Continence Coach: Medicare Coverage of Catheters

Ostomy Wound Management proudly introduces Continence Coach, a new column for clinicians seeking information on continence-related issues.

     A little-noticed policy change announced in May 2008 by the Centers for Medicare and Medicaid Services (CMS) could have a positive impact on the safety and quality of care of millions of people with chronic diseases and conditions. Previously, Medicare covered the cost of only four catheters per month for individuals managing their bladders with intermittent, self-catheterization (IC) throughout the day. Now, coverage has been extended to 200 single-use, disposable catheters per month in a number of defined circumstances. Specifically, the policy change affects self-catheterizing Medicare beneficiaries in one or more of the following categories:

     • Residents of a nursing facility
     • Immuno-suppressed patients, such as persons with AIDS or on cancer chemotherapy
     • Patients with documented vesico-ureteral reflux
     • Pregnant, spinal cord-injured patients
     • Patients with recurrent urinary tract infections (UTIs).

     Self-catheterization with reuse of catheters over the course of a week and following “clean technique” for cleansing and storing supplies has worked successfully for millions of people over the years. However, for others the practice has been untenable and downright unsafe because of the possible complications, risks, and cost of infection. From the outset, no catheter has been approved by the US Food and Drug Administration (FDA) for anything but single use in the US. Unfortunately, the personal economics faced by private citizens forced reuse of the device, as the CMS and private insurers chose to ignore for years the FDA’s single-use approval language.

     Clinicians working in a long-term care facility, consulting in home care, or assisting a hospital discharge nurse in educating patients at the end of acute care stay need to be current on IC device technology in order to guide product selection knowledgeably. A variety of gender-specific intermittent catheters in different materials, shapes, and sizes is available. Some catheters require lubrication and others, such as hydrophilic catheters, have different types of surface technology aimed at greatly reducing rubbing that can occur in the urethra and contribute to irritation.

     In addition, clinicians can advocate for residents or patients and significantly lower the incidence — and subsequently the financial costs and medical risks — associated with UTIs. The case can be argued with private insurers if patients are not covered by Medicare but otherwise fit the agency’s criteria for inclusion. The CMS has finally acknowledged that a “one-size-fits-all” approach to coverage and reimbursement policy has no place in the current healthcare system and certainly not for people with chronic illnesses and conditions such as multiple sclerosis, spinal cord injury, and AIDS.

     It is time for clinicians to do their part to put the new thinking into action, one patient and one life at a time. Recognizing the unique continence needs of certain patient populations, the National Association For Continence has published a series of booklets authored by clinical experts on Parkinson’s disease, multiple sclerosis (MS), and spinal cord injury. The booklet on MS has a detailed, step-by-step set of instructions for men and women on IC. To order copies, visit www.nafc.org or call (800) BLADDER.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to peer review.