Trends in Wheelchair Recommendations in a Dedicated Seating Department

In the early 2000s, the federal government discovered rising Medicare expenditures for power mobility devices. Investigations revealed high profit margins and fraudulent activity, which resulted in legislation changes. This spurned changes over the past 20 years that have the potential to impact patient access to wheelchairs. However, no longitudinal research studies exist that examine wheelchair recommendations over a period of time. Therefore, this research sought to understand how the demographics of people needing wheelchairs changed over an 11-year time period, and second, how the type of equipment recommended changed over time.

This quantitative, descriptive study utilized a retrospective chart review of all letters of medical necessity written by physical and occupational therapists in a dedicated seating department between 2007 and 2017. Only recommendations that included a wheelchair base were coded. The seating department, consisting of about four full-time physical and occupational therapists, served people of all ages and diagnoses that presented with a need for wheelchair services. Services were provided onsite as outpatients and mobile in the community. Select inpatients were seen until 2016, when the seating department added inpatient spinal cord injury patients to their caseload.

During the analysis, age, sex, type of wheelchair (manual or power mobility device), complexity of wheelchair (standard or complex), and cushion complexity (1. General or standard use; 2. Skin protection, positioning, or both non-adjustable cushions; 3. Skin protection, skin protection and positioning adjustable cushions, and 4. Custom or not-coded cushions) information was coded from the documents. Funding source was examined for the 2017 recommendations only. Intra-rater reliability was calculated for 10% (n=452) of the documents. A descriptive analysis of the demographics and recommended wheelchairs and cushions occurred.

The results display changes in 4,252 wheelchair recommendations made over the time period in the categories of standard and complex wheelchair equipment and cushions, in relationship to population characteristics including age, sex, and diagnosis. Over the 11-year time period, recommendations grew from 295 to 658 per year. The median age of the sample increased from 33.2 years of age in 2007 to 39 years of age in 2017. Recommendation counts grew the most for people in the 19-64 age category, from 167 in 2007 to 364 in 2017. Overall, more complex wheelchairs were recommended than standard (n= 3,576, 84.1%).Standard and complex power mobility device recommendations changed more than standard and complex manual wheelchair recommendations, with recommendations for standard power mobility devices growing over the time period. Cushion recommendations for the general category grew over the time period. In this sample, people without Medicare were more likely to be recommended complex manual wheelchairs (n= 291, 76.0%) and power mobility devices (n= 89, 33%).

In conclusion, this study did reveal changes in the recommendations made for full wheelchairs over an 11-year time period, which may be related to external economic and healthcare policy, and internal, organization factors. Most notably, the results directly relate to policy with implications for the proposed bill, H.R. 2408 Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019. A slight decline occurred in complex power mobility recommendations for people over the age of 65, in spite of an increase in the number of recommendations this age category from 2014-2017. More research is needed to determine if this is due to policy changes restricting access to complex equipment, or if due to changes in population needs.

References

Sprigle, S., & Taylor, S. J. (2017). Data-mining analysis of the provision of mobility devices in the United States with emphasis on complex rehab technology. Assistive Technology. https://doi.org/10.1080/10400435.2017.1402391

Stanley, R. J. (2015). Medicare and complex rehabilitation technology: A 20-year review: The impact of delegislation and regulation on complex rehabilitation technology. Topics in Geriatric Rehabilitation, 31(1), 74-87. DOI: 10.1097/TGR.0000000000000045

Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019, H.R. 2408 116th Congress. (2019). Retrieved from Congress website https://bit.ly/304yJ3B