Under Pressure: Scrutinizing the Rise of Thermal Compression Devices
FAST FOCUS: Healthesystems continues to monitor top cost drivers among ancillary products and services, including durable medical equipment (DME). Trends demonstrate increased utilization of thermal compression devices within workers’ comp, despite a lack of clinical evidence for their efficacy, resulting in unnecessary treatment and costs.
WHAT ARE THERMAL COMPRESSION DEVICES?
Thermal compression devices combine hot and cold therapies with pressure for the treatment of pain, inflammation, swelling, and circulation in the extremities (ankles, knees, elbows, shoulders, wrists). They are typically used following acute injury or a surgical procedure, making them attractive to healthcare professionals as a therapy option for the injured worker population. Physical therapy clinics may utilize these devices along with physical therapy or exercise regimens. However, these devices are also manufactured and marketed for at-home use.
The devices consist of sleeves that wrap around a patient’s extremities to provide pressure and cold and/or heat. Some devices come with a connector hose that attaches to a mechanized compression pump, but other devices simply circulate ice water. Regardless, the principles of pressure and temperature adjustment are still present.
GROWING COST DRIVER
Thermal compression devices have comprised a growing portion of overall DME spend over the last five years due to increased prescribing and utilization of these devices. Having insight into such trends can help guide strategies for controlling utilization and costs.
In light of their growing use, what should claims professionals know about thermal compression devices?
WHAT ARE THE CONCERNS?
Thermal compression devices come at excessive costs without providing additional significant clinical benefit to most patients over traditional hot and/or cold therapies.
Unproven Clinical Efficacy
The American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines and the Official Disability Guidelines (ODG) consider the use of thermal compression devices to be purely investigational, with no significant clinical evidence proving that thermal compression devices provide greater therapeutic results than standard cryotherapy with ice packs or reusable gel cold packs.
Prices for thermal compression devices vary depending on model and purchasing channel, but devices can cost thousands of dollars. According to GameReady, their products retail for approximately $1,000 for a two-week rental.2 Upfront purchase or rental costs are not the only factor. Some thermal compression devices come with recurring costs of additional equipment, such as replacement pads, extra connector hoses, carrying cases, and more. These recurring costs can compound the overall costs associated with these devices over time, underscoring the continued need for visibility into the shifting cost drivers among ancillary services and products such as DME.
Thermal Compression Considerations
While different payers have different claims management strategies regarding thermal compression devices, it is helpful to be aware of this growing trend.
Know the products:
Claims professionals should familiarize themselves with thermal compression device models and manufacturers. Examples include:
- GameReady products
- VascuTherm (ThermoTek)
- Polar Care (Breg)
- Cryo/Cuff (DJO Global)
- VenaFlow (DJO Global)
- Bio Compression
Know the alternatives:
Consider the use of ice packs and reusable gel cold packs. According to evidence-based medical guidelines, thermal compression devices have no proven clinical benefit over these traditional hot and/or cold therapy treatments.
Know the exceptions:
In the event a prescriber determines a thermal compression device is medically necessary, payers can implement different strategies for managing utilization, such as limiting use to certain conditions and for short rental duration.