Posture-Triggered Abdominal Compression for nOH

Click any step to see what it holds for this idea. donecurrentloopinghuman only

The packet a human reads. See docs/wrap-spec.md. This section says nothing about whether the idea is good — it says the file is finished enough to be read, and names what to do next. Filling it in advances no candidate and approves nothing.

The one-paragraph version. A wearable for people whose blood pressure falls when they stand up because the nerves that should tighten their blood vessels have failed, mostly people with Parkinson disease, multiple system atrophy or pure autonomic failure. They get dizzy, faint and fall on standing, and the two drugs for it (midodrine and droxidopa) raise blood pressure lying down too, which is its own harm. This is an inflatable belt worn around the abdomen with a small pump and a posture sensor. When the wearer stands it inflates to about 40 mmHg and squeezes blood out of the gut's veins back toward the heart. When they sit or lie down it deflates, so it adds nothing while they are lying down. A published crossover study got a benefit from the same squeeze, but there the belt was inflated by hand just before a short stand, not triggered by posture. The plan is to sell it as prescribed home equipment paid for by Medicare under the existing pneumatic-compressor codes, not through any new fast-coverage pathway. Medicare buys equipment in that code family once rather than renting it, so the business turns on whether one payment covers the cost of the belt system and its replacement garments.

What would have to be true, quoted from each deck's load-bearing condition:

• Desirability: "whether adults with Parkinson disease, MSA or PAF (pure autonomic failure) would actually wear and operate a powered abdominal garment during every upright period, day after day, for months claim 28unconfirmed."
• Viability: "whether the one-time Medicare purchase allowable of the code this device would actually bill under — E0650, the lowest in the family, if a single non-segmental bladder takes the non-segmental descriptor — exceeds the fully loaded cost of one patient's controller plus the garments it consumes claim 96unconfirmed claim 140unverified."
• Feasibility: "whether a single torso-worn posture classifier can keep false-upright inflation of a recumbent wearer below 1 in 1,000 recumbent periods in Parkinson disease, MSA and PAF patients, including those with camptocormia and dyskinesia claim 108unconfirmed."

The viability condition moved in the 2026-09-29 rebuild. The earlier build named Medicare coverage for nOH (claim 41unconfirmed); the deck says coverage is still necessary, and that the condition moved because the refutation of claim 117refuted changed what coverage would buy.

The assessment's decision queue says which of these the business dies without. Its top two:

• B7 It is a business. A stock-sized… (blocking, holed, cheap) "It is a business. A stock-sized controller-plus-garment system, built from dual-source parts through a standard test campaign, costs less per patient than Medicare pays for it, at the allowable and in the cadence Medicare actually pays, including the garments that wear out. That holds at a volume the prescribable population supports and through a supplier channel that will carry it. The margin pays back the fixed programme." It reads blocking because claim 117refuted sits under it, and the assessment says plainly that the refutation came back on the side P0 the original shape was built on, not against it: read B7 It is a business. A stock-sized… as critical, turning on claim 96unconfirmed, claim 122unconfirmed and claim 123unconfirmed.
• B6 Neurologists and autonomic specialists will… (critical, open, cheap) "Neurologists and autonomic specialists will prescribe a DME device into an indication they manage with midodrine and droxidopa, and will carry the prescription and prior-authorisation paperwork. The reason they do is a difference those drugs' labels actually leave open: no treatment effect while supine."

Cheapest next test: Two, answering different questions: CMS Chronic Conditions Warehouse Parkinson-disease prevalence for the TAM row (score-mover) and the full text of DME MAC LCD L33829 and its policy article (REQ-0125 Full-text retrieval of DME MAC LCD L33829…), then Operations' cost build-up against the one-time purchase allowables B7 It is a business. A stock-sized… (decision-mover).

• Cheapest score-mover: the TAM row's gap analysis names three sources, "CMS CCW Parkinson-disease prevalence among Medicare FFS beneficiaries, plus DMEPOS utilization and published fee-schedule allowables for E0650-E0652 — public, hours of connector work". Two of the three are now in the file: national E0650-E0652 utilization claim 25verified and the published allowables claim 107verified. What remains is the CCW prevalence figure. No connector in connector_status.py reads the CCW, so that half is a find-verify-fetch job of the kind REQ-0139 Find the CMS DMEPOS fee schedule file in… was, not a lookup. TAM is the one core factor still blank in the Verified Composite, and that composite was computed on 2026-09-28 over claims 1-87, before claims 25 and 107 were re-checked, so a /rescore is due as well. This is a selection from the Scores table's "What would settle it" column, not a new judgement.
• Cheapest decision-mover: decision queue row 1, B7 It is a business. A stock-sized…: "first REQ-0125 Full-text retrieval of DME MAC LCD L33829…, the full text of LCD L33829 and its policy article, which says whether replacement garments are paid separately (claim 122unconfirmed)", which is now the only recurring payment line, "then Operations' cost build-up (REQ-0123 What is the expected unit cost of goods, REQ-0114 What unit does the idea-019 money model…) against the published purchase allowables". It decides whether one Medicare payment per patient can carry the device at all.

They differ. The first moves a rubric factor. The second decides whether there is a business. The previous version of this section named B6 Neurologists and autonomic specialists will… as the decision-mover. B7 It is a business. A stock-sized… displaced it when claim 117refuted's refutation derived blocking. B6 Neurologists and autonomic specialists will…'s test, structured calls to 15-20 movement-disorder neurologists and autonomic specialists using the instrument REQ-0140 Specify the primary research that would… asks Commercial to specify, plus the drug label text (REQ-0138 What do the current FDA labels for…), is still queue row 2 and still cheap.

Where the evidence actually stands. 54 of 142 claims verified, 80 unconfirmed, 7 unverified (claims 136-142, appended on 2026-09-29 by the business case and the decks and not yet put to the Verifier), 1 refuted. By evidence class, the verified claims are 9 registry fact, 23 published finding and 22 unstamped. wrap_status.py reports 9/9 factors scored and 4/4 core; that counts the draft Scores table, whose every row is a triage score on unverified claims. The Verified Composite is 25/100 on 7/9 factors (TAM and strategic fit blank) and 3/4 core. It was computed on 2026-09-28 over claims 1-87 only, so it has not seen claims 88-142 or the refutation below. The gate check cleared, which means only that no verified claim fires a kill condition. The assessment posture is repair-pending, derived from B7 It is a business. A stock-sized…'s blocking; the impact review it waits on has been run (IR-20 claim 117 came back refuted, absorb), and what is still pending is Market Access's re-statement of its refuted condition, not a repair to the business. Seven chairs have stated positions at P0 the original shape: five conditional, two abstaining (Legal & IP, Commercial), none blocking. The loop record reads converged: no as of turn 3, because Market Access has not re-stated over the refuted condition. 37 cross-department requests are open.

claim 117refuted is refuted. Market Access had stated that Medicare pays for the E0650-E0652 pneumatic-compressor family as a capped rental. The July 2026 CMS DMEPOS fee schedule puts all three codes in the inexpensive-or-routinely-purchased category on every pricing line, so a device billed in that family is paid as a one-time purchase, not as a monthly rental stream claim 117refuted. The fee schedule publishes the allowables claim 107verified. The non-rural new-purchase amounts across the contiguous states and DC are E0650 $872.43-$1,026.39, E0651 $1,112.52-$1,308.85 and E0652 $6,422.01-$7,555.31, allowed amounts with coinsurance coming out of them [claim 96unconfirmed: unconfirmed; the tag is held by the claim's unsourced cost-of-goods half]. Which code the device would bill under is unsettled claim 40unconfirmed, and the viability deck's reading that it would be E0650, the lowest, is claim 140unverified. The trunk and chest appliance codes E0656 and E0657 are capped rental, E0656 at $82.35 per rental month non-rural claim 107verified. The refutation fires no pivot and changes nothing in the shape as generated, which assumed a purchase; it moves the weight onto cost of goods and garment payment.

Three things a reader should not misread. First, some of what is unconfirmed is blocked on tooling, not on a finding. The DMEPOS fee schedule, the HCPCS Level II file and DMEPOS utilisation are now cached and have been read, which is why claims 25, 107 and 117 now carry a verdict. What is still blind: the coverage cache holds no DME MAC LCD text, so LCD L33829 has never been read, and its refuted on E0650 and E0656 is a cache limit, since routinely covered controls also came back refuted claim 118unconfirmed. The repo has no drug-label connector, so the midodrine and droxidopa labels are unread claim 11unconfirmed. None of these is evidence that a policy or a label says anything. Two gaps an earlier version of this section listed are closed. policy --expect now reads Federal Register text from GovInfo, and claim 63verified was re-verified that way claim 63verified. A patent field sweep now exists (patent-scan --cpc/--applicant/--text), but none has been run for this candidate, so freedom to operate is unexamined, not clear and not blocked claim 27unconfirmed. Second, the verified coverage facts are obstacles. NCD 280.6 (a Medicare national coverage determination number) covers limb garments for lymphedema and venous stasis ulcers claim 9verified and describes an intermittently inflated arm or leg garment that does not reach this device claim 116verified. No policy yet says yes to orthostatic hypotension claim 41unconfirmed. Third, the defining feature has no clinical precedent. The published efficacy result used a hand-inflated binder before a short stand claim 73verified. The one sham-controlled trial of the mechanism completed with 28 enrolled and has posted no results claim 98unconfirmed. Published (class-2) findings stay out of the composite until a human decides the corroborated tag; admitting them would move the draft to about 33/100 on 8/9 factors, per the Scorer's note.

Source file: knowledge-base/candidates/idea-019.md