United Ostomy Association, Inc.
Evansville, Indiana Chapter
Re-Route

 
Contents:

MEDICARE POLICY FOR OSTOMY SUPPLIES IMPROVED
DISCHARGE PLANNING AND FOLLOW - UP CARE
WHAT IF YOU CAN'T TAKE CARE OF YOUR OSTOMY??
CHICKEN SOUP THE CURE AFTER ALL
I AM A STOMA!
MAILING LIST MESSAGES
CARTOONSVILLE

Re-Route Archive

Volume 28, Number 3  December, 2000

MEDICARE POLICY FOR OSTOMY SUPPLIES IMPROVED
News Release from The United Ostomy Association
The United Ostomy Association (UOA) is pleased to inform you that the four Durable Medical Equipment Regional Carriers (DMERC's) have adopted recommendations from the UOA for improving their Medicare ostomy policy. The specific improvements are listed below: 

Utilization of Supplies 
The DMERC's have increased the number of items you can use per month without the need for additional documentation for medical justification. The monthly utilization guidelines have changes as follows: Drainable pouches have increased from 10 up to 20/month. Urinary pouches have increased from 10 up to 20/month. Closed pouches have increased from 31 up to 60/month. Irrigation sleeves have increased from 1 up to 4/month. Solid skin barriers and skin barriers with flange have increased from 10 up to 20/ month. You can now also use one ostomy belt per month.
 
Medical Justification 
    Basic documentation continues to be required for the dispensing of supplies. This continues to be a doctor's order or prescription. 
    If you have a colostomy and choose to use closed pouches to manage your ostomy, you do not need to provide any additional medical justification for the use of closed pouches.
    If you still need more supplies than the new increased guideline amounts, the DMERC's have streamlined the process for providing the required medical justification: 
    You will simply be required to obtain a letter from your doctor explaining the medical reason for needing more supplies than the usual maximum quantities as listed above. Your supplier does not need to routinely submit this letter with your claim, but must keep it on file in your records as a copy may be requested in the future by the DMERC. 
    These changes took effect for the whole country on October 1, 2000. 
Remember: You are entitled to obtain 1, 2, or 3 months supply at a time if you live at home and 1 months supply if you are in a nursing home. 
    Please share this information with your suppler. For more details see: Medical Care Policy for Ostomy Supplies. 

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DISCHARGE PLANNING AND FOLLOW-UP CARE
By: Bill Capman, Worcester, MA New Dimensions
    One of the current and more frustrating problems facing a new ostomate today is the shortened hospital stays that are part of the cost control efforts of today's "new" health care system. The "get-them-in, get-them-out" procedure is barely enough time to come out of the anesthesia, wake up, and realize what's been done, let alone get help, training and an understanding of an ostomy and its care. This is very unfair to the patient and his family. The medical establishment must find a better way. Based upon the following, perhaps they have found that "better way". 
    A recent news release from the National Institutes of Health, entitled "Transitional Care from Hospital and Surgical Patients", highlighted a study of a more intense program of discharge planning and transitional care for the elderly. 
    Older people with common medical and surgical problems who were discharged from the hospital realized significant improvement in their health, at reduced costs to the health care system, according to research published in the February 17 issue of "The Journal of the American Medical Association". It was led by Mary Naylor, Ph.D., RN. FASN, of the University of Pennsylvania's School of Nursing Research. Although this study focused on the elderly, it could and should, be applied to everyone discharged from the hospital after any serious surgery. The study used a multi-disciplinary team and involved comprehensive discharge planning, including determination of patient care needs outside the hospital, and follow-up in the home by advanced practical nurses specializing in geriatrics. Findings revealed that six months after discharge only 20% of the intervention group was re-hospitalized, compared to 37% for traditional discharges. Per-patient days in the hospital were fewer for the intervention group - 1.53 vs. 4.0 for the traditional group, and the cost of post-discharge health services was about $600,000 lower. 
    According to Dr. Naylor: "The traditional care model is a sharp contrast with current practice, which leaves most patients, once discharged, on their own, to obtain necessary follow-up care." (Anyone who has had recent surgery can attest to that.) In other NINR-supported studies, the model has been tested with highly favorable results in patient populations ranging from pregnant women with diabetes, to women undergoing hysterectomies. 
Let's hope that this study gets the attention of the health care professionals, and appropriate changes are made soon. 

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WHAT IF YOU CAN'T TAKE CARE OF YOUR OSTOMY??
Author unknown, Baltimore Ostomy Bulletin & Chicago's North Suburban Chapter
    During a recent hospitalization, I had "no hands" because of IV's, and when my appliance needed to be changed, I found myself giving instructions to a pair of cooperative assistants. 
    Each had a sense of humor needed by the time I was patched, scaled and bagged again. Later, I thought, "What if I had been unable to speak?" I had nothing written down, and none of my family knows exactly how I prepare and change the appliance. 
    Does anyone know how to care for your ostomy? In case no one is available to help, have ready, specific instructions on what to do, where supplies are kept, what not to do. 
Anticipate such questions as: Can you be placed on your abdomen for an extended time? Are you accustomed to daily irrigations? Should you not have an irrigation? 
Carry instructions with you always. None of us is immune to accidents that can interrupt our lifestyle. If you are unconscious, advance preparations will be especially important. Damage can be done to your body, and severe illness may result. 
    Note From Ron: Likely, no one in your household knows what is done behind the closed bathroom door. And, what shouldn't be done! How could they possibly help? What about an accident while traveling where you are unconscious? Sound far-fetched? I was just involved in a car accident requiring a paramedic and emergency room trip. Teach someone at home - and make a procedure list so someone else can take care of your ostomy in emergency or unusual situations. 

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CHICKEN SOUP THE CURE AFTER ALL
Via: Kankakee, IL Ostomy Association 
    The protein and starch in chicken and rice soup can markedly increase the body's ability to absorb water, making it an excellent cure for diarrhea. Home remedies, used for generations to treat diarrhea, have been documented and tested by a team of doctors working in Bangladesh. They have reported the benefits of the combination of protein and starch. 
    Though doctors have long known sugar increases the body's ability to absorb salt and water during digestion, they did not realize starches and grains can do the same, early in the digestive process. In the United States, doctors usually hospitalize dehydrated patients and feed them intravenously, an effective therapy, but one which is both expensive and subject to bloodstream infection. TIP. Tomato juice is also good for dehydration and helps restore electrolytes.

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I AM A STOMA!
Mary Lou Thomas, RN, ET, North Arundel Hospital via OAB Bulletin, Boston  
    Hi, I'm a stoma! I am great when you think about it. I must admit I have upset many people. Some people even consider me crude, rude and socially unacceptable. Well, excuse me!!
    Just about everyone gets bent out of shape when their doctor says, "It may be necessary to create a stoma". Me!! They make it sound like a dirty word. Listen, it isn't the greatest for me either. I'm usually created from a piece of your intestines. I guess you know all about that. And then, just maybe you don't. So I will tell you.
    Becoming a stoma wasn't my original function. No sirreee!! I used to just lie there in your abdomen, minding my own business. Then boom!! Some surgeon decided - let's make a stoma. He had a nerve! Why?? How could he consider such a thing? Well, I guess it was because you hurt so much, because you were very sick from a disease like Ulcerative Colitis or cancer, from a trauma like that automobile accident or from a birth defect. Your surgeon knew that by putting me to work, you could be free of discomfort and problems. In truth, so you could get on with living.
    If that is why I was created, then why do so many people complain about me? Did you know that I am not given to just anyone? You see, there is a lot of planning and evaluation of each human being before I am created. So I know you can say only a "chosen" million or so are lucky enough to have me. You see - my people are special. My people are not like the normal run-of-the-mill people. I must say it takes them a while to recognize that fact. And, sad to say, there are a few who never do.
    It isn't easy being a stoma! Some of you just don't understand what a miracle I am! Listen, before creation, I just lay quiet and usually content in your abdomen.
    Now I work! It's rather easy when faecal waste comes through because that's what I'm used to. But some character decided, why not water waste as well? We then found out that character was very wise because that works also.
    You think YOU have problems adjusting! Phooey. Did you realize that I am a delicate mucus membrane? Yet I am durable but some people think I am asphalt tile. Thank God, I don't have feelings. But my friend skin does. You want complaints? Give a listen to her sometime. She really gets upset because of ulcers, fungus, irritants, barriers, etc. We are a team! And a darn good one. I'm moist, she is dry. I'm pink red, she is natural. I'm smooth, she is a little bumpy.
    One of my biggest problems is my size. I am not always the same size from one human to the next. I am not always round. I don't always protrude nicely. Then why do some of you insist that my pouch opening is always the same? You need to check my size once in a while and fit me appropriately. Your shoes fit, don't they?
    Some of you complain because I'm not pretty. Well, your anus wasn't Miss America! I think I am attractive. I am red like a rose. I am always moist if I am healthy. And, I don't smell. My discharge can't help what you put in your mouth. If you care for me with thought and keep my equipment clean, that  just about takes care of that.
    In closing, let me say you can live a good life, a productive life. It's up to you. Believe me, I do not deserve a pedestal life. I am just part of you trying to do my job. All I ask is that you be honest about me. The doctors, special nurses, other professionals and your Ostomy Association are always ready, willing and able to help you.

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