Complicating Complex Rehab Technology

What a name! Complex Rehab Technology. No wonder the average wheelchair user is staying on the outside of this medicare issue.

Those who are following medicare’s Complex Rehab Technology issue already know what it’s about. For those of you who don’t care, well, you can save your eyesight and head off to your favorite stop. If you’re just confused about all of this complex rehab stuff then stick around and I’ll confuse you even further.

Basically put, complex rehab is what you and I might call high-end wheelchairs or customized wheelchairs with lots of add-ons and lots of special components. You know, the kind of wheelchair that when you see someone tooling around in one you’re thinking “Glad I don’t need one of those.” However, there are many people who depend on just this type of powered wheelchair in order to carry on with their lives or at times to restart their lives.

Today’s complex rehab issue has a pedigree. It is born of medicare parents and includes in its genetic mix past issues such as why a medicare wheelchair is needed, qualifying criteria on where it is to be used, who can get one, what type of wheelchair can be had, what additional components will be paid for, who needs to be evaluated for one, who needs to do the evaluation, who can sell one, how is the cost decided, and of course the usual government mix of laws, regulations and codes that are all bundled up with some very familiar looking red tape.

This issue is the same old story of good guys and bad guys. medicare (Hiss! Yuk!) would like to get a handle on costs even at the expense of their wheelchair using clients. Or are they beneficiaries? No, maybe they are recipients. Anyway, we can certainly agree that they are all people. An alliance of not-for-profit organizations, coalitions, and industry players (Hurrah! Rah-rah!) would like to stop them for reasons that range from it being the right thing to do to the bottom line on the ledger. Somewhere in the middle are a large number of people who use wheelchairs who are not voicing in on all of this and who may very well be confused by this mix of bureaucracy, dollars, ethics, and players.

So why don’t wheelchair users  get it? In my opinion, because there is no focal point in any of this. The Bad Guys give it a high sounding but cloaked name to include leaving out a key word such as “Wheelchair”. The Good Guys pick it up and run with it and then wonder why grassroots wheelchair users don’t get it. The Bad Guys try to box it in their infamous codes so that they can better control things and the Good Guys chase after them thus bringing the focus on the equipment itself and on the Medicare codes that control the flow. Meanwhile the public has to try and follow this bouncing ball so that it makes sense. Guess what? They won’t! At some point the public gets lost in this and extracts themselves leaving the insiders to talk to each other.

In all of these good, bad, and marginal intentions there is still something missing that makes it tough for the average wheelchair user to connect to the issue. That something is people. This issue certainly impacts on people but it doesn’t focus on them any longer except for occasional biased generalities by the sides who chronically reference the good and bad of it as they see it.

From experience, wheelchairs and wheelchair components are never “complex”. People on the other hand are. The PERSON, their physical and functional deficits, their needs, their ambitions and desires are extremely complex and unique. Figuring out the correct wheelchair technology interventions and strategies is complex and tough. Applying those interventions to a person and having the “Person” function as desired in the real world is complex and takes damn near a miracle to achieve. Those are the things that the spotlight should be on and it should be there with laser precision. The wheelchair user and their unique requirements should dictate the wheelchair and its configuration. It’s easy to understand and when plainly stated makes sense to everyone.

Does the average wheeler care what code medicare assigns to a chair or component? Do they care what goes on while the red tape is being applied. No, and they should not. They, wheelchair using medicare recipients, are the object of the exercise and the focal point. Attempting to magnetize grassroots wheelchair users by way of public dissertations on medicare coding, procurement practices or processes doesn’t work. It’s too impersonal, difficult to follow and understand, and boring as hell. Why not just lay it on the table plainly with the PEOPLE in the center so that everyone can understand and relate to it?

Ziggi Landsman

A tip of the hat to those therapists and suppliers who struggle to bring the right wheelchair solutions to their clients and who are faced with limitations and restrictions that make that endeavor impossible.

My sympathies go out to wheelchair users who are dependent on a system that does not understand or recognize them as individuals.

My thanks to all of those who have made a commitment to work toward improvement.

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