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Episode of Care Assurance Program

eCAP Episode of Care assurance program



The eCAP initiative pairs Smith & Nephew’s entire line of primary total hip and knee reconstructive systems with two of its most innovative wound care products: PICO Single Use Negative Pressure Wound Therapy and ACTICOAT Flex 7 Silver-coated Antimicrobial Barrier Dressing. Smith & Nephew warrants the performance of its primary total knee systems, primary total hip systems, PICO Single Use Negative Pressure Wound Therapy System and ACTICOAT Flex 7 to perform as expected. If a patient is readmitted within 90 days following a procedure for a surgical site infection or to revise the implant due to a failure of a Smith & Nephew product, Smith & Nephew will pay a hospital's unreimbursed costs for the readmission up to the purchase prices of the implant, PICO and ACTICOAT Flex 7.

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Program Details

If during the 90 days immediately following a total knee arthroplasty or total hip arthroplasty surgery (either a "Surgery") using a Smith & Nephew primary total knee system or primary total hip system (either a "Smith & Nephew Implant"), a patient is re-admitted to Customer's facility to treat an infection at the site of the Surgery or to revise the knee or hip system (a "Readmission"), Smith & Nephew will refund to Customer its costs for the Readmission up to, but not exceeding, the purchase price paid (net of rebates or other unreimbursed discounts) by Customer for the knee or hip system and the Smith & Nephew wound care products specified below. This warranty is subject to the following conditions:

To be eligible for this warranty, patients must be either (i) Medicare patients covered by the Centers for Medicare and Medicaid Services’ Comprehensive Care for Joint Replacement model or Bundled Payment Care Improvement initiative (model 2 or 4); or (ii) covered by commercial health insurance (excluding participants in so-called Medicare Advantage plans); or (iii) uninsured. Medicaid patients or other Medicare patients are ineligible for this program.

Patients whose care is subject to this warranty must have used Smith & Nephew's PICO Single Use Negative Pressure Wound Therapy System and ACTICOAT Flex 7 Antimicrobial Barrier Dressing on the site of the Surgery immediately following the Surgery and as prescribed by their surgeons. The Smith & Nephew Implant, PICO System and ACTICOAT Flex 7 Dressing must have been used in a manner consistent with the products’ Instructions For Use. 

The Readmission must result from a failure of the Smith & Nephew Implant, the PICO System, or the ACTICOAT Flex 7 Dressing to perform as expected (consistent with the products’ labeling).Customer will complete and provide to Smith & Nephew an Episode of Care Assurance Program - Readmission Report for each warranty claim under the program.

Customer will allow Smith & Nephew reasonable access to or copies of Customer's books and records, if requested, sufficient to enable Smith & Nephew to confirm that warranty claims submitted by customer satisfy all conditions of this warranty.

Following a determination by Smith & Nephew of a valid warranty claim, Smith & Nephew will issue a cash refund to Customer in an amount equal to Customer’s unreimbursed costs for the Readmission up to, but not exceeding, the aggregate purchase price of the Smith & Nephew Implant, the PICO System and the ACTICOAT Flex 7 Dressing. Payment by Smith & Nephew is not available for any costs Customer recovers from federal health care programs, commercial insurers or other payors. Smith & Nephew’s determinations as to eligibility, satisfaction of the program conditions, and payment amounts will be conclusive absent manifest error.

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This information is intended for health care professionals in the United States only.

Caution: US Federal law restricts the sale of these devices to or on the order of a physician.