From the Editor: Understanding DME Companies

  The ancient Egyptians had a relatively advanced wound care formulary given their level of scientific knowledge. As early as 1500 BC they were using lint, animal grease, and honey as topical wound treatments. The lint provided a fibrous base that promoted wound site closure, the animal grease provided a barrier to environmental pathogens, and the honey served as an antibiotic agent. Until the late 1800’s, most dressings consisted of unclean cotton sweepings collected from the floors of textile mills, which means that no real progress was made in the field of dressing technology for more than 3,500 years. Finally, in the early 1900’s, Robert Wood Johnson created ready-made, sterile, surgical dressings, wrapped and sealed in individual packages. Most dressings continued to be made of woven textiles until the 1960’s because they functioned only as protective coverings. However, 21st century dressings are sophisticated “biomaterials,” designed to perform specific aspects of wound bed preparation which may actually facilitate healing.

  The concept of dressings as an integral part of the healing process has generated new challenges for the healthcare delivery system. The government has had to create “coverage policies” to define the type and number of dressings a patient can have. This has created documentation requirements, administrative challenges and economic opportunities for manufacturers and medical equipment companies. Of course patients my need many other types of durable medical equipment. In this issue of Today’s Wound Clinic, we have worked hard to pull together the information you need to assist your patients with DME supplies. Dot Weir and Pam Scarborough have summarized the Medicare surgical dressing policy (an encore of a longer article from a past issue). I have tried to provide an overview of the way things work with durable medical equipment companies and how to optimize the use of durable medical equipment orders for the benefit of your patients. Laurie Rappl gives us insights about obtaining medical equipment from a patient perspective. Having just brought my mother home after major surgery, Laurie’s comments resonated with me as I struggled to incorporate all the helpful but space occupying equipment that arrived from the hospital along with my Mother. Reimbursement and coding guru, Kathleen Schaum, discusses the latest news and how these will impact the wound care clinic setting.

  As our understanding of the healing process has evolved, innovation by manufacturers has increased. The Product RoundUp section focuses on the topic of debridement products and devices. There was a time (not long ago) when the idea of “debridement in a tube” would have seemed like science fiction, but enzymatic debridement has made this a reality. And only last week, I was able to painlessly debride a gigantic fungating breast cancer without the need for any pain medication because I used an ultrasonic debriding device. The Clinician’s Report this month covers foam dressings with one of those in-depth product surveys unique to TWC. We also have an exclusive interview with a representative from Organogenesis, Inc. Bioengineered skin may represent the pinnacle of innovation in biologically active wound “coverings.” And of course you will not want to miss another of Tom Serena’s entertaining and creative columns, this one a Shakespearean take on wound care quality measures. Even Shakespeare knew a thing or two about wound care. In his day, cobwebs were used as bandages. Their natural adhesive properties were taken advantage of to stop bleeding and approximate skin edges which is what the character, Bottom, meant when he said, “Good Master Cobweb: if I cut my finger, I shall make bold with you?”

  No matter how well cobwebs worked for open wounds, I am grateful that we have access to modern dressing technology and are no longer dependent upon them, or the ancient Egyptian concoction of lint and animal grease. I do wonder, though, having walked through the “mummy room” of the Cairo museum, what the Egyptians would have accomplished if they had had access to modern dressings!

Caroline Fife, Co-Editor of Today’s Wound Clinic, cfife@intellicure.com