|
| Cost Comparison for Treatment Versus Complications:
TREATMENT: 1) Physical Therapy/Rehab $3,200.00 to $5,000 intensive phase 2) Compression Bandaging $75.00 to $175.00 each (replaced every six months) 3) Foam Compression Garments $550.00 to $2,500.00 each (replaced every two years) 4) Multi-Density Foam Garments $550.00 to $3,000.00 each (replaced yearly to every two years) 5) Compression Stockings $ 80.00 to $300.00 per pair (replaced every six months) 6) Miscellaneous Other Compression $ 50.00 to $1,500.00 each 7) Gradient Compression Pumps $5,500.00 each (replaced every five years) Physical therapy/Rehab, compression bandages, and compression stockings are required for each individual. Other items are various alternatives therfore each patient would not need all seven items listed. Each person would use one or two of the items listed with rehab, stockings, and bandages. Both diseases can be managed with appropriate treatment. When not managed, these diseases become worse. When these diseases progress health complications occur and the cost are significantly higher than treatment as follows: COMPLICATIONS: 1) Wounds/Re-ocurring wounds $900 to $500,000 2) Infection/Cellulitis $100 to $250,000 3) Infection/ Osteomylitis $80,000 to $500,000 4) Limb deformation cost unknown 5) Reduced Mobility cost unknown 6) Obesity due to lack of mobility cost unknown 7) Amputation $25,000 8) Loss of ability to maintain employment Unknown These amounts are per incident. Since wounds and infection reoccur, the cost of health care results in millions of dollars being spent yearly unnecessarily. The CDC estimates 50% of amputation could be prevented with effective disease management. The only items Medicare covers is $1,750 per year for rehab and gradient compression pumps. No other items listed are currently covered under Medicare guidelines. In addition, as stated above, rehab was covered as needed as long as progress was documented. As of January, 2006, rehab benefits are now capped at $1,790 per year. Coalition for Quality Healthcare Copyright 2006 Click here To See Cost Comparison Chart Lymphedema is a devastating disease resulting from an excess accumlation of lymph fluid in the interstitial tissue. This disease is caused by a deformation or interrupution of the lymph system. It can be caused by a congential deformality, disease, surgery, trauma, injury, and as is most commonly seen, cancer treatment such as lymph node removal and/or radiation. Vascular disease is a disease that results in a dysfunction of the blood vessels. Chronic venous insufficiency many times is a diabetes related complication, and affects approximately 2% of America's population. Chronic venous insufficiency, peripheral vascular disease, and peripheral arterial disease many times result in non-healing or reoccurring ulcers. Vascular diseases also frequently result in amputation. There are approximately 5.1 to 7.5 million American's affected with Lymphedema, and approximately 20 to 30 million American's affected with vascular disease. Currently, Medicare does not cover most of the very inexpensive therapies available for disease management. Our nation is unnecessarily spending millions yearly on the expensive complications, such as chronic non-healing wounds, re-ocurring infections, amputation, amputation related rehab, prothethes and other complication related therapies. These complications can be avoided with proper treatment and long-term disease management therapies. COMPREHENSIVE TREATMENT GUIDELINES Establishing Disease Management Guidelines for LYMPHEDEMA Cyndi Ortiz Contributing Authors: Phyliss Tubbs-Gingrich, RN, LANA-CLT Wade Farrow, MD, CWS, FCCWS Cheryl L. Morgan, PhD Lawrence L. Tretbar, MD, FACS Benoit Blondeau, MD Disease Management Practice Guidelines Lymphedema Cyndi Ortiz, with Phyliss Tubbs-Gingrich, RN, LANA-CLT, Wade Farrow, MD, CWS, FCCWS, Cheryl L. Morgan, PhD, Lawrence L. Tretbar, MD, FACS, Benoit Blondeau, MD COPYRIGHT 2005 All Rights Reserved Lymphedema: Goals and Objectives: Goals and objectives in current medical practice for lymphedema are concentrated on assisting affected individuals with successful treatment and long-term disease management of chronic intractable lymphedema, with a focus on patient independence. Lymphedema is a chronic disease due to an obstruction, interruption, or malformation of the lymph system. Currently, there is no cure for lymphedema. The physical results are chronic edema caused by excess fluid that accumulates in the interstitial tissue. This fluid is high in protein content, which distinguishes it from other types of swelling. This fluid also has not yet been filtered and has a high content of bacteria and other waste products not normally found in this tissue. Health risks include progressively degenerative edema, tissue fibrosis, fibrotic skin changes, blisters, wounds, re-occurring cutaneous and sub-cutaneous infections (cellulitis), osteomylitis, deformed limb(s), decreased mobility due to inactivity, repeated hospitalizations for infections, severe weeping of lymphatic fluid from swollen wounds (lymphorrhea), and in severe cases can even result in amputation, or death due to sepsis. The psychological affects due to appearance, pain, reduced function, can be devastating to the quality of life of affected patients. As with many chronic diseases, untreated lymphedema tends to worsen over time, resulting in increased complications and morbidity over time without treatment. When this chronic diseases are not effectively managed, the disease process progresses causing significant and expensive health complications. Collateral affects resulting from physical limitations and complications can interrupt a patient’s normal lifestyle activity including employment, family relationships, social activities, and exercise activity. Patients report a lack of desire to socialize due to appearance, difficulty purchasing clothes and shoes that fit properly, which in turn, causes depression. The change in physical abilities contribute to depression causing a feeling of being needy or worthless. Prior to experiencing lymphedema, many individuals report being able to perform normal daily functions as well as actively assisting friends and family in meeting their needs. Once the disease progresses to a point of affecting function, they are no longer able to participate in normal daily activities such as cleaning their home, shopping for groceries, caring for children or family, or other menial but important activities healthy individuals take for granted. Goals and objectives must include the education of medical practitioners in properly diagnosing upon early onset, education of medical professionals in properly identifying risk of onset, early diagnosis, appropriate treatment, and educating patients about the management of this life long disease. Treatment and disease management that are geared towards individual needs will create an environment for successful long-term management. This environment should consider and provide treatment and tools that facilitate effective results, compliance, independence, exacerbation prevention, and complication prevention. Treatment and management that is individual needs based not only should include effective treatment, but providing an individualized treatment plan allows patients to enjoy a psychological view that gives them control over their disease. This improves compliance by increasing their ability to maintain normal lifestyle activities, while implementing disease management into their daily regime. Because 20 to 45% of cancer survivors who are treated with surgery, radiation, and/or lymph node removal develop lymphedema at some time in their lives, patient education and early intervention for “at risk” cancer patients is essential. Some develop lymphedema immediately after treatment, and some years later. Many cancer survivors never develop lymphedema; therefore, those who do may have an existing obstruction or minor congenital defect of the lymph system prior to treatment, which predisposes them to experiencing lymphedema. Education for at risk cancer survivors provides them with the necessary information for early recognition, so they are able to obtain treatment immediately upon symptom onset. Early intervention is essential in achieving treatment success. As with any chronic disease with early intervention, desired goals are achieved at an accelerated rate, thus reducing the need for lengthy treatment, preventing expensive and debilitating health complications, and better enables patients to continue with normal lifestyle activities. Failure of medical practitioners in properly diagnosing early on, ordering the proper treatment, and long-term disease management can facilitate disease progression that can not only lead to health complications but facilitates employment loss, and other devastating life changing events. In order to achieve effective results and better enable long-term success, several factors must work together in order to ensure longterm disease management success: education, early intervention, effective treatment, and effective needs based home management tools that will allow independent, successful, and long-term home disease management. Treatment and management should include a comprehensive approach that addresses each individual’s physical, mental, and social objectives. Considerations during the treatment and long-term management planning should not only include the patient’s objectives, but their level of motivation, physical abilities, system of support, employment and social activity schedules. A realistic approach to disease management should include the evaluation of each patient’s ability and motivation to implement management into their daily regime, and should involve the necessary tools that are realistic in independent application. Prevalence In the United States: Lymphatic obstruction resulting in lymphedema can be caused by a congenital malformation, a surgical procedure(s), trauma, a benign or malignant tumor, radiation, lymph node removal, sentinel node biopsy, and disease. Because those affected are considered an underserved population, a lack of knowledge in the medical community has resulted in many individuals who experience lymphedema to remain undiagnosed. Estimated figures are available however, they may be significantly lower than those who truly experience lymphatic disease. Current Cases Estimated in the United States due to reasons other than cancer or cancer treatment: An estimated 2.5 Million current cases of lymphedema that exist in the United States resulting from congenital malformation, trauma, surgical procedures, or disease. Approximately 26% of cancer survivors treated with surgery and/or radiation will develop lymphedema at some time in their lives. The National Cancer Institute reports in a survey of 1151 women treated with radiation for breast cancer, 23% reported lymphedema at zero to two years after treatment and 45% of these women developed lymphedema at fift |
| Printed with permission from Cyndi Ortiz |
| LYMPHLAND |
