302 408 251 499 

o 2 0 0 2 1 

*0.O	 *4.1 *0.O *0.O *4.1 *2.O 

0 8 0 0 14 70 

16.	 Have supplier representatives ever attemptd to help you determine which Medimre-eligible 

patients in your facility need various wound care supplies? 

,. .\..:,. . . 

‘.”’ ““.;.:,* ~~ ~“’”.‘;“:“,~v’ ~“ “:.*:. ; @?%~_ ‘ R@”@:m~~ :’.::~! “’, ‘“ 

22 36 

Yes 

No 

No Response 

20 36 22 19 

*9.8 

*12.2 *14.2 *12.O *11.2 *12.1 

2521 

,127 149 118 87 159 

80 61 78 81 76 63 

*12.2 *14.4 *12.O *11.2 *12.5 *9.9 

509 253 419 370 549 4412 

o 2 0 0 2 1 

*2.O 

*0.O	 *4.1 *0.O *0.O *4.1 

70 

0 8 0 0 14 

17.	 Have supplier reprmentatives ever attempted to help you determine if patients not eligible for 

Medicare need various wound care supplies? 

~:.,,..,.:‘::.::.:, ,,. .,,. .,....:,.,. 

Yes 

No 

No Response 

17 23 20 21 13 25 

*11.5 +12.4 *11.6 *11.6 *9.8 *8.8 

108 95 107 96 94 1751 

83 75 80 77 84 73 

*11.5 *12.8 *11.6 *12.O *1O.7 *9.1 

528 311 430 352 607 5112 

o 2 0 2 2 2 

+0.0 *4.1 *0.O +4.0 *4.1 *2.9 

0 8 0 9 14 140 

D-11

18.	 Have you ever been offered inducements by suppliers such as free products to allow them to 

provide wound care supplies to your patients? 

Yes 

No 

No Response 

15 23 7 4 22 13 

*10.9 *12.4 *7.4 ~5.6 *12.1 *6.9 

95 95 38 18 159 910 

85 75 89 96 73 86 

*10.9 *12.8 *9.O *5.6 *13.O *7.1 

541 311 478 439 528 6023 

o 2 4 0 4 1 

+0.0 *4.1 *5.7 *0.O *5.7 *2.O 

o 8 21 0 29 70 

If yes, please describe the nature of such inducements. 

19.	 Has a supplier ever provided you with the necessary prescription forms to be filled out by your 

facility’sphysician or the patient’s family physician? 

9 15 34 11 8 

*8.5 *1O.3 *13.5 *9.1 *5.5 

37 81 155 80 560 

91 83 66 84 91 

*8.5 ilo.9 *13.5 *1O.7 *5.8 

377 446 302 607 6373 

0 2 0 4 1 

*0.O	 *4.O *0.O *5.7 *2.O 

o 11 0 29 70 

D-12

.

.

. ... ... .... ... ..’. . . . . . ..... ,,.

20.	 Has a supplier ever filled out the prescription form and presented it to you for the physician’s 

signature? 

. t 

Rafiiti .“. “: .::+., , ~ , . ...

.lL’. yi “.~~m:,i?qim: 

Yes 

No 

No Response 

2 5 7 21 9 7 

*4.3 *6.4 *7.4 +11.6 *8.4 *5.2 

13 21 38 96 65 490 

90 95 91 77 87 92 

*9.2 *6.4 *8.3 *12.0 *9.8 *5.5 

572 393 489 352 629 6443 

7 0 2 2 4 1 

*7.8 *0.O *4.O *4.O *5.7 *2.O 

45 0 11 9 29 70 

21.	 Does the supplier representative decide the number of supplies to be delivered in a given 

month? 

,,,...,.,..... . ‘ti&ti, “, .:,,~. :;.. ,: .,~: .;~’. ,,Ny. .’: : “+&&&i: ::;..:”:,:.;;~. .+ “’” .,.,...

Yes 

No 

No Response 

7 11 24 34 22 24 

*7.8 *9.2 *12.3 *13.5 *12.1 *8.7 

45 46 129 155 159 1681 

90 89 70 60 71 73 

*9.2 *9.2 ~13.2 *14.0 *13.3 *9.1 

572 368 376 274 513 5112 

2 0 7 6 7 3 

*4.3 *o<o *7.4 *6.8 *7.5 *3.5 

13 0 38 27 51 210 

22.	 Have you ever been told by a supplier that Medicare requires the use of certain types of 

products on patients suffering from wounds? 

: .. .:

..

.:,

..

,.,,:,, ..; ...:,,.:..’::: .: . ‘. ,.;.,,:+..:.: ; .,. ., .:..:....’. ,...?.:... ~:::.:.’.’,.,“.,,...,.,, . .....,.,,. ““:’:: <.:..Qg&&g,..;: .,..’ .,:::, .:.”. .. >.:. ,,.,...,,::...,.., >j,:; ,.{,:::;:: .,,, .,,.,,, , .:. :. . .::::,.. ,,:,,., ,,,,,, ....,,. .,, :::::~:,:~ , ;~: .:, .,: jq+:,: ,, .,,,,,. ,.\ ;..:&::’ .“,p~k.”: 

Yes 

No 

No Response 

2 20 9 4 13 8 

*4.3 *11.8 *8.3 *5.6 *9.8 *5.5 

13 83 48 18 94 560 

95 80 91 96 84 90 

*6.7 +1108 *8.3 *5.6 *1O.7 *6.1 

604 331 489 439 607 6303 

2 0 0 0 2 2 

*4.3 *0.O *0.O *0.O k4.1 *2.9 

13 0 0 0 14 140 

D-13

..

. .

23.	 Have you ever been told by a supplier that Medicare requires the use of wound care@ on 

Medieare beneficiaries? 

&spanie , . . “: :. ‘cl!.,..””” . .. :.. $.:.:, ,.IL.;. ,, r.iy ..~. ‘..& j &’~~ ; 

Yes 

No 

No Response 

5 16 7 4 11 12 

*6.7 *1O.8 *7.4 *5.6 *9.1 *6.6 

32 66 38 18 80 840 

95 82 93 % 82 87 

*6.7 *11.4 *7.4 *5.6 *11.2 *6.9 

604 339 499 439 593 6093 

o 2 0 0 7 1 

*0.O *4.1 *0.O *0.O *7.5 *2.O 

o 8 0 0 51 70 

24.	 Has a supplier ever told you that wound care supplies will be provided to Medicare 

beneficiaries at no cost to the patient? 

, ““:$&@.&e “;”..;., :;, : “e&: ‘fi& ““’‘ ‘:”..NY: ,‘q... ““’‘.’? .“.:’i&.’ ..

dii%ii,: ...... 

Yes 

No 

No Response 

32 27 28 13 22 29 

*14.3 *13.1 *13.0 *9.6 *12.1 *9.3 

204 112 150 59 159 2031 

68 73 72 83 69 68 

*14.3 *13.1 *13.O *1O.7 *13.5 *9.5 

432 302 387 379 499 4762 

o 0 0 4 9 2 

*0.O *0.O *0.O *5.6 *8.4 *2.9 

o 0 0 18 65 140 

25. Is the same basic wound care kit provided to every Medicare beneficia~ in your nursing home? 

Yes 

No 

No Response 

22 36 22 13 24 25 

*12.7 *14.2 *12.O ~9.6 *12.5 *8.8 

140 149 118 59 174 1751 

63 45 59 72 51 55 

*14.8 *14.7 +14.2 *12.8 *14.6 *1O.2 

401 186 317 329 369 3852 

15 18 20 15 24 20 

*10.9 *11.4 *11.6 *1O.2 *12.5 *8.2 

95 75 107 69 174 1401 

D-14

26.	 Has a supplier ever suggested that a standard number of wound care trays or kits per day (e.g. 

three per day) should be used? 

;.: 

Yes 7 9 17 6 18 12 

*7.8 *8.5 *10.9 i6.8 *11.2 *6.6 

45 37 91 27 130 840 

No 90 91 80 87 73 85 

*9.2 *8.5 *11.6 *9.6 *13.O *7.3 

572 377 430 398 528 5953 

No Response 2 0 2 6 9 3 

*4.3 +0.0 *4.O *6.8 *8.4 *3.5 

13 0 11 27 65 210 1 

‘“ii: “;.’”?!-’’ =:_~

~=. 

27.	 Have you ever been told by a supplier that Medicare will cover routine supplies such as saline 

solution if gauze or speeialty dressings are purchased? 

‘~;.; ., : ::<.‘@+&i+e”:;::: :‘:: :: “: “:..,,, ,., i+ .,’:;”:.IL“:.; ‘::Ni:::: .~’” ; “. W!@’.

Yes 

No 

No Response 

10 14 7 2 16 11 

*9.2 *1O.3 *7.4 *4.O *10.7 *6.4 

64 58 38 9 116 770 

90 86 93 94 76 86 

~9.2 *10.3 *7.4 *6.8 *12.5 *7.1 

572 356 499 430 549 6023 

o 0 0 4 9 3 

*0.O *0.O *0.O ~5.6 *8.4 *3.5 

o 0 0 18 65 210 

D-15 
28.	 Do your suppliers routinely waive the 20 pereent copayment required of Medicare 

beneficiaries? 

r 

ReSFWC : . ,“””m ..” IL 

Yes 

No 

Do Not KtlOW 

No Response 

2 0 9 0 9 2 

*4.3 *oco *8.3 *0.O *8.4 *2.9 

13 0 48 0 65 140 

29 45 15 43 27 33 

*13.9 *14.7 *10.3 *14.2 *13.O *9.6 

184 186 81 197 195 2311 

44 45 70 55 47 58 

+15.2 *14.7 *13.2 *14.2 *14.6 *1O.1 

280 186 376 251 340 4062 

24 9 7 2 18 8 

*13.1 *8.5 *7.4 *4.O *11.2 �5.5 

153 37 38 9 130 560 

29.	 Has a supplier ever provided a wound care specialist or specialty nurse to assist you in patient 

care or in developing a treatment plan? 

Yes 

No 

No Response 

41 39 22 36 31 37 

*15.1 *14.4 *12.O *13.7 *13.5 *9.9 

261 161 118 165 224 2591 

59 59 74 60 62 62 

*15.1 *14.5 *12.7 *14.0 *14.2 *9.9 

350 244 397 274 448 4342 

o 2 4 4 7 1 

*0.O *4.1 *5.7 *5.6 *7.5 *2.O 

o 8 21 18 51 70 

D-16 
30. Has a supplier ever offered training to your staff concerning the treatment and care of wounds? 

Yes 

No 

No Response 

‘“J?L. “, .. .. :% ‘“. z%. OTHER 

68 68 63 72 51 73 

*14.3 *13.8 *14.0 ~12.8 *14.6 *9.1 

432 282 338 329 369 5112 

32 30 35 28 42 25 

*14.3 *13.5 +13.8 *12.8 *14.4 *8.8 

204 124 188 128 304 1751 

I

o 2 2 0 7 2 

*0.O *4.1 *4.O *0.O *7.5 *2.9 

o 8 11 0 51 140 

31. How does your staff become aware of new wound care products that might benefit your 

patients? 

TrainingKlmferenees 

offered by suppliers 

Medieal journalsfliterature 

Training provided by 

mediealhursing 

associations 

Other (please specify) 

No Response 

more than one answer was 

56 57 

*15.2 *14.6 

356 236 

59 55 

*15.1 i14.7 

375 228 

68 68 

*14.3 *13.8 

432 282 

59 61 

*15.1 *14.4 

375 253 

20 23 

*12.2 *12.4 

127 95 

0 2 

*0.O *4.1 

0 8 

Jetted by some re 

-

““’ ‘i; .;’ 

54 

*14.4 

290 

41 

*14.2 

220 

57 

*14.3 

306 

41 

~14.2 

220 

20 

*11.6 

107 

7 

*7.4 

38 

@iiiEii 

68 58 71 

*13.3 *14.4 *9.3 

311 419 4972 

60 44 42 

*14.O *14.5 *1O.1 

274 318 2941 

83 49 61 

*1O.7 *14.6 *1O.O 

379 354 4272 

62 36 47 

*13.9 *14.0 *10.2 

283 260 3291 

23 20 24 

*12.O *11.7 *8.7 

105 145 1681 

D --17

32. Have supplier representatives ever requested to review patient medical records? 

t 

B“&aIise “. .: : : ;,c~ :“. “..:7L;’”.’~i.,’”,: ,- :..., ,. ,, ‘lx o’@ER

Yes 12 16 13 47 11 20 

*9.9 *1O.8 *9.7 *14.3 &9.1 *8.2 

76 66 70 215 80 1401 

No 88 82 83 51 84 80 

*9.9 *11.4 *10.9 *14.3 *10.7 *8.2 

560 339 446 233 607 5602 

No Response o 2 4 2 4 0 

*0.O *4.1 *5.7 *4.O *5.7 *0.O 

o 8 21 9 29 0 

If yes, for what reason? 

33.	 Have supplier representatives ever suggested how medical records should be documented to 

support the need for wound care supplies? 

R+*+ ‘“.’”:., ..~., .’ +& .“.,i. .: : ,. 

Yes 

No 

No Response 

12 25 9 17 20 17 

*9.9 *12.8 *8.3 *1O.7 *11.7 *7.7 

76 104 48 78 145 1191 

85 75 85 81 73 76 

*1O.9 *12.8 *1O.3 *11.2 *13.0 *8.7 

541 311 456 370 528 5322 

2 0 7 2 7 7 

*4.3 +0.0 *7.4 *4.O *7.5 *5.2 

13 0 38 9 51 490 

D-18 
34. How many different suppliers provide you with wound care supplies for your patients? 

Number of Suppliers 1.6 2.0 1.4 1.7 1.5 1.7 

*0.4 *0.7 *0.3 *0.3 *0.4 +0.2 

35.	 Please list the names, addresses, and phone numbers of the suppliers who provide your facility 

with the majority of wound care supplies for your patients? 

36. Are wound care supplies marketed to you in kits or as bulk supplies? 

Both Kits and Bulk 32 30 26 26 31 37 I 

Supplies *14.3 *13.5 *12.7 +12.5 *13.5 *9.9 

204 124 140 119 224 2591 

Wound Care Kits 20 16 22 9 20 7 

*12.2 +10.8 *12.O *8.2 *11.7 *5.2 

127 66 118 41 145 490 

Bulk Supplies 32 34 39 43 29 39 

*14.3 *14.0 *14.1 *14.2 *13.3 *1O.O 

204 141 209 197 210 2731 

Other (please specify) 12 5 4 11 7 10 

*9.9 *6.4 *5.7 *8.9 k7.5 *6.1 

76 21 21 50 51 700 

No Response 5 16 9 13 13 8 

*6.7 *1O.8 �8.3 *9.6 *9.8 *5.5 

32 66 48 59 94 560 

D-19

37. Are wound care supplies shipped to you in kit or bulk form? 

.&:: :$$,., “. “iii “. ..NY , — — — 

Both Kits and Bulk 29 23 22 21 31 29 

Supplies	 *13.9 *12.4 *12.O +11.6 *13.5 *9.3 

184 95 118 96 224 2031 

12 7 22 6 20 5 

Wound Care Kits 

*9.9 *7.5 *12.O *6.8 *11.7 *4.5 

76 29 118 27 145 350 

Bulk Supplies 44 41 39 45 31 48 

+15.2 *14.5 *14.1 *14.2 *13.5 *1O.2 

280 170 209 206 224 3361 

Other (please specify) 7 7 2 13 4 9 

*7.8 *7.5 *4.O *9.6 *5.7 *5.8 

45 29 11 59 29 630 

No Response 7 23 15 15 13 9 

*7.8 *12.4 *1O.3 *1O.2 *9.8 *5.8 

45 95 81 69 94 630 

38. When delivered by the supplier, are wound care kits or supplies marked or identified as being 

intended solely for a particular patient? 

““:.:*:’: [ “ 

32 27 35 51 33 37 

204 112 188 233 239 2591 

No 59 59 50 34 49 54 

“~‘Risliie:: ::”:.’;““’”’::@””” :~:”:’””

Yes 

*14,3 *13.1 *13.8 *14.3 *13.7 *9.9 

*15.1 i14.5 *14.4 *13.5 *14.6 *1O.2 

375 244 269 155 354 3782 

NO Response	 10 14 15 15 18 9 

*9.2 *1O.3 *1O.3 *1O.2 *11.2 *5.8 

64 58 81 69 130 630 

39. If suppliers market or ship wound care kits to your facility,what supplies are typimlly 

~ntained in a kit? 

.“:,;.: @+&risk;:”: 

Provided Information 

Did Not Provide 

Information 

7 

‘: “&”: ““ik”” :’~c”:. “tW ,*;; :,“::@~& ,. ‘;:;:”’““:.: ..:.. . 

76 100 60 85 83 75 

24 0 40 15 17 25 

--mm---
....

40.	 If suppliers market or ship wound care kits to your facility, do you typically use all of the 

supplies within those kits? 

ZzIEiiE 

Yes 34 27 35 40 32 

*14.5 *13.1 *13.8 *14.3 *9.5 

216 112 188 289 2241 

No 7 16 17 11 22 15 

*7.8 *10.8 *1O.9 *8.9 *12.1 *7.3 

45 66 91 50 159 1050 

No Response 59 57 48 62 38 53 

*15.1 *14.6 *14.4 *13.9 *14.2 *10.2 

375 236 258 283 275 3712

+ 

If no, what supplies are typically not used? 

Provided Information 33 71 38 20 50 43 

Did Not Provide 67 29 63 80 50 57 

Information 

41.	 Have you ever asked a supplier to make equipment changes, such as removal or addition of 

products, in their standard wound care kit? 

,.““’::l+-&& ;{’:;:: 

Yes 

No 

No Response 

... ,, ““@~”” ‘ .:.”’” it’:.’””’“’;:iL ‘. *.” “::’ti.... ‘@iiER’ ::

12 16 11 15 7 17 

*9.9 *1O.8 *9.O *1O.2 *7.5 *7.7 

76 66 59 69 51 1191 

61 57 59 45 76 55 

*14.9 *14.6 *14.2 *14.2 +12.5 *10.2 

388 236 317 206 549 3852 

27 27 30 40 18 27 

*13.6 *13.1 *13.2 *14.0 *11.2 *9.1 

172 112 161 183 130 1891 

If yes, what changes did you request? 

Provided Information 100 86 100 100 100 81 

Did Not Provide o 14 0 0 0 19 

Information 

D-21

If yes, did the supplier make the changes? 

_ :.?%: _ 

Yes 

No 

No Response 

12 11 9 11 7 15 

*9.9 *9.2 *8.3 *8.9 *7.5 *7.3 

76 46 48 50 51 1050 

o 5 0 6 0 3 

*0.O *6.4 *0.O *6.8 *ooo *3.5 

o 21 0 27 0 210 

88 84 91 83 93 82 

*9.9 *1O.8 *8.3 *10.7 *7.5 *7.9 

560 348 489 379 672 5742 

42. Do suppliers provide you with all the neeessary wound care supplies for each patient once a 

Yes [ 37 

*14.8 

235 

No 46 

*15.3 

293 

No Response 17 

*11.5 

108 

NY”,“.:“Ty;:6*’”: 

&

25 37 49 51 39 

h12.8 *14.0 *14.3 ~14.6 *1O.O 

104 199 224 369 2731 

45 41 30 27 37 

*14.7 *14.2 *13.1 *13.O *9.9 

186 220 137 195 2591 

30 22 21 22 24 

*13.5 *12.0 +11.6 *12.1 *8.7 

124 118 96 159 1681

If no, how are supplies provided by the supplier? 

Provided Information 74 67 78 79 50 79 

Did Not Provide 26 33 22 21 50 21 

Information 

D-22

43. How are wound care supplies stored in your nursing facility? 

bedside *0.O *0.O *0.O *6.8 

Stored by individual 15 27 24 36 

patient assignment in *1O.9 *13.1 *12.3 *13.7 

supply room 95 112 129 165 

Stored in general supply 78 66 70 47 

room *12.7 *14.O *13.2 *14.3 

4% 273 376 215 

Stored by the patient’s z0 0 0 6

o	 0 o 27 I 

Other (please speeify) 10 14 9 13 

*9.2 *1O.3 *8.3 *9.6 

64 58 48 59 

No Response 7 11 2 9 

*7.8 *9.2 *4.O *8.2 

45 46 11 41

+ 

more than one answer was ected by some rt pondents 

44. What happens to unused or excess supplies? 

.ti,. 

13 

Stored for future use by 

specific patient 

Stored and used as needed 

for all patients 

Other (please speeify) 

No Response 

more than one answer was 

. 

& 

12 

*9.9 

76 

20 

*12.2 

127 

56 

*15.2 

356 

15 

*10.9 

95 

7 

*7.8 

45 

XZi&Tl 

20 24 53 ~ 

*11.8 *12.3 * 14.3 

83 129 242 

14 24 17 

*1O.3 *12.3 *10.7 

58 129 78 

36 33 17 

*14.2 ~13.6 *1O.7 

149 177 78 

27 13 13 

*13.1 *9.7 *9.6 

112 70 59 

16 9 17 

*10.8 *8.3 *10.7 

66 48 78 

some respondents 

ZiiiiEl 

29 

*9.8 *9.3 

94 2031 

78 66 

*12.1 *9.7 

564 4622 

0 2 

*0.O	 *2.9 

o 140 

9 11 

*8.4 *6.4 

65 770 

9 4 

*8.4 *4.O 

65 280 

16
 35

*1O.7 *9.7 

116 2451 

16 26 

*1O.7 *9.O 

116 1821 

40 32 

*14.3 *9.5 

289 2241 

16 12 

*1O.7 *6.6 

116 840 

18 9 

*11.2 *5.8 

130 630 

D-23

47. Do you have written or verbal agreements with your wound care suppliers? 

12 32 

*9.9 *13.8 

76 132 

10 2 

*9.2 *4.1 

64 8 

66 59 

*14.5 *14.5 

420 244 

12 7 

*9.9 *7.5 

76 29 

— NY

34 

*13.5 

155 

15 21 

*1O.3 +11.6 

81 96 

61 38 

*14.1 *13.9 

328 174 

7 6 

*7.4 *6.8 

38 27 

w, \Cyi@Z 

20 26 

*11.7 +9.0 

145 1821 

4 4 

*5.7 +4.0 

29 280 

60 59 

*14.3 *1O.1 

434 4132 

16 11 

*10.7 *6.4 

116 770 

55 71 

45 29 

Yes (verbal) 

No 

No Response 

If yes, please describe the nature of such agreements. 

67 60 60 81 

33 40 40 19 

Provided Information 

Did Not Provide 

Information 

48.	 Have you ever complained to Medicare or other authorities about the marketing or business 

practices of any wound care suppliers? 

Yes 

No 

No Response 

o 0 2 2 9 4 

*0.O *0.O *4.O *4.O *8.4 *4.O 

o 0 11 9 65 280 

90 95 93 94 89 93 

*9.2 *6.4 *7.4 *6.8 *9.1 *5.2 

572 393 499 430 643 6513 

10 5 4 4 2 2 

*9.2 *6.4 *5.7 *5.6 *4.1 *2.9 

64 21 21 18 14 140 

D-25 
If yes, what was the nature of these practices? 

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D-26