Policy Analysis on Power Seat Elevation Systems.

In the early 2000s the Centers for Medicare and Medicaid Services determined that power seat elevation systems did not meet the definition of durable medical equipment, and therefore are non-covered items. Yet, power seat elevation systems are covered by other funding sources, and many power wheelchair users utilize these systems regularly when performing tasks such as transferring, reaching, and looking at objects in environments designed for ambulatory people. Adjusting for height when performing these tasks may reduce the onset of pain and comorbidities. To improve access to power seat elevation systems, a clinical team of 4 Clinician Task Force members investigated applicable literature, compiled evidence, and evaluated existing policies to explain the medical nature of power seat elevation systems as a part of a greater interprofessional effort. This manuscript aims to analyze Medicare's policy decision that power seat elevation systems are not primarily medical in nature using Bardach's 8-step framework. As a special communication, this will inform health care professionals of the medical nature of power seat elevation systems and the evidence-based conditions under which power wheelchair users may need power seat elevation systems, as well as empower clinicians to engage in policy directives to affect greater change.

Retrospective Chart Review Examining Differences and Timelines in Recommended and Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department.

OBJECTIVE: To compare recommended wheeled mobility equipment with delivered equipment, excluding custom seats and backs, considering demographic factors, such as sex, age, and funding source, as well as the timeline of the procurement process. DESIGN: Retrospective chart review. SETTING: Dedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers. PARTICIPANTS: Wheelchair recommendations (N=546) made between January 1, 2017, and December 31, 2017, to physician-referred wheelchair users of all ages and diagnoses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Recommended and delivered wheelchair equipment type and length of time between recommendation and delivery. RESULTS: Differences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (P≤.001). Delivered manual wheelchairs were 7% more likely to be different than the recommendation for each year decrease in age (P≤.001), although the model lacked sufficient predictive accuracy for clinical application. The average length of time from equipment recommendation to delivery was about 6 months (mean, 176d). Standard and complex power mobility devices were associated with longer timelines (median, 137d and 173d, respectively; P=.001), although only complex power mobility device timelines were significantly associated with public funding sources (P=.02). CONCLUSIONS: Wheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be studied further. Health care professionals should consistently follow up on delivered equipment to ensure that expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication postrecommendation may improve patient outcomes.

Trends in wheelchair recommendations in a dedicated seating department.

INTRODUCTION: In the early 2000 s, investigators at the federal government noted growing Medicare expenditures for power mobility devices, which were related to high profit margins and fraudulent activity. Medicare responded with policy and program changes, and stakeholders in wheelchair service delivery have noticed an impact on their services and changes in wheelchair user access to needed equipment. METHODS: This study examined 4,252 wheelchair clinical recommendations made by full-time wheelchair seating department therapists between 2007 and 2017 through a retrospective chart review. Demographic counts and percentages were examined in relationship with equipment over time. RESULTS: The number of recommendations increased over time in all age groups, but most for people aged 19-64. Fifty percent of people with Medicare were younger than 65, and 63% of Medicare recommendations were for complex wheelchair bases. Overall, decreased recommendations were noted in 2008, consistent with the economic recession. An increase in recommendations occurred from 2014 to 2017, consistent with the onset of the Affordable Care Act. CONCLUSIONS: Most change occurred for middle and older age groups, complex manual wheelchairs, and standard power mobility devices. This study supports the need for a separate Medicare category of Complex Rehabilitation Technology for those with severe disabilities.

Policy analysis on power standing systems.

Power wheelchairs provide people with mobility disabilities opportunities for independence in mobility and repositioning themselves. However, current power wheelchair power options covered by Medicare limit the person to a horizontal plane. In the home, access to the vertical plane is also required for mobility related activities of daily living. Power standing systems on power wheelchairs are one option for providing access to the vertical environment, although currently these systems are not covered by Medicare. Power standing systems also aid in medical management and in preventing common comorbidities associated with chronic neurological and congenital healthcare conditions. Therefore, a legal group led an interdisciplinary effort to change Medicare policy on power standing systems. A policy analysis using Bardach's Eightfold policy framework was conducted to analyze a clinical groups' action within this interdisciplinary team. The clinical team considered three viable options to address the problem and evaluated these options against five criteria. Ultimately, a national coverage determination reconsideration would provide a needed opportunity for the coverage of power standing systems. Suggested coverage criteria for power standing systems, based on existing literature and expert clinical experience, are proposed.