In wake of survey, ‘it’s time to rewrite CMS policy,’ stakeholders say

PITTSBURGH – A recent survey that shows most stakeholders are not satisfied with the current wheelchair service delivery process is damning but necessary if the industry wants to drive change, Mark Schmeler and Brad Dicianno say. 

The survey, conducted by the University of Pittsburgh, The Ohio State University and University of Michigan, found that only 18% of 1,052 respondents felt positively about the delivery process. 

“People may say, why is this significant; we knew people felt this way,” said Dicianno, MD, medical director of the Center for Assistive Technology at UPMC, director of the Adult Spina Bifida Clinic at UPMC, and medical director and COO of the Human Engineering Research Laboratories (HERL), a partnership between VA Pittsburgh Healthcare System and UPitt. “But it’s important to document this, so we’re not just saying people are dissatisfied and giving hints as to why. That’s really important as we move to make changes to policy.” 

Of the respondents, 41% were clinicians, 30% suppliers, 24% consumers/caregivers, 3% manufacturers and 2% payers. 

The part of the delivery process that is one of the most problematic is what Schmeler calls “after care – the things that happen after they get their wheelchair.” While fitting, training, and delivery were viewed most positively with more than 42% positive responses, follow-up, maintenance and repair were viewed the second least positively with 9% positive responses, according to the survey. 

“The survey data cleary show a huge deficit in after care,” said Schmeler, PhD, OTR/L, ATP, associate professor and vice chairman for clinical services and policy for the Department of Rehabilitation Science & Technology at UPitt and director of the Center for Assistive Technology at UPMC. “There’s so much attention on getting a wheelchair, we kind of forget what they need once they get it – even the clients do.” 

The part of the delivery process that was viewed least positively: funding and procurement, with only 5% positive responses. Dicianno and Schmeler acknowledge there is a balancing act between making sure there isn’t another “Operation Wheeler Dealer,” a campaign CMS launched in the early 2000s to stop fraud involving power wheelchairs, and protecting access to equipment and services.  

“CMS and other payers don’t allocate enough funding or have enough of a billing structure for us to spend enough time with clients,” Dicianno said, whether it's for fitting, delivery or maintenance and repair. 

Now Dicianno, Schmeler and other researchers are getting to work on how to marry the results of the survey with other data sets, including the Functional Mobility Assessment, which has grown to 17,000 deidentified cases, to show how serious the problems are with the delivery process and to drive policy changes, including a potential separate benefit for complex rehab technology. 

“The idea is to combine common sense with research data to show it’s time to rewrite CMS policy,” Schmeler said.

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