A nail, a horse, and a lost war

It's always a pleasure to speak with Weesie Walker, the executive director of NRRTS and before that a long-time clinician with National Seating and Mobility. Here's the thing about Walker: She may be one of the most unassuming people you know, but she's also one of the smartest.

Being as steeped in the complex rehab world as she is, naturally we talked about the urgent need for legislators (or CMS itself, for that matter) to permanently protect accessories for complex power wheelchairs from being influenced by competitive bidding pricing. As it stands, CMS will transition to bid related pricing for these accessories on July 1, a move that will result in cuts of 25% or more according to estimates and threaten the ability of clinicians to continue providing them.

The word that Walker uses most frequently to describe the possibility of this happening: scary.

“What do you do?” she wondered. “When you're the clinician, how do you approach this with the consumer and explain to them that these cuts are preventing them from getting these accessories. And we hate that word—accessories.”

Walker hates the word because, when we're talking about complex power wheelchairs, these accessories aren't really accessories, or “things that can be added to something else to make it more useful, versatile or attractive.” They're really necessities: indispensible.

Walker says the current situation reminds her of a story her husband likes to tell about a nail and a horse and a lost war. When we got off the phone, I literally googled “nail, horse, lost war.”

It turns out, Walker's referring to a proverb called “For Want of a Nail,” which has many variations, including one that goes like this:

For want of a nail a horseshoe was lost,

For want of a horseshoe a horse went lame

For want of a horse a rider never got through

For want of a rider a message never arrived

For want of a message an army was never sent

For want of an army a battle was lost

For want of a battle a war was lost

For want of a war a kingdom fell

Long story short: The lack of a nail…caused a kingdom to fall.

In Walker's mind, without accessories, a wheelchair will fail.

“If you don't have, say, a head rest, it negates the function of the whole  system,” she said.

Leave it to Walker to put it so simply, yet so impressively.