Mobility Matters hits another nail on the head

The Mobility Matters bulletin sent out yesterday by AAHomecare featured a Q&A with Mark Schmeler on the documentation process for power wheelchairs (the last bulletin, you'll remember, featured an interview with Dr. Jerald Winakur on the same topic). Schmeler, assistant professor in the Department of Rehabilitation Science & Technology at the University of Pittsburgh, makes a good point—that CMS is asking for something that physicians, at least general practitioners, usually can't provide. Here are a few snippets from the Q&A that illustrate this point:

Medical records need to reflect an impairment, lack of function, or inability to perform a necessary activity of daily living that could not be performed without the power wheel-chair. Physicians especially never had to do this in the past nor do most really understand the intricacies of mobility devices given there is so much else they need to understand to be good general practitioners or specialists in areas of practice not necessarily directly related to rehabilitation. It is difficult to suddenly hold physicians to a new standard when things were so lax and vague for many years."

And:

The reality...is that the documentation can only be as good as the level of understanding the physician or therapist has related to the treatment intervention. Even many physicians or therapists trained in rehabilitation have limited knowledge of power wheelchairs, let alone the complexity of the new coverage policies. The reality is that once you take the time to dissect the coverage language (which most do not have the time or desire to do), it is not that complicated especially if you have training in rehabilitation. But suddenly, physicians are being asked for an assessment of the patient's strength, range of motion, their function, etc. Many physicians may look at the requirements, and say, 'I don't do this kind of medicine, I don't know what they're looking for.'"

The answer, Schmeler says, is for the physician to refer the patient to an OT or PT who specializes in rehab. But the policy doesn't make it clear that this is an "acceptable referral pathway." So what is there to do? It's easier to state a problem than to identify an alternative, but Schmeler says everyone would benefit from:

• CMS providing better guidance to physician; and
• The industry identifying, defining and documenting an "an acceptable standard of practice for the provision of mobility devices that CMS will likely reference for future policies."

Schmeler's bottom line:

We have a growing population of people with mobility limitations who want to remain active participants in their homes and communities. The spirit of our nation is to allow them to keep their freedom and independence and not be stuck in a nursing home. Powered mobility is an obvious viable option for many—we just need to figure out a way to provide this in a reasonable manner that ensures those who need powered mobility get it without too much burden. The government, industry, clinicians, and consumers each have a role and stake in finding this balance. CMS is certainly in the position with the most power to facilitate this through appropriate policy guidance."

Liz Beaulieu