The workers’ compensation landscape is experiencing a significant shift in how durable medical equipment (DME) supports injury recovery. According to recent market data, DME represented a nearly $60 billion expenditure as of 2022, with growth projected at 6% annually over the next seven years. More telling, however, is the dramatic change in recorded fee schedules — jumping from under 1% increases in 2020 to 8.7% in 2023.

This surge reflects broader health care trends that are fundamentally changing how injured workers recover. The rise in home health care services, increasing prevalence of chronic conditions, and an aging workforce all contribute to greater DME demand. For case managers and adjusters, these trends represent both challenges and opportunities to improve outcomes while managing costs effectively.

“DME covers a broad plethora of things — crutches, wheelchairs, special mattresses, breathing and monitoring equipment  — but we’re focusing on those items that support injury recovery or provide some therapeutic value,” said Michelle Despres, PT, CEAS II, REAS, CETS, director of clinical education at One Call, who brings 27 years of physical therapy experience to workers’ compensation challenges.

“Durable medical equipment — including prosthetics, orthotics, and related supplies —accounts for roughly four to thirteen percent of total medical costs,” Despres explained. “Not every injured worker needs DME, but for those who do, it’s essential to ensure they’re truly the right candidate.”

The Strategic Shift Toward Home-Based Recovery

The transformation in DME utilization isn’t simply about equipment — it’s about reimagining the recovery process itself.  The shift toward home-based recovery has accelerated due to several converging factors.

Hospitals and clinics face capacity constraints, while patients increasingly prefer recovering in familiar environments. Additionally, chronic conditions requiring ongoing management have risen significantly, creating demand for equipment that can be used independently at home.

This evolution requires a more sophisticated approach to DME selection and management. Rather than viewing equipment as a simple add-on to traditional treatment, successful programs treat DME as an integral component of comprehensive recovery strategies.

Navigating Provider Conversations and Treatment Guidelines

One of the most challenging aspects of DME management involves interpreting physician prescriptions and determining appropriate alternatives when necessary. The complexity increases when providers specify “no substitutions” or brand-specific requirements, which can significantly impact costs without clear clinical justification.

There are complex prescription terms that you have to look out for and that can also limit when replacements can be offered. However,  this allows opportunities for conversation with treating physicians, which is something that is often missed.

The key to productive provider dialogue lies in preparation and positioning. Rather than challenging medical decisions, successful case managers frame conversations around understanding the clinical rationale behind specific equipment choices. Questions like “What symptoms is the patient having that make this the best option?” or “Is this considered long-term use?” demonstrate collaborative intent while gathering essential information for decision-making.

Treatment guidelines such as Official Disability Guidelines (ODG) and the American College of Occupational and Environmental Medicine provide valuable frameworks for these discussions. However, individual assessment is important. ODG is just that — a treatment guideline — every injured worker is unique.

These guidelines serve multiple purposes beyond simple approval decisions. They can help automate approvals for clearly effective treatments while providing talking points for cases that fall outside standard parameters. The goal isn’t to restrict care but to ensure appropriate utilization based on evidence and individual circumstances.

Using ODG as a resource, increasing your knowledge, and maybe even automating some approvals for some specific effective treatments that are already approved in ODG, is critical. It provides tools to have active conversations with treating providers about specific injured workers.

The Buy Versus Rent Decision Matrix

Determining whether to purchase or rent DME requires careful analysis of multiple factors that extend beyond simple cost calculations. The decision impacts not only immediate expenses but also long-term outcomes and patient compliance.

Duration of need serves as the primary consideration, but it’s often the most difficult to predict accurately. It raises questions such as, “How long will they need it?” and “Are there both rental and purchase options, or ‘rent to own’ conversion plans?” Sometimes there are limitations because the product may not offer a purchase solution.

Several factors favor purchasing equipment. Long-term cost savings become significant when usage extends beyond typical rental periods. Purchase options also allow for personalization and customization that can improve compliance and effectiveness. Additionally, some programs offer trial periods that let patients test equipment before committing to purchase.

However, purchasing isn’t always the optimal choice. Maintenance and repairs do happen in medical treatment. Medical devices can malfunction, and patients may struggle to recognize when equipment isn’t functioning properly.

The analysis must also consider the total cost of ownership, including supplies, maintenance, and potential replacement needs. Some equipment requires ongoing consumables — such as electrodes for electrical stimulation units or gel for ultrasound devices — that can accumulate significant costs over time.

Patient factors play an equally important role. Individuals with cognitive limitations, those living alone, or those with complex injuries may struggle with equipment that requires regular maintenance or adjustment. In these cases, rental arrangements often include support services that ensure proper utilization.

“Every injured worker is different,” Despres emphasized. “So, when we use guidelines, they’re guides. There could be someone who doesn’t fit the criteria as specified in the guideline, but it still makes sense. Or it could be somebody that appears to meet the criteria, but maybe there’s something that prevents them from being a good candidate.”

Identifying and Preventing Common Pitfalls

Despite the benefits of well-implemented DME programs, several common pitfalls can undermine effectiveness and create additional complications. Understanding these challenges and developing prevention strategies is essential for successful outcomes.

Improper equipment fit represents one of the most frequent issues. Devices, such as a Controlled Ankle Motion (CAM) boot, that are too tight can restrict circulation and cause tissue damage, while loose-fitting equipment fails to provide intended benefits.

Secondary injuries often result from compensatory movements required when one area is immobilized. When an ankle is placed in a walking boot, for example, the knee, hip and back must work harder to maintain normal function to make up for what is happening in the ankle. “If you have injured workers who say — after wearing the boot —  ‘my back hurts’ or ‘my hips hurt’, those certainly could be irritated, inflamed, or fatigued because they’re doing more work,” Despres explained.

Case managers should prepare injured workers for these secondary effects and monitor for related complaints. Rather than dismissing new symptoms as unrelated to the primary injury, teams should recognize them as potential consequences of necessary treatment and address them appropriately.

Safety hazards represent another significant concern, particularly for equipment used in home environments. Electrical devices with cords create trip hazards, while thermal treatments can cause burns if used improperly. It is also not recommended for patients to sleep in some devices because they may experience adverse effects, particularly if they sleep soundly.

Patient education becomes critical for preventing these complications. Instructions must be clear, comprehensive and reinforced through multiple channels. Visual aids, demonstration videos and follow-up calls can help ensure proper utilization.

Compliance challenges often arise when equipment is difficult to use or when patients don’t understand the treatment rationale. “If they’re compliant, it’s a wonderful thing. If they’re not compliant, then it’s money that’s wasted,” Despres said.

Successful programs address compliance through several strategies. Clear education about why equipment is necessary helps patients understand the importance of consistent use. Equipment selection should consider patient capabilities and living situations. Some devices include compliance monitoring features that provide objective data about utilization patterns.

As the DME landscape continues to evolve, successful workers’ compensation programs will be those that view equipment not as isolated tools but as components of comprehensive recovery strategies. This approach requires ongoing communication between all stakeholders, careful attention to individual patient needs, and continuous monitoring of outcomes.

“Every injured worker’s needs are different,” Despres said. By maintaining this individual focus while leveraging available guidelines and technology, programs can achieve the dual goals of improved outcomes and cost-effective care.

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