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The Role of the WOC Nurse in Advancing Compression Therapy Options to the Next Level

Monday, December 8, 2014   (0 Comments)
Posted by: Becky Dryden
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By Mary Nametka, MSN, RN, CWS, CWON, FNP-BC

Member, National Public Policy Committee

How many times have we, over many weeks,painstakingly applied layers of compression wrapping rejoicing with the patient as the circumferential measurements comedown and painful ulcers healed? Yet, haven’t we also experienced the depressing, costly process repeat itself,as uncontrolled edema with new open areas reoccur once wraps are discontinued? Patients often can't afford compression stockings as there is no reimbursement under Medicare. Yes, many, if not most, of us have suffered with our patients and felt the discouragement of this all too familiar cycle. And how many of us, weary with the fatigue of fighting this uphill battle, understand why this situation exists and what can be done about such a complex issue?

This past January, WOCN leadership charged our National Public Policy Committee with addressing these questions. Now, we can share the fruits of our labors and explain how you can be part of a powerful, focused action plan to work upstream and create the option for reimbursement of the compression therapy our patients need. 

All of us are, in some way, policy makers. Whether setting up a budget at home or helping draft guidelines at our workplaces, each of us as a WOC nurse impacts local policies in countless ways on a regular basis. We may not feel we can be effective on some issues that seem too big to change. That's where our National Public Policy Committee comes in, by identifying really daunting barriers to our practice and developing strategies we all can participate in achieving a goal. Currently, this issue is reimbursement for compression garments.

Why aren't compression garments reimbursed? It has to do with how the rules for the Centers of Medicare & Medicaid Services (CMS) were originally set up by Congress. It turns out that no category for compression stockings was created,making reimbursement impossible until Congress amends the rules! There's good news, though: We identified the etiology of the problem. Now for the hard part, the solution became clear: We need Congress to change the rules!

We decided that leveraging our collective expertise with building some sort of alliance or coalition might be the most effective, if not the only viable way to move this agenda forward in the near term. By doing an Internet search, we discovered that another professional organization committed to the care of lymphedema patients was sponsoring a bill entitled The Lymphedema Act. This group already had legislators sponsoring the bill, and while their focus is lymphedema, we identified an opportunity to join their effort in support of reimbursement for effective lymphedema management as part of our broader objective to advocate for reimbursement of compression garments to treat and reduce recurrence of venous leg ulcers and to control secondary lymphedema.

A document was drafted expressing support and offering endorsement of The Lymphedema Act, adding appropriate evidence based content more inclusive of our treatment of VLUs. The draft was submitted and, after some revision,accepted by the WOCN Board of Directors and the endorsement was sent forward. The endorsement can be found on the WOCN Society's Advocacy and Policy home page at

We encourage review of this informational document and support of this legislation by the WOCN membership.This is the right thing to do for our patients and as a means to control healthcare costs.We encourage each of you to reach out to your members of Congress and express our desire as constituents, to support this legislation. You might consider working on public policy committees in your area or with the WOCN National Public Policy Committee. It's a great feeling to be able to work upstream on those problems that may at first seem too big to change.

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