Page 15 - Mobility Management, October/November 2019

and maybe they need an alternative drive control to drive their chair — most Group 2s can’t accommodate that. Their medical condition isn’t changing; the condition is just progressing, so you can’t get them a new chair once they’ve progressed because their condition hasn’t changed.”
Angie Kiger, M.Ed., CTRS, ATP/SMS, Clinical Strategy & Education Manager for Sunrise Medical, said about such condi- tions, “When I first started with power wheelchairs, it was ‘Plan for today with tomorrow in mind.’” Admittedly, though, payors often focus more on the present, which can mean that clinicians and ATPs have to be smart and creative to be sure they’re getting a full and accurate picture of what their clients need.
“When you’re evaluating somebody,” Stephenson said, “you have to ask the question: Is this your typical performance of these activities, or is it because you’re well rested, or maybe your medication is working especially well today? You need to differentiate: Is this your normal day-to-day, or are you performing so well because you feel better than normal today, right now?”
Kiger agreed that asking questions to get a fuller perspective is critical. With MS, for instance, “you’ve got to think about what they look like on their best day and what they look like on their worst day,” she said. “And you have to look at their comorbidities.”
reaction that makes patients’ blood pressure rise and makes them behave differently in front of medical personnel. So, “you have to try to paint a picture, rather than just looking at how they are in that moment,” Kiger said. “I ask, ‘Do you have any pictures of you out and about in the community?’ I just want to see what they look like asopposedtothatday,whenthey’reprobablygoingtobedresseda little nicer, they’re probably going to be looking better. See if they’ve got videos [of themselves] on their phone; they often do, like ‘This was me at my grandchild’s picnic.’ While you’re looking at those, you’re able to see what they look like on a Saturday afternoon when they went to their grandchild’s birthday party.”
OBLIGATIONS TO PAYORS & PATIENTS
Even when the client has a diagnosis that, as Stephenson said, has been aligned with a Group 3 power chair, it’s still necessary to demonstrate why a lesser mobility device won’t suffice.
“We have to always rule out the lesser equipment,” Kiger said. “It’s like climbing a ladder: This is why a cane’s not going to work, this is why a walker’s not going to work, this is why a manual chair won’t work. The same thing happens with power chairs: You have to look at maybe they can do a sit-and-drive wheelchair now, but if it’s a progressive condition? How fast are they going to progress? What
Kiger also references “White Coat Syndrome,” the subconscious road are we headed down?”
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