It's hard to pigeonhole rehabilitation. An auto-accident victim might have different needs than an elderly patient who has suffered a stroke. One wheelchair will not fit all, or even just a few. Clinicians and Rehab Technology Suppliers (RTSs) determine specific equipment needs only after a detailed technology assessment.
Fitting such work into the Medicare system is a puzzle that CMS has been piecing together for almost a year. At press time, some observers were expecting as many as 40 new wheelchair codes to be thrown into the mix. Meanwhile, a government panel called the Interagency Wheelchair Work Group, consisting of clinicians from several federal agencies, has developed a proposal for new coverage criteria. When the codes are released and the coverage determination finalized, the industry is hoping Medicare officials consider all that goes into making a patient functionally mobile.
However, because rehab experts say their equipment recommendations can change so dramatically from patient to patient and, many times, from funding situation to funding situation, it makes setting reimbursement standards all the more difficult.
One advocacy group, the Coalition to Modernize Medicare Coverage Policy for Mobility Products, has attempted to clear up the picture. The coalition's Clinician Task Force has submitted a long list of recommendations to CMS, among them that the agency consider specific levels of mobility needs.
In addition, as the industry muddles through coding and coverage criteria challenges, patient advocates say putting a human face on rehab can be a learning experience and a healthy exercise.
Consider, for example, a 47-year-old woman who's had multiple sclerosis for 10 years, has balance problems and frequent falls. According to Barbara Crane, a physical therapist and professor at the University of Hartford who is co-coordinator for the clinician group, the process starts with asking many, many questions. Crane explains that the woman's specific physical limitations — the fact that she falls frequently and she can't ambulate without assistance throughout the day — scrapes just the tip of the iceberg when evaluating her mobility needs.
Lifestyle factors must be considered: The woman is employed part-time. She has two children and a husband who works a long week. She gets the kids ready for school in the morning, works in her home office for a few hours, then, exhausted, sleeps for several more before school is out. She drives to pick up the kids and wants to do so for as long as she is able. She helps with homework and cooks dinner.
Even this picture is just the beginning. How many times a day does the woman fall? When? How much time is there between falls? Through in-depth analysis, Crane must find the idiosyncrasies behind balance and coordination problems, along with a host of other clinical data.
Then, armed with such information, Crane works with an RTS to match technology and equipment to the woman with MS. It's a time-consuming but important process. For those needing mobility assistance, Crane says, “it's a very, very difficult transition.”
For a copy of the Clinician Task Force's coverage recommendations to CMS, visit www.cliniciantaskforce.org.
