Coordination Is the Key

Subscribe | Advertise | About Us | Contact Us | Home

October 2001

By Ginger Walls, PT, MS, NCS, ATP s Successful seating and mobility outco

Physical and occupational therapists must be knowledgeable in principles of seating/mobility and in durable medical equipment.

The primary goals of wheelchair seating and mobility systems are to maximize the independence and safety of the person using the system. Other important goals include increasing comfort, increasing environmental access, preventing skin breakdown and aspiration, integrating with environmental control units and/or computer technology, and maximizing postural support/alignment and customer satisfaction. A client who is able to work as part of an integrated, organized seating clinic team has the best chance to achieve these goals, regardless of their diagnosis or position in the continuum of care. Key components to reaching successful outcomes for patients in seating and mobility include the following:
1. Intervention of a physical or occupational therapist knowledgeable in principles of seating/mobility and in durable medical equipment (DME) products.
2. The PT or OT recommending the DME must also be knowledgeable about third- party reimbursement for DME.
3. A knowledgeable and customer-friendly DME vendor who specializes in rehab equipment must be involved in the DME recommendation process.
4. Trial or "demo" equipment must be available for the client to try different equipment options.
5. Coordination among the patient, therapist(s), vendor, and insurance company is necessary for successful outcomes.

Positive Intervention
Because the primary purpose of seating and mobility systems is to assist the disabled population in maximizing their posture and function, PT and/or OT involvement is critical to the successful achievement of this goal. Maximizing posture and function are part of therapists' special body of knowledge. Patients who obtain DME directly through the recommendations of a DME vendor miss out on vital therapist input. DME vendors alone do not have a sufficient medical rehabilitation background to fully and accurately perform assessment and intervention with seating and mobility equipment for the disabled.

The PT/OT involved with the seating/mobility evaluation and DME recommendation process must be knowledgeable in this specialized area of practice. An experienced therapist who knows the elements of a thorough seating and mobility evaluation and who has a comprehensive knowledge base about DME products is able to creatively and practically integrate this information to provide the best possible recommendations and outcomes for the client. PTs and/or OTs who have experience in seating may be eligible to sit for the RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) examination for credentialing as an ATP (assistive technology practitioner). Providing therapists with the continuing education and support to obtain and retain this credential adds credibility and provider quality assurance to seating outcomes. A rehabilitation engineer (RE) is also able to sit for the ATP examination and can be a valuable member of the seating team.

Reimbursement Expertise
Therapists understanding how to perform a seating and mobility evaluation and having a strong product knowledge base are not sufficient by themselves. Therapists must also be knowledgeable about third-party reimbursement for DME. If the therapist completes a comprehensive evaluation and DME recommendation, but the client is not eligible for the DME recommended, then the outcome is still poor. The therapist must know up front who the client's insurance carrier is and what eligibility requirements exist for new DME. The therapist also must have a good working knowledge of the Medicare qualifying criteria for various types of wheelchairs and seating equipment. Many third-party payors use the Medicare guidelines as the basis of their approval criteria as well. The basic rule of thumb is that a Rolls Royce is not medically justifiable when a Chevy will do. With good documentation and justification, clients have the best chance possible of having their insurance pay for the equipment they need and qualify for. Therapists are frequently required to write letters of medical necessity (LMNs) to provide medical and functional justification for the DME recommended. The LMN must include the client's diagnosis, age, height, weight, secondary diagnoses, prognosis, functional status, problems with and/or complications caused by the client's present DME, and expected outcomes with the new DME recommended. The LMN must specify why the client requires the exact DME specified, including why less expensive equipment will not meet their needs and/or why any upgraded accessory item is required.

Your Friendly Neighborhood Vendor
The extent to which a vendor can impact the success or failure in seating outcomes cannot be understated. It is important for therapists and clients to understand that they have a choice about who will provide their DME. Not all DME vendors are created equal. Some vendors sell patients expensive DME irresponsibly and without regard to client outcomes. Some vendors only occasionally sell rehab DME. Some vendors sell rehab DME as only a small part of a large medical equipment and/or home oxygen business. Vendors who specialize in custom rehab DME are best equipped to assist the therapist and the client in reaching the best seating outcomes.

A vendor who specializes in rehab DME must be extremely knowledgeable about a broad range of DME products and reimbursement. In addition, the vendor should have a strong service component to their business, so that the patient can depend on the vendor to make repairs to their DME when needed, including "house calls." The vendor must have a customer-friendly customer service department, staffed with people who can answer questions from therapists and clients about DME orders, reimbursement, and service. These vendors must be able to work with multiple third-party payors as well.

An experienced rehab DME vendor may qualify to sit for the RESNA examination for credentialing as an ATS (assistive technology supplier). The ATS certification represents the highest standard of expertise and quality in the field for vendors. Many vendors also obtain certification as a certified rehabilitation technology supplier (CRTS) from the National Registry of Rehabilitation Technology Suppliers. Therapists and clients looking to elevate the quality of service and outcomes in seating and mobility should involve ATS-credentialed vendors in their equipment evaluation and recommendation process. An experienced ATS understands his or her role on the team and is able to successfully contribute to the skills of the therapist for benefit of the client.

Try Before You Buy
The best way for a client, therapist, and vendor to assess how the equipment recommended will work is to have the client try it out during the seating evaluation. This simulation or "test drive" allows the client, therapist, and vendor to see if DME recommendations and/or modifications produce the outcome desired. Because it would be impossible for any therapist or vendor to stock every type of wheelchair and seating system on the market, it is helpful for the therapist and the vendor to have good relationships with the manufacturer representatives from a variety of equipment companies. The manufacturer representatives can work with the vendor and the therapist to ensure that adequate trial wheelchairs and seating equipment are available to assist with patient evaluation and equipment recommendation. This demonstration equipment is also helpful in educating the client about their DME choices. In addition, manufacturer representatives are helpful in providing therapists and vendors with resource information about their products.

Communication Emphasized
The therapist and the vendor must educate the client about their roles and the steps involved in the process of equipment evaluation, recommendation, procurement, and follow-up. After the seating and mobility evaluation is completed, and the therapist, vendor, and client agree on what DME will be ordered, the process of medical justification to obtain insurance authorization begins. The therapist and vendor must work with the patient and his or her physician to ensure that all necessary documentation (prescriptions, LMNs, CMNs [certificates of medical necessity], required by Medicare in addition to LMNs, and any other insurance specific forms) is correctly completed for submission by the vendor to the insurance company. The insurance authorization process frequently takes longer than any other phase of DME procurement. Communication from vendors to clients and therapists during the time of waiting for authorization helps them understand where their order is in process. Once the vendor obtains insurance authorization for the DME, he or she should be able to order it from the manufacturer(s), assemble it, and prepare it for delivery to the client.

The client, therapist, and vendor should agree at the time of evaluation where the fitting of the new DME will be done. With custom seating and positioning equipment, the best outcome is achieved if the client returns to the seating clinic, so the therapist and the vendor together can fit and train the client with the DME. The facility should have a designated person whose role is to coordinate seating appointments among the client, the therapist, and the various vendors and to obtain physician orders and insurance authorization for these appointments. With more basic DME, a rehab DME vendor is able to make the delivery and perform the fitting and training independently.

The best client outcomes for seating and mobility can be obtained with experienced therapists and vendors, knowledgeable in the principles of seating and mobility, DME options, and reimbursement, working together with clients to meet their needs.

Ginger Walls, PT, MS, NCS, ATP, is clinic manager for the National Rehabilitation Hospital (NRH)/Regional Rehab, Washington, DC, and neuro program specialist for the NRH/Regional Rehab Outpatient Network. She is also chair of the Spinal Cord Special Interest Group of the Neurology Section of APTA.

LOOKING FOR EXPERT ADVICE?

Experts here are available to answer all your questions!

Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER

Interactive Media

Resources

	Classifieds
	Calendar
	Consumer Resources
	Media Kit
	Advertiser Index EAB Reprints Submit an Article

Featured Jobs

Administrative Director Heart & Vascular Center
Quincy, Illinois

OT Occupational Therapist
LaGrande, Oregon

Hospitalist Dorchester General Hospital
Cambridge, Maryland

More Jobs...

Find a Job

www.thejobcure.com

ADDITIONAL ONLINE RESOURCES

Allied Healthcare		Medical Education
24X7mag Chiropractic Products Magazine Clinical Lab Products (CLP) Orthodontic Products The Hearing Industry Resource HME Today Rehab Management	Physical Therapy Products Plastic Surgery Products Imaging Economics Medical Imaging RT Magazine Sleep Review	SynerMed Communications IMED Communications
		Practice Growth
		Practice Builders

Become a featured employer

Featured Employer

Triage Staffing

Our Values and Priorities are In Order

Are you looking for a little less "give" and a little more "take?" Do you have a proven track record of patient care and professionalism?

Let's Explore Partnering Our Strengths Today

October 2001