Legal Issues

Industry News's picture

Industry News

Bethesda, MD -- Sept 26, 2018 –The Alliance of Wound Care has questioned a new exclusionary United Healthcare (UHC) policy on cellular and/or tissue-based products for skin wounds (CTPs) slated to go into effect on Oct. 1st. In a comment letter to UHC medical directors addressing “Commercial Medical Policy 2018T0592A, Skin and Soft Tissue Substitutes” the Alliance alerted the insurance provider of concerns that the policy would be detrimental to patient care. The Alliance requested a meeting to address concerns and encouraged UHC to delay policy implementation.

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Janet Wolfson's picture
wound care coverage and health insurance

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

Our clients with wounds and lymphedema incur many expenses in dealing with their recovery or disease process. When the Affordable Care Act (ACA) was passed, it afforded coverage for care that was denied, paid out-of-pocket, or just didn't happen in the past. Most lymphedema garments were still not covered because of the lack of definition as Durable Medical Equipment covered by Medicare. The individual mandates' repeal would take billions of dollars off the US deficit but leave millions of folks without health insurance and, therefore, likely with poor-to-no health care. Eliminating pre-existing condition coverage would mean much sicker people making difficult choices among such things as food, rent, schooling, gas... and health care.

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Aletha Tippett MD's picture
wound care and legal issues

by Aletha Tippett MD

Medical providers, and especially wound care providers, seem to always be under the looming shadow of lawsuits and legal issues. I have written about this before, but it continues to be an issue as I receive requests for legal reviews repeatedly. I have read many charts for legal reviews, and it actually is very straightforward to avoid or mitigate any legal problems.

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Aletha Tippett MD's picture
support surface technology and pressure injury prevention

by Aletha Tippett MD

The idea that pressure injuries (ulcers) can be prevented through equipment or device technology is one we must challenge as clinicians. A manufacturer of support surfaces, for example, may try to tell us that their beds, technologically superior, will prevent pressure injuries from forming.

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Thomas Serena's picture
leadership in wound care

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

This past May we celebrated the anniversary of John F. Kennedy's quixotic "moon shot" presentation to congress during which he laid out a plan to put a man on the moon by the end of the decade. To the world's surprise, his leadership and unwavering commitment to this dream succeeded and in the aftermath, created our modern space program.

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Cheryl Carver's picture
off label drug prescription

by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

Providers may view off label drug use (OLDU) for wounds as the "new wave". However, if there is little or no scientific evidence supporting the practice, it can possibly lead to more problems than good. Keep in mind that not every health care setting embraces off label drug use. For example, state surveyors view OLDU differently in long-term care versus home care. Providers should avoid any risk of being involved in a pressure injury investigation. OLDU may be considered a factor in the event of such an investigation. Hospice patients are considered to be in more of a "dying with dignity" category, therefore OLDU may be considered more acceptable.

Rick Hall's picture
documenting wounds

by Rick Hall, BA, RN, CWON

Wound care documentation is a hot topic with overseeing agencies dealing with the medical industry. Good documentation is imperative to protect all those giving care to patients. Documentation should be Legible, Accurate, Whole, Substantiated, Unaltered, Intelligible and Timely. If these components are not incorporated into your documentation, you could end up in a LAWSUIT.

Rick Hall's picture
Legal Case

by Rick Hall, BA, RN, CWON
Clinicians are aware that organs begin to shut down as a person starts their journey through their last weeks and even days. Caregivers, however, are often left bewildered by what some patients must go through prior to death. The Kennedy Terminal Ulcer is devastating to the caregiver if there has been no education provided on what to expect at the end of a patient's life and the skin changes that may occur.

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Cheryl Carver's picture
safety net

by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

Substandard documentation tops the list of mistakes for long-term care facilities. It involves "all hands in the chart" so to speak. This encompasses all disciplines, from the nursing assistant to the physician. Discrepancies and gaps in documentation put your facility at risk of litigation. Impeccable documentation is essential in defending any case. Your facility must have a "safety net" in place. This "safety net" consists of educating staff about the importance of timely and detailed documentation not only for the facility, but for their license. Often times, clinicians are not aware of the legal repercussions of their actions. Surveyors will also consider other related Federal Tags (F-Tags) during investigations for compliance.

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Mary Ellen Posthauer's picture
medical records

by Mary Ellen Posthauer RDN, CD, LD, FAND

As Dr. Aletha Tippett noted in her December blog, following wound documentation standards can help clinicians avoid legal issues. Pressure ulcer litigation often involves nutrition issues. Patients with chronic wounds frequently have unintended weight loss, dehydration and malnutrition. In long-term care facilities, the most prevalent types of alleged harm are falls, pressure ulcers, weight loss and dehydration. The odds of being sued are positively associated with pressure ulcers and weight loss.