Complex rehab: Collaborate for change

Q. What is the current state of complex rehab? 

A. When you consider the state of complex rehab technology today, are you impressed by the advancements, or do you wonder why there aren’t more innovative and breakthrough technologies that address the unmet needs of people living with disabilities? While I have seen some impressive and innovative products over the last few years, few have become widely available in the U.S market. There are many barriers to bringing new products to the market in the U.S. New products that align with the current codes and payment are more likely to be successful.  

Reimbursement is one barrier that comes to mind. If the available reimbursement is too low, few people will be able to access new technologies. Coding can be an additional barrier, and one I have a particular interest in, as I see coding as the foundation for reimbursement and coverage policies.  

Most CRT codes were established 20 or more years ago, and the code characteristics and testing requirements have not been updated. Consider the fact that there is only one HCPCS code, implemented in 1993, to represent the array of ultralight weight manual wheelchairs. Anyone who understands the high degree of variation in features and function of these wheelchairs knows the impact having only one HCPCS code and one reimbursement amount has on access.  

Change is needed. Change is possible. 

However, meaningful change cannot happen without dedicated effort and collaboration by all stakeholders. A stakeholder consensus conference involving all stakeholder groups would allow development of a blueprint for change. Consumers, payers, clinicians and physicians, suppliers, manufacturers, researchers and testing facilities, and those who develop product testing standards need to come together to discuss comprehensive change to improve access to innovative technologies. A consensus is important and should improve access to public and private funding of the necessary work. 

Rita Stanley is principal and policy consultant at Merriman Innovation Consulting. Reach her at rita.stanley@merrimaninnovation.com.