Page 22 - Mobility Management, April 2019

ATP Series
The Complexity of E1161
provide easier mobility and those with greater tilt ranges to maximize the benefits of pressure relief. The market is starting to see more manufacturers develop new posterior tilt technology devices that provide a limited tilt range, which includes only up to 20° of tilt and meets the code E1161. Each manufacturer may provide its own unique benefits for the clients, e.g., light weight, foldable frame, and low seat-to-floor heights. The challenge is
to provide a product that supports the clients’ changing needs today, which might need minimal tilt range for some positioning, but long-term needs might require more tilt for pressure relief when a client diagnosis progresses. We are also starting to see more power add-on devices configured with E1161 chairs.”
“Improvements and refinements in rotational tilt-in-space technology have brought about a new generation of wheelchairs that are less disruptive and more intuitive for the user and safer and easier for a caregiver to operate,” said Karl Schultz, Associate Product Manager, Freedom Designs and Invacare Corp. “The
use of higher-quality materials and manufacturing techniques is providing parts and components that operate and function with durability and precision.” Foster Davis, Rehab Sales Specialist
for Invacare Corp., added, “The PRO-CG [E1161 chair] from Freedom combines light weight with 24" wheels, which can allow some patients to propel for vestibular training, spatial awareness, and less dependence on caregivers.”
“Knee-tilt style tilt-in-space wheelchairs have been around
for a while,” said Frank, “but until the introduction of the Ki Mobility Liberty FT in 2018, there was no model available that was also lightweight and portable. This is the first chair of its kind to combine ease of transport with STFH options that facili- tate foot or hemi-propulsion and the ability to change seat angle to optimize postural support and activity-specific positioning.
“One particular population that could benefit significantly
from the features of the Liberty FT is individuals who have had a stroke. In the United States, the stroke population may be underserved in terms of the equipment they commonly receive. Often, individuals who’ve had a stroke are provided with stan- dard manual wheelchairs that may be inadequate in providing postural support, especially with regards to independent mobility, or they are placed into manual tilt-in-space chairs in which they are completely dependent.”
But there are other options, Pucci said. “In many cases, these individuals are assumed to be incapable of any independent mobility and MRADLs, without even being given the chance to explore the possibility. Sometimes this may be a limitation of the individual’s diagnosis and impairments, but many times, it may
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be a limitation of the equipment they’ve been provided.”
Overcoming E1161 Challenges
Despite the many benefits to be had, accessibility to E1161 chairs can still be a challenge.
“Medicare and competitive bidding have set up a paradigm where people are afraid of trying to do anything to service that popula- tion [of users],” said Tom Whelan, VP of Product Development, Ki Mobility. “They’ve become so rote that everybody’s going to get a K0003 wheelchair — if you’re lucky, you might be able to bump them to K0004. Then there’s competitive bidding, and to get to
an E1161, there are a couple more hurdles: Now an ATP has to be involved. And K0003s and K0004s don’t require ATPs.”
The added work and the uncertainty of success can make some providers hesitant to offer an E1161 chair instead of a standard manual one. But Whelan added, “That doesn’t mean we can’t create a different paradigm, and that’s what we’re trying to do with the Liberty FT. We know there is nothing in Medicare that prevents
a better paradigm for stroke patients who really do need a better level of intervention to meet their needs. The Medicare system does allow a stroke patient who needs it to get an E1161. Their own poli- cies allow and set up a clear path for access to E1161 technology.”
Pucci said, “I think the confusion about ruling out lower-level [wheelchairs] is within Medicare’s LCD. To get from a K0003 to
a K0004, you have to address someone’s ability to independently propel the chair within their home environment. When you move to the E1161, you don’t have to necessarily address propul- sion. What you have to address is the functionality of that chair that cannot be provided in an upright manual chair — so, the tilt function or the adjustable seat angle function. I think that creates confusion when people are trying to go through that justification process.
“As a clinician still working in a seating clinic, I let patients and families know: There are chairs that fall within this code that provide more options. I will educate them and show them.”
Rita Stanley, VP of Government Relations for Sunrise Medical, said access to E1161 chairs hinges on documentation: “Since the Medicare coverage policy only requires the beneficiary meet all the requirements for a manual wheelchair plus a specialty evaluation by a qualified OT/PT, etc., and be provided by a supplier with an ATP involved in the selection — the documentation is the key. It is important to detail what features the consumer requires that are not available on any lower-level device. So, in the case of tilt, the justification needs to provide objective details regarding why the person needs tilt... and of course, they need to justify the other components being requested as well.”
Michael Salvi, Director of Passive Manual Mobility & Seating for Invacare Corp., said the many benefits of today’s E1161 are worth pursuing. “The ease of tilt and maneuverability are critical. Tighter frames as a result of these technologies and our advance- ments in center-of-gravity tilt and manufacturing improvements really make a difference to the caregiver. Technology has truly benefited the caregiver as well as the end user.” m
Medicare does allow a stroke patient who needs it to get an E1161
— Tom Whelan
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