PITTSBURGH – Mark Schmeler, PhD, OTR/L, ATP knew that stakeholders were not happy with the wheelchair service delivery process, but he admits, “Our grade point average is actually worse than we thought it was…Sometimes you have to study what you already know to have science behind what you’re saying.”
The science came via a survey conducted by the University of Pittsburgh, The Ohio State University, and the University of Michigan. The data revealed that just 18% of 1,052 respondents felt positively about the delivery process. “Health policy is driven by data,” says Schmeler, an associate professor and vice chair for Clinical Services and Policy at the University of Pittsburgh School of Health and Rehabilitation Sciences. “There’s no trust between our industry, our providers, and payers.”
According to the study, respondents included clinicians (41%), suppliers (30%), consumers/caregivers (24%), manufacturers (3%), and payers (2%). “Funding and procurement was viewed in the least positive light, with 5% positive responses,” researchers wrote. “Follow-up, maintenance, and repair was the second least positive component with 9% positive responses. Fitting, training, and delivery was viewed most positively with over 42% positive responses.”
Conclusion: The wheelchair service delivery process is not viewed as performing well by its stakeholders. Funding, procurement, maintenance, and repairs are viewed particularly negatively, representing opportunities for focused system reform efforts.
Medtrade Monday sat down with Schmeler (pictured), who also serves as director of the International Seating Symposium (ISS) when hosted every other year in the U.S., to discuss the reasons for distrust—as well as the possible effects of “wild card” issues such as tariffs.
Medtrade Monday: What issues are top of mind when trying to establish a better framework for wheelchair service delivery?
Schmeler: One area of interest is value-based care. The problem is how do you measure value? Is a lower cost wheelchair better value? How do you measure that value? The ‘winner’ in this scenario could be the person providing the cheapest wheelchair that doesn’t meet the need. The loser could be the person who’s trying to do the right thing that may cost more money.
Medtrade Monday: How might tariffs affect wheelchair costs?
Schmeler: Usually medical devices are exempt from tariffs. That was a point of discussion at ISS. However, the materials that make up the equipment, the steel for instance—we don’t know where that is sourced. That’s where the tariffs might start kicking in, so it’s unknown.
Medtrade Monday: What if significant Medicare and Medicaid cuts become a reality?
Schmeler: My concern is that quality of equipment will suffer. We are already seeing that. One of the larger data sets we have looks at wheelchair repairs and failures, and that is increasing over time. There is no desire or payment to do preventative maintenance. Choices are going away.
Some of the bigger providers are going to have to move toward more volume discount approaches. Instead of having five different kinds of wheelchairs that fall into a code category, it may come down to two or even one. Manufacturers may be building a device that meets a price point because suppliers/clinicians have to pay an ATP, pay their people, and meet a certain margin. That’s not just with CRT. That’s happening all over health care.
Medtrade Monday: What is one main reason for the prevailing distrust among stakeholders?
Schmeler: I believe we’re still on ‘probation’ because of the Scooter Store [fraud scandal from more than a decade ago]. It still comes up with policy people.
Medtrade Monday: How does CRT fit in with DME?
Schmeler: Complex rehab does not fit well with DME. It aligns better with prosthetics and orthotics. It’s a similar skillset. Prosthetics is replacing a limb. CRT is putting someone in a wheelchair. As a society, we still don’t value the wheelchair. When you factor in the history of waste, fraud, and abuse, it puts us behind. There is a lot we have to do to put our house in order.
