Questions for valve replacement patients.

[QAS Lance]

Hello,

QAS is potentially getting involved in a new study at a major clinic in the United States. The goal of the study is to
see whether or not a valve patient who is 3 days post operation would be able to receive training and successfully operate
a home test monitor. Obviously, this will not include patients who have complications or those who are incapable of operating
the monitor. Any comments or suggestions?


Lance

QAS

 

[Ross]

I myself cannot fairly answer this poll. Both of my surgeries involved complications and I wasn't even with the program for at least 5 weeks after surgery. In other words, I wouldn't have a clue what a normal outcome patient may feel after 3 days.

 

[SJJ]

Lance,
I was discharged on the morning of the third day after my surgery and was feeling pretty good and was clear headed, probably enough to be trained. The main problem may be in the fact that a lot of folks are still pretty loopy from the pain meds or a little pump headed. To be on the safe side, I think it would be best left until a week or so post op and/or if done in the first 3 days would need to include the co-training of another responsible adult who could assist. As you well know, the testing is too important to screw up. Actually, since my surgery was done 3 hours from where I live, going to my cardio's office for weekly INR tests at first provided a comfort zone as I could ask questions while I was there. Hope this helps. As I'm approaching my three months out status, I'll be turning my paperwork over to my cardio shortly so I can get my own machine-QAS will be hearing from me. By the way, talked with one of your folks a few weeks ago and I must say the individual I spoke with was pleasant, well informed and very helpful. I was so impressed, I referred another individual who has been on coumadin for years but never considered getting his own machine.
Sue

 

[Raverlaw]

Lance,
I had a textbook AVR with no complications. I could have handled training and self-testing from the third day on without problems, I think. I've been twiddling my thumbs waiting for the artificial three months to expire, and will be pushing for home testing next week when my time's up.

Are you aware of any one who's gotten Blue Cross of California (PERSChoice) to pay for all or part of the home tester? Right now they're spending $109 per week for a lab test -

 

[QAS Lance]

Thanks for the Responses and Comments!

Thanks for the Responses and Comments!

Hello,

We have had several approvals from BCBS of California, so the answer
to your questions is YES. However, remember the decision is based on
medical necessity, so I would say we probably have a 50/50 shot at getting
approval. By the way, the new Lifescan Harmony monitor is no longer
available to patients, as the company is for sale. QAS now offers three
choices for home testing monitors:

QAS CoaguChek Department: 800-563-5801

QAS INRatio Department: 800-563-5680

QAS ProTime Department: 800-298-4515

 

[Raverlaw]

Lance - more details, please?

Lance - more details, please?

Lance,

What would qualify as a medical necessity? I'm on warfarin for life, so it is medically necessary that I test my INR regularly. The nearest lab to me is only open two mornings a week, and it costs $109 per test (although BC pays less).

How do I know which machine is appropriate for me? I'm 49 years old, male, have a mechanical AV and can follow detailed instructions. I occasionally travel and would want to take the tester with me on extended trips if possible.

 

[RobThatsMe]

Hi Lance,

3 days after surgery I was still in the hospital and trying to walk. I was also on some major drugs, (pain killers for example). I don't think I could have handled self testing competently. I was still trying to mentally grasp what I just went through.

Also, during the first few weeks as a person recovers from surgery, the INR fluxuates greatly. Most doctors require testing every 3 days during the early stages / weeks post surgery until they get some stable readings. Home testing may make it easier for the patient, since they could call in the results.
Although personally, I enjoyed the excuse of going to the lab as a reason to get out of the house.

I think a patient could receive training and self test 1 day prior to hospital release. (Based on a normal hospital stay of 5 to 7 days).

Hope you are doing well,

Rob

 

[QAS Lance]

In regards to Medical Necessity, the arguement we have to make is that this
is not a convenience item. When the deny authorization, they say that it is not a medical necessity to test at home. Sometimes they think of it as a "luxury" item. We have to establish the reasons that it is better to test at home versus going to the lab. Sometimes this can be hard to accomplish, even though it is more cost effective to the insurance company. Just because someone is on Coumadin/Warfarin for life doesn't make it a medical necessity to test at home, according to most insurance companies.

Regarding which monitor is best for you to use, please call me and I'll explain the advantages/disadvantages of each one. Thanks, and call me anytime.

Lance

 

[catwoman]

Bill:

For the certificate of medical necessity, my PCP stated that I (1) have a mechanical heart valve; (2) will take warfarin for the rest of my life; (3) test weekly; and (4) travel.
United Health Care approved my ProTime 3 and paid 100%; good thing I got it in 2003 -- they'd only pay 90% this year.

Lance:

Three days is too quick after surgery. I was loopy some from painkillers. Would I have been able to undestand everything? No, not without a family member being there.
A week to 10 days is better. Also, there is too much adjusting that needs to be done the first few weeks to 2 to 3 months. Many people may not be capable of adjusting to all the changes that have been done to their body in surgery, medication changes/additions, etc.
Some can, but I'll bet most can't do it and remember it.

 

[Gail in Ca]

Since I almost died before my last AVR, I would have to say I probably would've needed at least a week after surgery to learn to home test. But, I would sure recommend it for people like me who have alot of scar tissue in the arm vein from repeated blood tests over the 2 surgeries. A finger poke is so much better. After only 3 days I would have been a bit weak and not caring at that point to self test in the hospital. But a few days makes a big difference.
Gail

 

[fyrfytr]

I think 3 days after surgery is to soon. I think the day you are going to be discharged would be a good day to train for home testing.
Take Care

 

[bvdr]

I think 3 days is too soon too. I thought I was very mentally clear following some back surgery years ago until I had to try to figure out what in the world I had done balancing my checkbook. Every surgery since then I have prepaid bills and haven't trusted my memory for the first week or two.

 

[Lisa in Katy]

Theoretically, I could have done it since I was up and walking around by that time. I think I even took a shower on the 3rd day. However, I didn't really understand the numbers game until a long time after my surgery (about a year?), and I think a better educated patient would be a better candidate for home testing. Not just educated with the machine, but also educated as to what it all means.

 

[SHerrin Hutt]

PT Testing

PT Testing

I think most of us it would take more time. It would take longer than that to get the insurance co. to ok the machine, It took me three months to get it through with the help of QAS.

 

[Brian]

I think 3 days is doable, but too soon. It all was a huge learning curve anyway, so I think one more thing might have tipped the apple cart. I did vote "yes", but I felt so much much more confident that the lab was looking after everything while I was just trying to get back up and at em. A week later would have been a piece of cake, or even 4 or 5 days..

 

[Dee]

I agree with Lisa about being more educated and just understanding the whole number thing. It took me a couple of weeks to understand what the INR meant and what things effected it etc...actually, I'm still learning to this day!! Like 2 nights ago I was 6.4, skipped a dose and tested again last night and it had dropped to 2.7...my Dr. is even scratching his head!! I'm somewhat of a problem child! I do think doing my own tests has helped to understand it all better.

I probably could have been walked through the steps on the third day, but as far as understanding it all, I don't think it would have 'sunk in' real well at that time.

~DeeDee~

 

[ticktock]

3 days?

3 days?

Lance,

Too soon is my vote. Enough to deal with, emotionally, physically, why put one more thing on the patient. Also, I think age should be considered, other physical infirmities. But no, even being relatively young last surgery (44) I would not have wanted to be responsible for it.

Can't help but wonder what this survey is about.... purpose??
mindy

 

[KathyH]

I was not feeling too great on the 3rd day, I don't think I could have absorbed all the information on how to test. I would say I could have by the 5day.
Kathy H

 

[tommy]

No way. I couldn't even take my oral meds properly.

 

[Nan]

I also think that 3 days is too soon. I was still on some pain medication and not fully understanding everything....I also did not fully understand the issues surrounding coumadin and the INR etc. It would have been too much at that time. Maybe, but only maybe, by the time I was discharged or say 5-7 days. But I think a month or so would be better.