The Vest System

Post Reply New Topic

Those are really cool vests. I want one.

I wish strapples every success... I think I will stick with my own vests as underwear LOL...

Okay, my brief post earlier I did in a rush this morning since I read it while eating breakfast before heading to work, with a little more time for now I can ay a bit more.

I might have some mild aspergers, and my 5 year old son is probably at a similar level on the spectrum. He has a diagnosis of PDNOS so he's gotten services in pre-school and is getting them in kindergarten, but at any rate that's how we came to learn about autism type stuff.

For a little over 3 years I worked for Hill-Rom as an engineer supporting current production hospital bed products. Somewhere around a year and a half ago, some of the air mattress products became my responsibility... While I never really had any direct involvement with The Vest, some of the people I worked with who had history on the air mattress products I worked with did have involvement with The Vest.

I was working in Indiana. Generally speaking, rental products (of which The Vest is one) are supported from Charleston, SC.

As an aside... Hill-Rom's business is medical devices, which means any use for their products has to be FDA approved and involves testing. Claims about treatment need to be backed up by clinical trials. These kind of costs are a lot of why hospital beds can cost more than cars.

But that doesn't mean spin-offs don't happen... Actually, the Sleep Number Bed was a Hill-Rom patent where Hill-Rom sold the rights to someone else who manufactures it, I'm paraphrasing the story so it might not be exactly right but I think that's the gist.

But it's an important piece of info in understanding what would be needed to offer something like The Vest as a compression treatment for an individual on the autism spectrum. Proving that it had some sort of treatment benefit might be a long process that might even be difficult to map out how you'd do it.

Maybe some sort of consumer goods type product might be a more practical route, but it'd have to not have any medical claims - more like comfort claims, and not have any medical risks. The Vest might be a bit much for the lay person, if I recall it's fitted to the individual and just putting it on a store shelf as it is built right now probably would create a risk of misuse that could overly constrict a users breathing or something like that.

But it's an interesting idea, I'm going to pass on the link to your website to someone I know that might know the right person to pass on the link to. It'd be interesting to hear if anything comes of it.

The CLINITRON bed uses a technology called "air fluidized therapy," or AFT, to treat a variety of very sick patients. These patients include, for example, severe burn victims and those with severe pressure ulcers that don't respond to other therapies. Very basically, AFT involves tiny silicon beads that are placed in motion beneath the patient by gentle air flow. The light air flow through the beads "floats" the patient resulting in reduced pressure on the patient's body. The reduction of pressure and accompanying elimination of shear and friction to the skin enhance healing and help prevent further tissue damage.

We developed the product in the 1970s. Numerous studies were conducted which reinforced the clinical efficacy of AFT. In 1987, the Public Health Service developed consensus guidelines for the proper use of AFT at home, with input from health professional societies and patient groups. By 1990, enough data existed that, after extensive study, HCFA issued an affirmative national coverage decision delineating the patients who could benefit from this therapy at home. That policy can be found in section 60-19 of the Medicare Coverage Issues Manual. As you well know, HCFA deliberates carefully before issuing national coverage determinations, and not many technologies have met that standard.

One would have thought that our story would end there. It did not.

To be quite blunt, the Durable Medical Equipment Regional Carriers, or DMERCs, did not embrace HCFA's decision. As best we can determine, they simply did not agree with the HCFA physicians and scientists on the usefulness of the technology and have sought to add their own definition of medical necessity that is inconsistent with the national policy. As a result, we estimate that the DMERCs have denied close to 80 percent of all claims for reimbursement of the CLINITRON bed presented to them since the national policy was published in 1990.

Appeals of AFT Claim Denials

While those denials have dissuaded some doctors and patients from seeking this treatment, many others, indeed thousands of beneficiaries with the severe injuries identified in the national policy, have sought to obtain access to AFT--despite the opposition from the DMERCs.

The appeals process for these denials involves five steps. In sequence, they are (1) a paper review by the carrier, (2) a "fair hearing" by a carrier hearing officer, (3) a hearing before an administrative law judge, (4) an appeal to the departmental appeals board, and (5) if necessary, an appeal to a U.S. court. Because of the tremendous time, inconvenience, and cost of such appeals, we have helped our elderly patients by accepting assignment of their claims, and have kept track of the results.

In the literally thousands of AFT appeals to administrative law judges since 1990, the beneficiaries have been successful in overturning the carrier decisions in more than 95 percent of the cases.

What the AFT Experience Tells Us About the Appeals System

On the one hand, that success rate is the good news about the system. With an obviously strong case seeking the enforcement of a national coverage decision, the beneficiaries are successful in over 95 percent of the AFT cases.

But in two very real ways, this example shows the system also fails. First, incredibly the initial denial of claims continues after nine years of the DMERCs losing thousands of appeals and after numerous meetings between the DMERCs and Hill-Rom. For the most recent 6-month period, the average denial rate for AFT by the four DMERCs is still over 80 percent. The appeals process has done nothing to resolve the fundamental dispute over the local DMERC policies that are inconsistent with HCFA's national policy.

Second, the system simply takes too long to effectively resolve even the claim-specific disputes. Data obtained from HCFA show that, in fiscal 1997, on average for a part B carrier claim, it took 119 days for a beneficiary to get through the carrier review and fair hearing. HCFA has previously testified before Congress that it takes 664 days, on average, to receive a decision from an administrative law judge, measured from the date the hearing is requested. Thus, combined, it takes an elderly patient on average 783 days, or well over two years, to obtain a decision from an ALJ after initiating the appeals process. That is simply too long to be an effective option for most beneficiaries. Moreover, most small medical device companies could not afford to take assignment of claims in these circumstances, and survive long enough to get paid.

what do you mean.. inflating underwear? wtf!?

Hi strapples!

LOL I was talking with my GF about this some while ago because the term "vest" means underwear here, like this...

(removed picture its a undergarment)

So nothing inflatable here I'm afraid, what you have as vests we call life-jackets, it is interesting at all the different names things have. I have learned a lot reading about your condition and how brilliantly you cope with it and explore new avenues.

FYI, my former colleague responded suggesting I make the suggestion using a new website Hill-Rom just recently set up for ideas:

http://www.hill-rom.com/usa/IdeaCenter.htm

I sent in the idea of using The Vest for deep pressure therapy for calming.

is my response on your vests LOL!! !! ! what country are you in may i ask,

we also have life jackets around here too lol.

thanks for learning and ow brilliantly i cope thanks for the compliments.

hello again

firstly I must apologise [to moderator] if the image was removed, I had no idea that an undergarment would be inappropriate LOL, anyhow in the [Dis}United Kingdom is where we are, Strapples!