Rolling the Right Way: The Physician’s Role in Wheelchair Prescription

摘要

Ms. Rholing, a 45-year old mother of 2with primary progressive multiple sclerosis,presented to the wheelchair clinicat Southern New England RehabilitationCenter for evaluation of her mobility status.Two years ago, with a prescriptionfrom her well-intentioned doctor, thisunfortunate woman obtained a simplepower chair that no longer meets herneeds. Like 177,000 other Rhode Islanders,Ms. Rholing has Medicare as herprimary insurer.1 Due to her physician’slack of awareness of stringent Medicareguidelines and documentation requirements,she is now precluded from obtaininga new, more appropriate, wheelchair.In an era of advanced medical technology,wheelchair prescription remains amisunderstood and undervalued service.Had Ms. Rholing initially been evaluatedat a wheelchair clinic by a team of expertsincluding a physical therapist, anoccupational therapist, and a qualifiedmedical supplier, the outcome wouldhave been much different. In this articlewe offer a model for a comprehensivewheelchair and mobility evaluation. Ideally,the evaluation should include:? Medical history? Current medical issues? Psychosocial history, includingarchitectural/community barriers? Musculoskeletal structure/function? Neurologic structure/function? Postural assessment? Functional mobility/activities ofdaily living? Skin integrity/sitting tolerance? Equipment history? Trial of new equipmentOnce this process is concluded, thetherapists formulate a detailed letter ofmedical necessity, highlighting the requiredequipment and justification for each component.This letter is forwarded to themedical supplier and the referring physicianfor review and signature. Given theprogressive nature of Ms. Rholing’s diagnosis,a skilled clinic team would have prescribedan adaptable wheelchair with advancedelectronics and seating options, capableof addressing the client’s deterioratingfunctional capacities. Medicare expectsthat a wheelchair base will meet the client’sneeds for a minimum of five years. Duringthat time, Medicare will reimburse upgradesbut historically has not approved anentirely new seating system.