Access to Supplies with Medicare – The Never-Ending Story

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Words of Advice from UOAA’s Advocacy Committee Co-Chair Sue Mueller and Advocacy Manager Jeanine Gleba

UOAA often hears from the ostomy community about their struggles with getting quantities of ostomy supplies that are over the Medicare allowable limits. UOAA recognizes that the process to obtain supplies beyond the maximum amount is difficult to navigate and is not well understood.  

Medicare’s coverage of ostomy supplies is explained in their Local Coverage Determination (LCD) policy (A52487) and the allowable quantity limits are in LCD policy L33828.  According to their policy:

“The quantity of ostomy supplies needed by a beneficiary is determined primarily by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. There will be variation according to individual beneficiary need and their needs may vary over time. The actual quantity needed for a particular beneficiary may be more or less than the amount listed depending on the factors that affect the frequency of barrier and pouch change. 

The explanation for use of a greater quantity of supplies than the amounts listed must be clearly documented in the beneficiary’s medical record. If adequate documentation is not provided when requested, the excess quantities will be denied as not reasonable and necessary.”

According to our conversations with the Center for Medicare and Medicaid Services’ (CMS) billing contractors the quantities listed are reasonable and necessary for 80% of the patient population. The key for the small population who require quantities of supplies that exceed the usual maximum amount, is the information documented in the medical record that explains the need for the increased amount.  What are the factors that affect the greater frequency of changes for you? You must determine what documentation is missing from your medical record that medically necessitates having the greater quantity and then work with your medical professional to get the missing information included in your records and have your supplier submit them to Medicare. Please note that a letter from a nurse or doctor is not sufficient nor is just having it listed on your prescription. The justification of your need for additional supplies must be in your medical record. To learn more read UOAA’s blog “Know What’s In Your Medical Record”.

Any claim that goes over the allowable quantity is automatically denied in the Medicare billing system. It must then be appealed and the supplier has to show the documentation that proves medical necessity etc.  Appeal denial is so frequent that most suppliers no longer advance the increased amounts while waiting for an appeal decision and do not automatically file appeals. They only submit claims for the allowable limits and then the consumer has to pay out of pocket for any overages. 

Given the cumbersome frustrating process, before you deal with the hassle, UOAA suggests that you consider being re-evaluated by an ostomy nurse. Together you can evaluate why you need more supplies and determine if you need a different pouching system or can find another work around.  For example someone who uses 3-5 pouches per day may benefit from changing to a drainable pouch. If there isn’t an ostomy nurse in your local area, some facilities have telemedicine options or UOAA has a self-pay virtual ostomy clinic. There are many different types of supplies available to meet varied needs of ostomates and remedy the challenges that occur over the lifetime of an ostomy. A certified Wound Ostomy Continence (WOC) nurse is the ideal person to assess your situation and make recommendations. 

Increasing the number of pouches is not the solution for every problem. For example someone with a high-output stoma producing greater than 2L of liquid stool daily will want to first consider looking at their diet by working with a dietician and reading UOAA’s Eating with an Ostomy information. In some situations the solution may be adding medications or the timing of medication and eating.  This is why it is important to consult with your medical team or obtain a medical team that is responsive to your needs.

After you have consulted with your medical team and determined that you have a justifiable need that can be documented for more pouches, then pursue the Medicare appeal process with your supplier. Be prepared to purchase your additional supplies while you wait for the Medicare decision. Try to get your needed supplies at the lowest cost through discounts and free supplies. UOAA lists lower cost supply resources here.

If your appeal is denied, another resource is your local State Health Insurance Assistance Program (SHIP). They can assist you with correcting billing issues, and filing complaints and appeals. With your permission, SHIP will work with Medicare directly to help solve problems on your behalf. Find your local SHIP here.

The information we just discussed applies to people with traditional Medicare, if you have a Medicare Advantage plan you should follow the appeal procedure of your plan. You may also request a case manager who is an employee of the plan for assistance with the process. The decision-making process is different with Medicare Advantage plans. 

UOAA has been advocating on this issue for many years and we will continue to beat this drum with the Centers for Medicare and Medicaid Services (CMS) and their coverage jurisdiction Medical Directors until improvements are made.

 

Caring for an Ostomate with Memory Loss

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By Sarah Biggart (Convatec me+™)

Frequently I speak to callers about the challenges of caring for an ostomate with memory loss. Often time, people who were previously self-sufficient, independent ostomates become pre-occupied with their pouch; sometimes even pulling on it, which could cause numerous issues1,2.

This could be in the future for some of us, and a reality some caregivers are facing now as they care for and support loved ones.

If you are assisting a loved one, and you see them tugging, pulling, scratching or playing with their appliance, the first thing you should consider is that there may be a reason for this behavior. Their peristomal skin may be itching or burning, or they might be experiencing pain or discomfort around the stoma3. For someone who may have trouble communicating, this could be their way of letting you know something is wrong.

If this is a new behavior, contact your local ostomy nurse or healthcare provider. It’s important to rule out any medical issues they may be experiencing.

If the issue is determined to be purely behavioral, we have some suggested tips and tricks that may help as you care for and support your loved one.

Pouch Change Tips1,2,3:

  • Create a safe, relaxed environment. Take your cues from your loved one considering where they are the most comfortable. Maybe instead of standing in the bathroom, try laying down on the bed with soothing music or a favorite show playing in the background.
  • If evenings can be tough, a morning pouch change before eating breakfast may make more sense for you.
  • Keep ostomy supplies organized and clearly labeled for people who may be able to handle pouch changes independently or for rotating caregivers.
  • Use a calendar or the My Ostomy Journey App to track pouch changes. Do not wait until there is a leak to change the pouch. A leaking pouch may contribute to skin breakdown issues.
  • It may be necessary to store pastes, powders and sprays securely, as patients may attempt to tamper with or ingest these items.
  • Try ostomy accessories designed to simplify pouch changes.

Daily Living Tips1,2,3:

  • Many people with memory loss find comfort in routine. Find a rhythm to ostomy related tasks, such as emptying the pouch, and use the same verbiage each time to bring familiarity. Coordinate with the entire care team to ensure everyone is aligned with using similar language and prompts.
  • Staying occupied may help with keeping hands away from the pouching system. Things like puzzles, sorting items and folding something, may be just the thing to help.
  • Try an Ostomy wrap. Employing the “Out of Sight, Out of Mind” principal, a wrap helps to keep the pouch concealed and supported. A good ostomy wrap is made from a soft and stretchy wicking fabric and helps to keep sweat and moisture away from the skin and the wearer cool and comfortable.

Feeling isolated while providing care for loved ones is a common challenge, we encourage utilizing groups for ostomy support.

And remember that caregivers need care too. You may find comfort in your local Ostomy Support group Find one near you on the UOAA support group finder: https://www.ostomy.org/support-group-finder/.

 

Ruth and her family were confused and stressed when they had to take on the care of their 99-year- old mother’s ostomy.

“My mother has had a colostomy for nearly 60 years. She is now 99 years old with dementia, but had been independently keeping up with her stoma and pouch until just a few years ago. When family members started taking on the task of assisting her, we had to scramble to get up-to-speed since we never paid attention to the details of changing her “appliance” or emptying and re-closing the pouch.”

Ruth connected with me+™ to learn more about how to use ostomy products and accessories, and received follow up product samples and ongoing support.

“Erica was compassionate, truly listened to the problems we were encountering with my mother’s situation, and suggested products that addressed each of those challenges. The bottom line is Erica made me feel supported in my mother’s care, and that she cared that our family wanted my mother’s quality of life upheld when other healthcare providers wrote her off due to her age and mental condition. Erica contributed to us honoring my mother’s wonderfully rich and productive life at a time when that’s not evident to a stranger’s eye. We are so grateful for the support we’ve received through Convatec’s me+ Clinical Support Nurse Team.”

 

If you have questions about product sampling or nurse support available through the me+™ program, please contact us at 1-800-422-2211 or cic@convatec.com.  We look forward to helping you soon.

Editor’s note: This blog is from one of our digital sponsors, Convatec. Sponsor support along with donations from readers like you help to maintain our website and the free trusted resources of UOAA, a 501(c)(3) nonprofit organization.

References:

  1. DementiaUK, Caring for a person with a Stoma and Dementia. https://www.dementiauk.org/information-and-support/health-advice/caring-for-a-person-with-a-stoma-and-dementia/. Accessed November 13th, 2023.
  2. United Ostomy Associations of America, Inc, Dementia Stoma Care. https://www.ostomy.org/dementia-stoma-care/. Accessed November 13th, 2023.
  3. McGrogan M. How holistic assessment and appropriate product selection will enhance quality of life for ostomates with cognitive impairment. WCET® Journal 2021;41(1):33-35

OPEN ENROLLMENT – YOUR CHOICES ARE IMPORTANT!

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Jeanine Gleba, UOAA Advocacy Manager
Sue Mueller, RN, BSN and UOAA Advocacy Committee Co-Chair

The Medicare Open Enrollment Period occurs each year from Oct. 15 to Dec. 7, and this gives consumers the chance to review and make changes to their current Medicare coverage. Many employers also have open enrollment for health insurance during this time period. Health care insurance plans are not equal and the plan you choose can make a difference in the amount and type of ostomy supplies you receive and the companies that provide your supplies. It’s crucial that people living with an ostomy understand their health insurance plan and shop around for the best plan to meet all of their medical needs. 

Although UOAA is not in the insurance business and does not give insurance advice, it does listen to our members and respond by taking action. We are committed to preserving your access to the supplies that you choose. UOAA’s Advocacy Committee has submitted federal comments and recommendations to the Centers for Medicare and Medicaid Services (CMS) as well as partnering with coalitions and endorsing policy papers that are used when advocating with healthcare insurance companies and key decision-makers. An example of this is the White Paper that UOAA co-authored and endorsed entitled “The Critical Need to Provide Ostomy Supplies Specific to Patient Need to Improve Health Outcomes”

As you do your research during your open enrollment period or become eligible for Medicare for the first time, be cautious with Medicare Advantage Plans (MC Advantage). These are also known as “Part C” and are a type of Medicare health plan offered by a private company that contracts with Medicare. Learn more about understanding Medicare Advantage plans.  According to data (from CMS) over half of eligible Medicare beneficiaries are now enrolled in private Medicare Advantage Plans (1). There are many known problems with these plans such as narrow provider networks, prior authorization requirements and high out-of-pocket costs. 

For the ostomy community, although MC Advantage Plans must cover the same medical services and treatments as original Medicare, how much they cover is up to them.  Some MC Advantage plans have less ostomy supply coverage than Medicare specifically by restricting where beneficiaries can shop for supplies and what kind they approve. UOAA has found that some ostomy patients with these plans must use products from multiple manufacturers. Some MC Advantage plan benefits exclude Medicare HCPCS (Healthcare Common Procedure Coding System) product codes for ostomy supplies such as filters, tape, adhesives, deodorants and other medically necessary items. What this means is that these supplies are not even available for you to choose.

There are many Medicare Advantage Plans in the United States. Each state’s insurance department approves the MC Advantage plans that can be sold in each state and each county within the state. So the plans vary from county to county. The MC Advantage plans usually have approved national provider networks for supplies however UOAA has found that in some counties the MC Advantage plans limit the suppliers you can use to local providers and do not let their beneficiaries choose from the national network providers. This may result in a limitation of your supply choices. One example UOAA has discovered is the difference in suppliers available in a rural county as compared to the national network provider offered to the residents in a large city.

Some MC Advantage Plans also have much lower reimbursement rates than traditional Medicare. These reduced fee schedules have resulted in suppliers to either stop taking individuals with an ostomy, offer lower quality products or offer a limited product line. (see the policy paper link above).  

This practice of restricting beneficiaries to particular brands, specific suppliers or less product coverage, limits patient access to the products they need. The consequence of this practice is that many ostomates are unable to obtain their prescribed ostomy supplies and are no longer able to effectively manage their ostomy.  

If you chose a high deductible plan, remember that although you have a lower monthly premium you will be paying out of pocket for all of your ostomy supplies which are expensive until you meet the deductible requirements. 

If you aren’t on Medicare but are selecting a new health plan, carefully review “basic” plans on the marketplace.  Some of these bare bones plans do not cover ostomy supplies.  

For more tips and information refer to the article released by UOAA’s Advocacy Committee entitled “Are You Covered? Know Your Healthcare Insurance and What You Need”. As you compare plan options and shop around, ask questions such as “Can I use my current supplier with this insurance?”. Here are more: 10 Questions to Ask Before You Choose a Health Plan.

 

 

1. Freed, Meredith, et al. “Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans.” KFF, 1 May 2023, https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/. Accessed 17 October 2023.

Hear Our Roar

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By UOAA Advocacy Manager Jeanine Gleba

When thinking of UOAA I am often reminded of William Shakespeare’s quote from A Midsummer Night’s Dream: “Though she be but little she is fierce.” United Ostomy Associations of America (UOAA) is a small national non-profit organization run by a dedicated volunteer Board of Directors with limited funding and a majority part-time 7-person staff. However, we are proud to be the leading organization advocating for the ostomy and continent diversion patient communities in the United States! We use several strategies to ensure our voices are heard including but not limited to:

1. We have a growing (2000) Advocacy Network of grassroots advocates who take time out of their busy schedules to take action when called upon to do so. They help us amplify our message! Please join our Advocacy Network. It’s a simple way to wet your feet in the advocacy world and doesn’t require a major time commitment.

2. We know we are stronger in numbers. UOAA is a member of several coalitions including the Access and Care Coalition, Digestive Disease National Coalition (DDNC) and the Safe Step Act Coalition where we share common goals and work together to achieve them. For example, the DDNC’s mission is to work cooperatively to improve access to and the quality of digestive disease health care in order to promote the best possible medical outcome and quality of life for current and future patients. Although UOAA is unable to have its own “ostomy” lobby days or fly-ins on the Hill (due to financial limitations), we are an important part of the annual DDNC Spring Public Policy forum. Ostomy advocates join forces with other digestive disease advocates to meet with Congressional staffers to share their stories and ask for support of our federal legislative priorities. These coalitions submit joint letters of requests or support/opposition to Congressional leaders and key regulatory decision-makers. An example of power and strength in numbers is the Safe Step Act Coalition which now comprises 215 patient organizations all advocating for passage of this important piece of legislation!

3. As a national organization we also develop position papers on topics concerning people living with an ostomy or continent diversion. These important documents might give background information, description of the impact on our community, and in some cases, advocate for change. We use them when talking to key decision-makers such as your elected officials, the media, or anyone who wants to know more about where UOAA stands on the topic/issue. An example of one of our position statements is our opposing stance on the cost-shifting tactic called “non-medical switching” of ostomy prosthetic supplies. Oftentimes, these papers include patient testimonials from the ostomy community to strengthen our message. You’re invited to share your story with UOAA and give permission for potential use in an advocacy effort.

4. We build relationships with like-minded organizations and collaborate on efforts that will benefit our collective groups. For example we frequently partner with both the Wound Ostomy Continence Nurses Society and Certification Board.

5. UOAA has a unique patient perspective and first-hand knowledge of the patient access issues facing the ostomy population. We are the trusted go-to source for ostomy information. We are compelled to take initiative and reach out to government agencies and Congressional Committees to share our views and extend the invitation to use us as a resource if they have any questions or if we can help in any way to move things forward. For example, in April 2023 we requested and attended a Patient Listening session with the FDA Center for Devices and Radiological Health (CDRH) Patient Engagement team to educate the FDA about the needs and challenges of this particular historically underserved patient population. We believe the FDA needs to understand what is important to the ostomy community when ostomy medical products are being developed and approved.

6. With regards to our federal priorities, 2023 was the start of the 118th congressional session. UOAA supports several bills related to the ostomy and continent diversion patient communities’ underlying medical conditions such as colon cancer or inflammatory bowel disease. Using the weight of our entire organization, we contact politicians via letters and in-person meetings to garner co-sponsors and “yes” votes. Some of the bills we are currently advocating for will significantly improve patient access to needed treatments:

· S 652/HR 2630, the Safe Step Act, would ensure that employer plans/PBMs (Pharmacy Benefit Managers) offer an expedient and medically reasonable step therapy exceptions process. This will empower individuals to navigate their insurance and help them access the treatments they need in time. Read the flyer and see the 215 orgs that support the bill.

· S 1375/HR 830, the HELP Copays Act, would ensure that copay assistance is counted towards a beneficiary’s deductible and out of pocket maximum. This will help patients afford their treatments. Read more.

For more information on our national efforts check out the 2023 UOAA Federal Advocacy Priorities Handout.

We all have the choice to do nothing or take action. I hope you choose UOAA and take action with us so we roar even louder!

Understanding Stoma and Ostomy Basics

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There are two main types of stomas, and they both have certain “ideal” characteristics in common. Do you know what they are?

Wound care nurses know that it’s not uncommon to hear the terms ostomy and stoma used interchangeably, even though they have different meanings.

What is a stoma?

Let’s start with the basics:

  • The stoma is the mouth-like, visible part of an ostomy.
  • A fecal or urinary stoma is composed of mucous membrane or the lining of the intestine that’s exposed to the surface.
  • Following ostomy surgery, effluent (output) — such as fecal matter, urine, or mucous — will pass through the opening of the stoma, called the lumen.
  • The patient will not have voluntary control of the effluent expelled by the stoma.

Types of stomas

There two major categories of stomas: the end and the loop.

End stoma

An end stoma is created when the surgeon brings one end of the GI tract through the abdominal wall, then folds it over. The surgeon then removes the other end or sews it shut.

In some cases, the surgeon will create end stomas from both ends of the GI tract, called a double-barrel stoma. In this case, you’ll see two distinct stomas: the proximal stoma discharges stool and the distal stoma discharges mucous. Sometimes an expanse of skin separates the two stomas, and sometimes they will share the same opening. This construction is most common for infants or very small children.

Loop stoma

To create this type of colostomy, the surgeon lifts a loop of the transverse colon through the abdomen. The colon is given a small split on the side facing out, and a rod is placed underneath for support. The rod may be removed after a few days when support is no longer needed. The proximal opening of the stoma drains stool from the intestine, while the distal opening of the stoma drains mucus. Loop stomas are usually created for temporary ostomies.

Characteristics of an ideal healthy stoma

Each stoma is unique, just as each patient’s physiology is unique. Different surgical techniques will result in stomas of different appearance. At the same time, the “ideal” stoma has some identifiable characteristics:

Moist

The inner surface of the stoma continually produces mucus to cleanse the stoma. Mucus production is a normal function of the intestines that serves as natural lubrication for food passing through the body. The mucus gives the healthy stoma a wet appearance.

Beefy red

Blood flow is essential to the health of the stoma. Normal stoma tissue is highly vascular and will appear deep pink to red. Pale pink is also normal in a urinary stoma. Stoma tissue may even bleed slightly when rubbed or irritated, which is normal. When a stoma turns pale, or dark, it means there’s a problem with the blood supply, so be sure to investigate.

Round

A round stoma is easiest to measure with circular rulers. It also works best with pre-cut skin barriers (the part of the ostomy appliance that affixes to the skin and attaches to pouch). An oval or irregularly shaped stoma may require cut-to-fit skin barriers.

The shape is affected by the type of ostomy and the individual’s body composition. The shape can also vary with the wave-like muscular contractions of the intestines, the peristaltic movement.

Budded/protruding

When a stoma has a rosebud shape (rather than flat or retracted), it protrudes into the pouching system. This allows the effluent to fall out into the pouch away from the body. The ideal protrusion is 2-3 cm with a lumen in the very center.

Strategically located

To easily accommodate the skin barrier, it’s ideal to have 2-3 inches of flat skin around the stoma. Avoid beltlines, bony prominences, skin folds, suture lines, or the umbilicus (belly button). Also, the patient will have more success managing a stoma located in an area that they can see and reach.

Stoma assessment

The stoma itself has no sensory nerve endings, which means there is no sensation for the patient. In other words, the patient may not feel pain or discomfort if the stoma becomes lacerated or injured. Therefore, your thorough clinical assessment of the stoma and the surrounding skin is essential to catching problems early.

Ostomy basics for healthcare clinicians: upcoming wound care conference session

As the third largest wound care conference in the nation, Wild on Wounds (WOW) is focused on advancing the healthcare workforce with impactful, innovative, hands-on wound care education built by and for clinicians.

This year, Joy Hooper, RN, BSN, CWOCN, OMS, WCC, AWCC, will present, “Ostomy: Basics and Beyond” which will provide a better level of understanding of colostomy, ileostomy, and urostomy surgery. The surgeries will be explained in a simple, relatable show-and-tell progression that builds on healthcare clinicians’ understanding GI tract anatomy. The presentation will include the concepts of peristomal skin protection from output and the different types of appliances available. The session will also include trouble shooting common peristomal skin common complications.

The session is intended for dieticians, nurses, and physical therapists and offers 4.00 contact hours. Learning objectives from the session include:

  • Identifying how to communicate basic ostomy care based on individual type of ostomy as it relates to a patient’s ostomy type
  • Selecting interventions to preserve peristomal skin integrity
  • Recognizing how to use ostomy products to customize fit thus promoting quality of life

WOW details

This year’s 17th annual WOW event is brought to you by the Wound Care Education Institute (WCEI) and Nurse.com, part of the parent company Relias’ family of brands. The conference will take place from September 13–16 in Hollywood, Florida. Conference attendees can choose from dozens of educational sessions and earn up to 25 contact hours for CE credits.

WOW offers innovative, interactive, and informative sessions, including simulation workshops, live product demonstrations, and a new pre-conference track with an entire day of legal sessions. Also new this year is a virtual poster hall featuring the latest in clinical research, clinical practice outcomes, evidence-based interventions, new technology, management of complex wounds, and more.

To learn more and register for Wild on Wounds, visit here.

-Natalie Vaughn, MBA, Senior Content Marketing Manager, Relias

Best-in-Practice Care for Ostomy Patients

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UOAA Research Results Are Published Showing Patient Rights Are Being Utilized but Gaps in Care Being Provided Exist

By Jeanine Gleba, UOAA Advocacy Manager

Everyone in the United States has the right to receive high quality care. However, the ostomy community continues to be plagued by poor quality care due to lack of trained medical professionals such as certified ostomy care nurses. Many caring for a person with an ostomy do not have the education related to the physical, emotional or quality of life needs of someone living with an ostomy. Thus, those in the ostomy community often feel a lack of compassion and respect regarding their care.  UOAA receives hundreds of calls and email inquiries annually, many of them desperately seeking assistance for proper ostomy care.

It is a primary mission of UOAA advocates to assure that quality ostomy care occurs universally across all health care settings.  

In 2019 UOAA embarked on a research journey to examine best-in-practice care for ostomy patients through the utilization of the Ostomy and Continent Diversion Patient Bill of Rights (PBOR), which are evidence-based for quality ostomy care. We wanted to know if these written standards are the accepted practiced norms for treatment and care for ostomates. 

Together let’s establish a culture that promotes the highest quality care for ostomates.

We collected data from both ostomy surgery patients (412 respondents) and medical clinicians (195 respondents) such as Wound Ostomy Continence nurses. The organization is thrilled to announce the release of our research results that were published in the September/October 2022 issue of the Journal of Wound Ostomy Continence Nursing.

There were three research questions that the study investigated 

  1. Is UOAA’s PBOR being used to care for ostomy patients analyzed from the perspective of patients and clinicians?
  2. Do patients and clinicians perceive that use of the PBOR is beneficial to ostomy patient health outcomes?
  3. Have clinicians witnessed positive patient health outcomes (e.g., decreased readmissions for dehydration, feeling better prepared to care for the ostomy)?

Promising findings showed that, for the clinicians familiar with the PBOR, more than half reported that the PBOR was being utilized to inform ostomy care1. Additionally, a majority of both patients and clinicians indicated that consistent use of the PBOR may be beneficial for ostomy patient health outcomes such as prevention of Emergency Department visits1. However, analysis identified a significant gap in specific standards of care being provided by clinicians versus the care patients reported they received1. For example, 22.5% of the patient population reported engaging in a discussion on the emotional impact of the ostomy surgery versus 65.6% of the clinician respondents reported it was provided1.  Another notable difference was the number of patients (55.1%) who reported receiving educational materials specific to ostomy care versus 82.5% of clinicians reported providing educational materials.

The study concluded that there are discrepancies between PBOR standards of care being provided by clinicians versus the care patients reported they received. Further awareness and wider utilization of the PBOR are needed to provide best care to patients living with an ostomy1.

Advocacy work is ongoing and quality health care is a team effort. Together let’s establish a culture that promotes the highest quality care for ostomates. When quality of care is not provided, people should speak up. The more people that demand these rights and the more medical professionals who perform these standards of care, the more improvements will be realized in patient care and outcomes.

 

1.Gleba, Jeanine; Miller, Leslie Riggle; Peck, B. Mitchell; Burgess-Stocks, Joanna. United Ostomy Associations of America's Ostomy and Continent Diversion Patient Bill of Rights: An Examination of Best-in-Practice Care for Ostomy Patients. Journal of Wound, Ostomy and Continence Nursing: September/October 2022 - Volume 49 - Issue 5 - p 462-468
doi: 10.1097/WON.0000000000000909

 

Good News for Ostomates with Medicaid in Some States

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By Jeanine Gleba, UOAA Advocacy Manager

Too many people living with an ostomy have the worry that due to a need for frequent pouch changes or a high output stoma they will run out of their monthly Medicaid allowable ostomy supplies.  For the past year, UOAA has been supporting efforts, led by Coloplast, to expand Medicaid coverage of extended wear products in states with remaining access problems across the country. 

UOAA’s advocacy work has included:

  • Raising awareness on this important issue
  • Recruiting Affiliated Support Group leaders that are also WOC nurses and other local clinicians to provide clinical support and insight
  • Sending letters to state divisions of Medicaid services urging them to review the ostomy supply policy regarding coverage of ostomy supplies for HCPCS codes and quantities, specifically for extended wear products. 

As the voice and leading organization advocating for people living with an ostomy, we know first-hand how important access to ostomy supplies are for our patient population. We share the patient perspective with testimonials from advocates as well as explaining patients’ unique needs, such as those who are unable to achieve normal wear time with a standard barrier. Improved access to extended wear barriers will assist those who do not have an optimal fit or have a high-output stoma and go through more standard wear barriers and pouch changes. For these individuals extended wear products would be the prescribed solution. 

As a result of the collaboration between Coloplast, UOAA, State Home Medical Equipment (HME)/Durable Medical Equipment (DME) Associations, local clinicians and other advocates, we have expanded patient access to extended wear products in seven states as noted in the above map. This is excellent news for Medicaid beneficiaries living with an ostomy in these states! (Note: States that are grey/light blue on the map were not seen to have any state Medicaid extended wear access challenges.)

More advocacy efforts are underway in Alabama, Arkansas, Georgia, Louisiana, Maryland, Missouri, Ohio, and Wisconsin to remove the current barrier to access in those states. These states have Medicaid coverage that is much less than the current Medicare standards.

Physical Rehabilitation After Surgery

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Have you ever wondered what you should be doing to fill your time as you recover from ostomy surgery?

After my first surgery at the age of 17, and even after my third surgery at the age of 23, I spent most of my time lounging around my parents’ house, waiting for the day that I would be cleared by my surgeon to return to “normal” activity. My parents would coax me out of the house to go on one walk a day, but I spent almost all of my time watching television and YouTube videos and sleeping.

Fast forward to age 30. At age 30, I ended up having my sixth major abdominal surgery. And by this point in time, I had been working as an Occupational Therapist (OT) in a hospital setting for six years. For six years, I had been helping other individuals recover and rehabilitate from major illness and injury. I had also spent years recreating in the mountains and enjoying a highly active lifestyle. So when I found out that I needed a stoma revision, I knew that my recovery would look very different from my previous surgeries. I knew that in order to improve my recovery time, decrease my risk for complications, and get back to the mountains, I had to put in more work.

For those who are less familiar with the rehabilitation professions, “Occupational Therapists enable people of all ages to live life to its fullest by helping them promote health, and prevent – or live better with – injury, illness, or disability” [1] and “Physical therapists [PTs] are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education” [2]. Although I’m an OT, seeking out my own rehab professional to work with was the best thing I could have done.

I already knew a lot of the basics of how to rehab myself, but having someone else who I would be accountable to and who I could bounce ideas off of was a bonus. I knew from my training as an OT that one 30-min therapy session prior to abdominal surgery, reduces the risk of complications by 50% [3]. So the first thing I did was set up an appointment with a pelvic health therapist prior to my surgery. I was able to find a local pelvic health PT to work with, although, both OTs and PTs may specialize in pelvic health. I sought out a pelvic health therapist because of her specialty training in digestive and urinary systems and the interaction between the abdomen and pelvic floor. In my time working as an OT, and in my time spent working with many PTs, I’ve learned that there are fundamental areas that ostomates should be targeting after surgery to improve their outcomes. Working with a therapist in the following areas can be quite beneficial:

Therapeutic Breathwork. Breath is necessary for life. If you aren’t breathing properly, you certainly won’t be getting back up on your feet and recovering from surgery any time soon. Breathing properly can also help decrease the pressure in your abdomen (i.e. intra-abdominal pressure) which decreases your risk for parastomal hernia and other complications.

Mobility Training. Focusing on walking in a strategic manner following surgery can also set you up for success in the long run. Not only is walking good for building up your endurance again, but it is a great way to begin engaging your core in a gentle manner.

Core Recovery. After surgery, your abdomen can be very tender. But it’s important to begin exercising in order to coordinate your abdominal muscles again and gain strength so that you will be less likely to injure yourself in the future.

Functional Daily Activities. Finally, as you go about your day-to-day routine, some tasks will feel more difficult than they used to. For example, bending to put on your socks can be painful and can pull at your incision. Working with a therapist on strategies to increase your independence and return to the daily activities you enjoy is invaluable.

I’m lucky that I decided to become an Occupational Therapist. It has enabled me to empower myself with knowledge about the human body and recovery from surgery. But you don’t have to be a therapist to have a positive recovery experience and lead a fulfilling life. If you’re feeling stuck, seek out a rehabilitation professional. You deserve quality care and support to feel confident and strong after surgery.

Wishing you well on your ostomy journey,

Charlotte

As you start your journey to recovery, you’ll experience that life after ostomy surgery is a new reality. No matter how far after surgery you are, you will need to adapt to your condition and cope with your new situation. If you’re looking for additional support during your ostomy journey, consider enrolling in Coloplast’s free online support program, Coloplast® Care! It is a personal product support program designed in collaboration with nurses to provide you with individualized product support and lifestyle education, and product access coordination. Coloplast Care is available when you need it – whether it is through our online educational resources offering reliable product and lifestyle advice, news and tips customized for your situation, or over the phone with our team of dedicated Ostomy Advisors. We’re here to help!

Visit us at www.ostomy.coloplastcare.us or call 1-877-858-2656.

Information from Coloplast® Care is for educational purposes only. It is not intended to substitute for professional medical advice and should not be interpreted to contain treatment recommendations.

About the author:

Charlotte Foley, MS OTR/L, CBIS, received her Occupational Therapy degree at Boston University and began her career in the adult Inpatient Rehabilitation setting. She now works in the adult Acute Care setting at Providence Alaska Medical Center in Anchorage, Alaska. Because of her own personal and professional experience, Charlotte founded and runs her own education and consulting business, Restorative Ostomy Solutions, to empower individuals to feel strong and confident as they recover from ostomy surgery.

Charlotte has received compensation from Coloplast to provide this information.

Editor’s note: This article is from one of our digital sponsors, Coloplast. Sponsor support along with donations from readers like you help to maintain our website and the free trusted resources of UOAA, a 501(c)(3) nonprofit organization.

 

References

[1] AOTA (2021). What is Occupational Therapy? Retrieved from

https://www.aota.org/conference-events/otmonth/what-is-ot.aspx.

[2] APTA (2021). What Physical Therapists do? Retrieved from

https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt.

[3] Boden, I., Skinner, E., Browning, L., Reeve, J., Anderson, L., Hill, C., Robertson, I., Story,

D., & Denehy, L. (2018). Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. British Medical Journal, 360:j5916. http://dx.doi.org/10.1136/bmj.j5916

Shining a Light on WOC Nurses

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In celebration of Wound, Ostomy, and Continence (WOC) Nurse Week 2021, help us to shine a bright light on these special nurses. They give us the hope, support, and specialized care needed to thrive in life with an ostomy.

WOC nurse volunteers spend countless hours advocating, leading support groups, educating, fundraising, and supporting UOAA programs and services. UOAA recognizes that not all ostomy patients have access to a WOC nurse and we’ll continue to advocate for access to a specialized ostomy nurse from preoperatively when your stoma site is marked through an ongoing lifetime continuum of care as outlined in our Ostomy and Continent Diversion Patient Bill of Rights.

We asked UOAA’s social media community to share how a WOC nurse has made a difference in your life, health, or support group. We hope more nurses will consider this rewarding specialty. Thank you WOC nurses, you are our guiding lights.

I would like to thank my WOC nurses who have and continue to support me as an ostomate. My nurses inspired me so much I went to nursing school and graduate this month with a BSN and plan on continuing on. To become a WOC nurse myself! Thank you WOC nurses! -Katie Lee

“My WOC was a lady named Gayle. She helped my Mom so much with me. I remember many visits to the ER ward and having her there. She was funny, nice and on it. I used to love seeing her. She stayed by my side from 3-6yr old into my adulthood. She fought hard to find a bag that was the perfect fit for me. She got a new product in and it changed my life significantly, she fought tooth and nail to keep me in that bag, even when Canada decided to stop offering it openly. I still wear that brand to this day. I always heard rumors she was also an Ostomate and I can’t say how long. That made me love her more. I will never forget those who had a hand in my welfare and saw me through their entire career. I miss her and the others immensely. Jody is my new WOC and although I rarely need her, she’s there to help, even if it’s a panic situation that couldn’t wait for an appointment.” –Camille C.

“Joanna Burgess Happy WOC Nurse week. You have been a true Angel of Mercy for me over the years!” –Col Justin Blum

“My son’s WOC nurses at CHLA were awesome!!” – Teri C.

I am a WOCN and worked with MANY ostomy patients in the past. The thanks go both ways — I have never (in a long nursing career) felt as appreciated for my clinical skills and assistance as I do when working with people with an ostomy. They are the reason I have stayed in nursing. -Cris R.

This is Karen with my husband at his 55th birthday party in 2019 -Pam Allen Williamson

We have 3 great WOC nurses in our community that come to our ostomy support meetings Karen Eubank, Michael Byars and Jason Pratt. Michael went above and beyond by creating a weekly outpatient ostomy clinic after I told him I learned some cities had those while attending a UOAA conference. Karen who has been coming to our meetings for over a decade, hosts many of our support group parties at her house, works at the ostomy clinic on a regular basis, pays to store donated supplies and often helps people after hours. Both of them visit my husband when he is hospitalized, came to the house to visit him when he was home on hospice and came to his funeral. We are extra grateful to Karen because before he left the hospital on hospice she applied a special high output bag connected to bed drainage bag to minimize the family’s need to interact with the ostomy. Karen who is a neighbor told me that she would come change the bag twice a week. The hospice nurse was fascinated and stayed late to watch Karen change it out. He was going to stay in the hospital as long as they would let him to avoid family having to deal with his bag because he had always been so independent with it until nearly the end. Karen’s solution allowed him to come home and be surrounded by family caregivers that loved him and have wonderful conversations remembering fun times and having important conversations instead of the visitor limitations hospitals right now. We are so grateful to her for this and hope it will benefit other families of bed-bound patients. BTW we still fondly remember my husband’s first WOCN Nurse Licklighter who was a nurse at Keesler AFB in 1993. She marked him before surgery and taught him how to handle his bag and he kept her handwritten instructions forever and sometimes copied them for others. -Pam A.W.

I can’t thank the nurses at Ohio Health Riverside Hospital they helped me so much and made an otherwise difficult transition quite non traumatic! –Carol B.

Thank you to Erin and Vanessa at New York Presbyterian! –Jameson Cycz

The ConvaTec nurse Lorelei. She has been a stoma saver. She helped me troubleshoot my leaking problem, got me into a new pouching system, that is awesome and when I ran out of samples and am in limbo with my supply company in getting the new pouches and other supplies, she set me up with a holdover supply, so that my stoma won’t be continuously injured by my current pouches.- Susan Gentner

I’m thankful for all of the WOCNs I have been to. Some I’ve known for many years. They are very knowledgeable and helpful with various products.I also want to give a shoutout to our great WOCNs at 11 Health & Technologies for being amazing for our team and patients. ? –Megan Alloway

Amazing Aimee Frisch. The best WOCN in know. Love you. -John Pederson

Happy ‪#WOCNurseWeek2021! What you do for ‪ostomy patients and the impact you make is immeasurable!  Plus we are grateful for all that you do to support UOAA and our ‪advocacy program! You are advocates for patients and can influence change. Shine on! @UOAA_Advocate -Jeanine Gleba