Practice Analysis of ABC Certified Mastectomy Fitters

January 2019

Appendix B

New Test Specifications

2019 Mastectomy Fitter Domain Test Specifications

Task Statements
	2. Formulation of Treatment Plan 15%
	1. Patient Assessment 29%
1	Review patient's prescription/referral
2	Obtain relevant patient medical history, including previous use of post-mastectomy items, diagnosis and activities of daily living (ADL)
3	Discuss patient's expectations and goals
4	Perform a diagnosis-specific functional clinical examination that includes observation of chest wall and evaluation of range of motion, manual dexterity, skin integrity and shape/physical characteristics
5	Consult with other healthcare professionals and caregivers about patient's condition, as needed
6	Refer patient, if appropriate, to other healthcare professionals (e.g., therapist, physician) for intervention beyond mastectomy fitter's scope of practice
1	Use the assessment results to formulate treatment plan, including goals and expected outcomes to increase patient comfort, enhance function, accommodate deformity (e.g., shoulder drop, scoliosis) and improve balance, symmetry and appearance
2	Consult with licensed healthcare prescriber to obtain supporting documentation and/or modify the original prescription, if necessary
3	Document the patient's need described in the treatment plan
4	Identify post-mastectomy items to support the treatment plan
5	Communicate to patient and/or caregiver about the recommended treatment plan and timeline for completion
6	Inform patient or responsible parties of their financial responsibilities as they pertain to the recommended treatment plan and/or any coverage limitations
	3. Implementation of Treatment Plan 32%
1	Measure patient and select appropriate post-mastectomy items to implement treatment plan
2	Assess fit and comfort of post-mastectomy items and make any necessary adjustments
3	Ensure that post-mastectomy items are provided as prescribed
4	Educate patient and/or caregiver about the use and care of post-mastectomy items (e.g., wearing schedules, cleaning), including benefits, possible risks and warranty information
5	Advise the patient and/or caregiver about their rights and responsbilities
6	Document treatment using established record-keeping techniques to verify implementation of treatment plan
7	Develop and communicate follow-up plan
	4. Follow-up 8%
1	Obtain feedback from patient and/or caregiver about the outcome of the treatment plan (e.g., tolerance, comfort, ability to don and doff, proper usage and function)
2	Re-evaluate the patient through a follow-up clinical examination that may include review of changes to patient status, shape and physical characteristics
3	Identify need for changes relative to initial treatment goals and expectations by assessing fit of post-mastectomy items
4	Modify or adjust post-mastectomy items based on assessment and/or patient/caregiver feedback
5	Educate patient and/or caregiver on proper use of post-mastectomy items relative to modifications/adjustments
6	Document follow-up care, including any changes in treatment plan
	5. Practice Management 16%
1	Comply with federal and state regulations for the delivery of items within the Certified Mastectomy Fitter Scope of Practice (e.g., CMS, Medicaid, OSHA, HIPAA)
2	Comply with policies and procedures regarding universal precautions and infection control
3	Comply with documentation requirements (e.g., document retention, verification that post-mastectomy items were delivered and billed as prescribed)

Knowledge and Skills
	Knowledge of:
1	Musculoskeletal anatomy, including upper limb and spinal
2	Anatomical landmarks
3	Tissue characteristics/management
4	Post-surgical edema
5	Range of motion
6	Medical terminology
7	Breast treatment options
8	Lymphatic system
9	Prescription/referral documents
10	Documentation and document retention requirements
11	Policies and procedures regarding Protected Health Information (PHI)
12	Roles and responsibilities associated with other healthcare professions
13	Reimbursement coverage criteria (e.g., CMS/third party payers)
14	Material safety procedures and standards (e.g., OSHA, SDS)
15	Universal precautions and infection control
16	Ethical standards regarding proper patient management
17	Scope of practice related to mastectomy fitter credential
18	When to refer the patient to other healthcare providers/caregivers
19	Post-mastectomy items
20	Post-mastectomy item fitting criteria
21	Examination techniques
22	Measurement tools and techniques
23	Care and maintenance of post-mastectomy items
24	Item warranties
25	Inventory control and management
26	Federal and state rules, regulations, and guidelines (e.g., CMS, ADA, state licensure)
	Skill in:
27	Performing clinical examinations and interviewing patients
28	Interpretation of physical findings
29	Developing or modifying a treatment plan
30	Adapting treatment plan relative to the patient's functional needs (e.g., patients with stroke cognitive impairment)
31	Measuring and fitting post-mastectomy items
32	Evaluating fit and function of post-mastectomy items
33	Documentation

	Mastectomy Item List
1	Breast prosthesis, mastectomy bra
2	Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral
3	Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral
4	External breast prosthesis garment, with mastectomy form, post-surgical
5	Breast prosthesis, non-silicone
6	Breast prosthesis, silicone
7	Nipple prosthesis
8	Custom-fabricated breast prosthesis
9	Breast prosthesis, silicone, with integral adhesive
10	Adhesive skin support attachment for use with external breast prosthesis
11	Compression garments

Contents

Practice Analysis of ABC Certified Mastectomy Fitters

Appendix B

New Test Specifications

2019 Mastectomy Fitter Domain Test Specifications