Page 19 - Mobility Management, February 2019

complex rehab technology, that ultralightweight chair, the individual’s got to be a full-time user, and there has to be some fitting or feature about that ultralightweight, adjustable chair that cannot be accommodated by a lower-level piece of equipment.”
Once the seating and mobility team has qualified a stroke client for a standard manual chair — K0001 through K0004 — there is a decision to be made. Yes, these wheelchairs can work in the client’s home. But is there a better, more functional answer, at least for some stroke clients?
Taking medical justification to the next level can be a lot more work. Given the busy days of clinicians and ATPs, is a possibly modest improvement to a client’s functionality worth the amount of effort it would take to justify a more fully featured chair?
Curt Prewitt, MS, PT, ATP, is Ki Mobility’s Director of Education, and he acknowledged, “Some folks are much more comfortable getting down to that greater level of detail and really fleshing out that justification, and some folks, frankly, might have a little bit harder of a time, feeling like maybe they’re asking for too much. They see it maybe as a significantly tougher fight to try to convince [the payor] for what might seem to be just a little more benefit.”
Linda Bollinger, PT, ATP, DPT, Clinical Education Manager at Sunrise Medical, said stroke patients’ environments can also play a role in the equipment they receive.
“I feel as though the self-propelling manual wheelchairs are less considered for the elderly/stroke patients due to two basic reasons: opportunity and process,” Bollinger said.
“When we think of the opportunities for the elderly/stroke patient to be assessed for self-propelling manual wheelchairs, we must consider the location of the client. For example, if the patient resides in a nursing home, the nursing home is
responsible for providing the wheelchair as part of the nursing home rate. Therefore, the patient is generally given a wheelchair from the ‘equipment closet.’ This closet is often stocked with standard wheelchairs that can be assigned to any resident.”
While therapists do their best to fine-tune such chairs to their clients’ individualized needs, Bollinger said, “Self-propelling may not be a consideration, especially when the goal is finding
a method to get the individual out of bed safely. In addition, because [therapists] are using standard equipment, they are unable to ‘optimally configure’ the wheelchair using components such as adjustable wheel axles and seat angles.”
Bollinger added that discharge teams who order equipment for stroke patients preparing to leave the hospital “may not necessarily include a seating and mobility specialist. The patient will generally have Medicare as primary funding. The discharge team is usually more familiar with the standard equipment (competitive-bid prod- ucts) versus complex rehab technology products. Again, this limits the consideration of self-propelling manual wheelchairs.
“If the patient is fortunate enough to be referred to a thera- pist with seating and mobility experience, then the evaluation and funding process is what often hampers the acquisition of
a self-propelling manual wheelchair. Even when the individual qualifies for a K0005 wheelchair, the individual does not always want to take the time needed to document the need. I had many patients complain about the number of appointments for the process, which includes face-to-face appointments with the doctor, therapist evaluations, equipment trials, etc. They also complain about the time the documentation process takes. Many will opt for just ‘getting what Medicare covers’ in an effort to get a wheelchair quickly and easily.”
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