Archive for the ‘Complex Rehab Network’ Category


Wednesday, April 11th, 2012

Active American Mobility

Justice was sitting in his driveway on a rainy Monday morning waiting for the school bus to pick him up and start the new week. His normal sitting spot while awaiting the bus was at the end of his yard next to the curb of the cul-de-sac. Today was different. It had been a rainy morning and the ground was saturated. Instead of waiting on the covered porch Justice decided to await the bus while sitting at the end of the driveway on the concrete with his backpack strapped to his shoulders and a small umbrella to protect him from the rain.
His neighbors shared a common driveway between the two homes and, on this morning, Betty, the neighbor, had to leave for work early to make final preparations for an important presentation with the board of directors. Betty’s company was struggling financially and Betty was under increasing stress of getting transferred or, worse, potentially being downsized and laid off. Betty left the house in a rush, opened the door to her Cadillac and quickly started the engine and backed out of the driveway.
She took no notice of her surroundings with the exception that she checked her mirrors and saw nothing evident through the blur of the rain covered glass. The thought did not occur to her that the elementary school bus picked up the children on her cul-de-sac at about this time each morning. After backing out of the driveway, she quickly threw the transmission into gear and accelerated toward the intersection.
At the intersection, she heard some kids yelling and carrying on but took no particular notice. Besides, the work meeting and her company’s financial position were foremost on her thoughts. Just before reaching thirty miles per hour, two children jumped in front of her car waving frantically. Betty slammed on the brakes, stopped the car, and got out thinking “What are you kids doing?” Before she could speak, one child yelled “Justice is caught on the back of your car!” and she saw the other boy run to the passenger rear corner of her fender. Betty gasped in horror as she saw a young blond boy dangling from the fender of her Cadillac, apparently caught and dragged along by his backpack for somewhere between her home and the middle of the street.
Judy, Justice’s mother, asked around to her friend who worked for a local durable medical equipment company, to see if she could get some advice on wheelchairs. Judy indicated that her son had received third degree burns and had been at Children’s hospital for the past week receiving burn treatments for damage to legs and shoulder areas. Following an extended hospitalization, Judy met with the elementary school administration who instructed her that her child needed to begin attending classes immediately or he would be required to either [1] attend summer school or [2] repeat the forth grade next year. Judy felt that in no way was her son ready to attend classes. He struggled with walking and needed to keep his left leg elevated to reduce pain and swelling.
Even though the wheel chair provided to Judy’s son was simple in design, not customized, and did not necessarily fit perfectly, Judy was grateful for the prompt service and delivery of a wheel chair that would provide a solution for her son’s immediate need.

In consideration of this story, I think about how something as seemingly simple as prompt delivery and service to a family in need of a basic item both helped in reducing the stress that this mother was going through and solved an immediate need by providing a means for Justice to attend school while his leg healed over the next two weeks.
Now project a little further into this scenario: a person, loved one, who has had a debilitating accident or progressively debilitating disease and has lost most functioning in his or her arms and legs. The miracle of the previous story is that the child survived the accident and, even during the painful recovery, remained hopeful of a full recovery in a relatively short time. Many disabled persons are not entitled to such hope. Their lives remain forever complicated by their disability and reliance upon others for assistance. Those of us who work in the rehabilitation / mobility device industry must keep our paradigms intensely focused upon client outcomes. Consequently, what many of us frequently forget is that outcomes are very much dependent upon processes. A friendly, interactive face, promises kept, and client centered customer service go al long way toward making a person’s experience positive, no matter how difficult their situation. Positive outcomes are not mutually exclusive of a favorable process. Take the case of the young boy and the wheel chair. The medical device solved the physical problem of temporary mobility; however, I would contend that the value of the customer service remained equally as important so at least the stress could be reduced by knowing and trusting fully that their mobility needs were being met.
Here at Active American, we pride ourselves on taking every individual case personally, trying our best to empathize with the client and their story through customer service and communication. It is difficult enough to admit that you are currently in a situation in life that you have to depend on equipment for mobility or actually need help from others to get through whatever the situation might be… working with a company that offers great customer service we feel is an absolute must.

by Robert Barr, ATP

The Complex Rehab X-Factor

Wednesday, December 7th, 2011

When it comes to providing complex rehab mobility, what is your (my) advantage over other providers that have the same products and services?  What is the difference between each of us through the client’s perspective? How do referral sources look at my ability to provide the best experience and correct products to enhance the client’s quality of life?

The answers to these questions could be defined as “Rehab-X” factors that client’s, physicians, therapists and referrals will judge us by. In all cases my professional relationships and professional network is only as strong as my ability to manage each account as if each is my only account.  This skill set is something I work on daily because I’m not as gifted in time management as I should be.  If I’m able to maintain a high level of contact with my client’s and all those involved, I will certainly develop one “Rehab-X” factor that will stand on its own merits. (more…)

Oh, To Walk Again

Wednesday, October 19th, 2011

by Mike Duenas, ATP

I have seen a lot of rehab equipment manufacturers come and go. Most of this rehab equipment has stood the test of time and gets better as the engineers make advancements with technology. Some equipment however only lasted a few short years and fades away never to be seen again, except for out on someone’s curb for trash pick-up. I came across a YouTube video that caught my attention. I shared it with my oldest son. My son is an army reservist and the video I found showed an “Exoskeleton” that a soldier can wear. This exoskeleton will aid with running and carrying heavy loads without stressing a solider physically. It was the coolest thing I have seen in awhile! It was very compact, light weight and flexible. It allowed the user to do so much more than they would have without using this system. I began surfing around and soon found a company using the same concept for paraplegics.

This company was developing and testing with several clients. It looks like if a client has good upper extremity straight and range of motion, they would benefit from technology! I realize that most clients have “wheeled” mobility and it works perfectly fine for most all they needs. I also know that if we were to be given the choice, most all of us would rather have the ability to walk if we could. This is the next wave of complex rehab that will soon become more than just a topic of conversation during a visit at your next clinic. I sure hope it doesn’t go the way of the “iBot”. I have included a few links that have the video and websites.

Michael S. Duenas – ATP
Active American Mobility

Former Hummer plant to make wheelchair friendly NYC vehicle

Wednesday, October 19th, 2011

Customers of New York City ‘s Metropolitan Transportation Authority may be among the first to ride in a purpose-built wheelchair accessible vehicle, thanks to a purchase from Miami-based Vehicle Production Group.

While VPG remains hopeful that taxi authorities, including New York’s Taxi & Limousine Commission, will buy its MV-1, that appears unlikely until other entries to the “Taxi of Tomorrow” competition are evaluated. Submissions were due in May 2010 and a decision is expected by November 2010.

Compliance with the federal Americans with Disabilities Act will be among the key requirements for any vehicle that will eventually replace the more than 13,000 taxi vehicles operating in New York.

The six-seater MV-1, which looks like a minivan but has integrated wheelchair ramps, will be built in Mishawaka, Indiana, at the same AM Genera plant that made the Hummer, once sold by General Motors.

Complex Rehab Service: A Hindrance or an Opportunity?

Wednesday, October 19th, 2011

By Patrick BoardmanSep 01, 2010
As Published in Mobility Management Magazine

There are many harsh realities to the complex rehab and DME industries. We are faced with an endless barrage of reimbursement cuts, rules changes, and miles of red tape, simply to deliver a piece of equipment to a client in need.

This daunting process could be likened to a marathon runner who is told that the other contestants have to run the 26.2 miles, while he must run 50. Added to the increased distance, the runner must also run with a 200-lb. sack of bricks on his back, and during the race, spectators will try to trip him and make him fall.

Our industry for the first time in our history has coalesced to address these challenges, but much work is yet to be done.

Endangered Providers, New Refugees for Today
Most complex rehab providers will agree that while running this race, service after the sale can often stretch a company to the breaking point.

Earlier this year, I attended a rate hearing at Texas Medicaid with several other companies to argue against the proposed 9.5-percent cut for complex rehab items. The Greater Texas Rehab Providers’ Council (TXRPC) consists of complex rehab providers and partners, with its goal being to ensure provisioning of enabling technologies and accessibility to these technologies for individuals with disabilities. In this rate hearing, about 10 representatives from our industry articulated the access-to-care issues that would result from such drastic cuts.

My peers performed exceedingly well, and we were successful in preventing the cuts. In my presentation to the committee, I explained that these access-to-care issues would have a direct impact in the Houston market.

In the last two years, three major complex rehab providers in Houston closed their rehab doors. The result was a barrage of wheelchair users who suddenly found themselves with no place to have their equipment serviced. In some instances patients were turned away by rehab providers simply because they didn’t have the particular insurance contract held by the patient. In other cases providers simply could not physically add new service patients for fear of failing their own existing clients.

When we think of the term refugee, we think of war-torn third-world countries. The truth is a new form of refugee is emerging in many towns and cities throughout our country. These refugees are “healthcare refugees.” These are individuals who find themselves confined to bed with a broken wheelchair and no rehab provider to repair their equipment.

Fortunately in Houston, the situation has improved. Yet the healthcare refugee issue still looms like a gathering storm. If the gap between reimbursements and costs associated with wheelchair repairs continues, the volume of healthcare refugees will increase at an alarming rate.

So what to do in the interim? Many of our trade organizations and manufacturers continue to fight on Capitol Hill to repeal competitive bidding. If every reader of this article simply picked up the phone and called their representatives to support H.R. 3790, which certainly would be a great first step, it would make a significant and measurable difference. In our office at Active American Mobility, we ask our entire staff to call. We give them the time to do so during their workday. I would certainly encourage you to do so.

Coordinating a Service Program
While legislative efforts are happening, we still have businesses to run. Thus we must look at efficiencies within our own organizations.

Often when a client calls for a repair, the first person who answers the phone handles that repair until it is seen through. There is nothing wrong with this approach. When we formed our complex rehab division at Active American Mobility, this is exactly how we operated.

In the beginning this process worked quite well. But over time, we discovered that this process was becoming more difficult to manage, and the frequency of errors was on the rise.

Our management team decided to create a new position called a “service coordinator.” Once this position was created, service became much more manageable, and client satisfaction increased dramatically. Another positive impact of this decision was our other rehab admins working the pipeline for new equipment saw greater efficiencies in their respective roles.

The service coordinator now takes all calls for repair, schedules all of the service calls, and is the go-to person for all things service.

Warren Buffet once said, “It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.” I think everyone will agree that better service is good for the patient, the company, and the referral source.

A Checklist for Successful Service Departments
In interviewing several rehab providers for this article, I heard many creative and effective ideas on efficiency as it relates to service:

• Measure Gross Profit Margin and Net Margin on every repair. Set a tripwire that if a gross profit margin (GPM) drops below a set percentage, the employee must explore other means to increase the margin before submitting for a purchase order to obtain repair parts. (In our company that threshold is 35 percent.)

• For providers who do mobile repair, always encourage the client to come to your facility.

• Ensure that each technician’s vehicle is always properly stocked with items such as batteries to eliminate the need to make multiple repair calls.

• Have a person other than the service coordinator issue purchase orders. Checks and balances are a good thing.

• Train technicians to know how to do a home assessment on each call. They can then offer to do home safety assessments for the clients they visit. Bathroom equipment, ramps, etc., are often needed by the consumers you serve and are easy cash-sale items. Ensure that each tech has a few ramps, double hinges, etc.

• Management should enforce a culture where each employee understands that a 30-cent bolt for a repair client can end up costing you a million-dollar account.

• Create a formulary for commonly stocked items such as seat belts, headrests, etc. Buy them in bulk, and negotiate for a volume discount.

Henry Ford once said, “A business absolutely devoted to service will have only one worry about profits: They will be embarrassingly large.”

While we may not see embarrassingly large profits in our service departments, better service is good for the bottom line.

This article originally appeared in the September 2010 issue of Mobility Management.

Patient Compliance:

Wednesday, October 19th, 2011

By Robert Spitzmesser, ATP

We have all heard the phrase “they are non-compliant” in this field. When we hear this we assume the patient or client is not adhering to the instructions given to them by their healthcare professional, whether it is a physician, therapist, nurse, ATP or even a care provider. In the realm of seating and mobility it can usually mean they are not using the equipment that was prescribed and purchased for them to help correct or prevent possible seating and positioning deficits that have been recognized during a seating evaluation.

How many times have we spent countless hours’ even days on configuring a specialized wheelchair and custom seating components for a patient only to return after a period of time to witness that individual using a pillow or rolled up towel in the place of lateral supports or a cushion? How many times do you go over a proper “pressure program” with the patient in conjunction with the recommendations of their therapist while sitting with them in the clinic only to find out they developed a pressure ulcer 6 months after receiving their “customized tilt-in-space” wheelchair? After almost 20 years in this industry I have rarely had the opportunity to actually come across a situation where I have met somebody that has truly embraced the instruction and direction they received and adhered to it for an extended amount of time and reaped the benefits of that “compliance.”

For privacy reasons, I will refer to this patient as John. I met John thru a referral from a home healthcare agency. I was told John was a 62 year old with a C-6 spinal cord injury he suffered when he was 20 years old in 1968. I was asked to see him about possible cushion recommendations as well as a power wheelchair replacement. Of course, I assumed the worst case scenario being he had been injured so long ago and had lived with this devastating injury for so long. I called and set up an appointment to go and see John. Surprisingly he answered the phone himself and was a very personable, upbeat individual!

When I arrived at John’s house I noticed an accessible van in the driveway with ramps going to the front entry. I assumed there would be a care provider answering the door, wrong! John answered the door while using a manual wheelchair! I went in and we sat in the living room and began to talk about his needs. I was absolutely amazed at this individual as he began to tell me his story and really his life since his injury.

When he was injured 42 years ago, he was in a rehab facility for almost 10 months. While he was there he told me the clinicians could not stress enough the importance of the things they were teaching him. He said he met several people there that had suffered injuries like him, but were back there because of complications that had arisen such as pressure sores, severe scoliosis, contractures etc. He told me that he decided then and there that he would not be like those people and that he would learn and implement everything that he was instructed to do to deal with his devastating injury.

In the 42 years since his injury, John had never had a pressure sore, his spine had a very, very slight curvature, and he had very minimal contractures of a few digits on his hands. His posture was impeccable and he had very little muscle atrophy in his extremities! I was extremely impressed to say the least! I had to know what he was doing. This was a man who had been completely paralyzed for over 40 years from the neck down except for some “gross” upper extremity movements! I also wanted to see what equipment he had been using and what if anything he needed from me that he obviously just couldn’t live without!

John had embraced everything and anything he had been taught at the rehab facility he was in so long ago. He explained to me that even though he was very uncomfortable with the seating and positioning he was prescribed so long ago he trusted what he was told and that it was what was right for him. He trusted the instructions and exercises he was given by his therapists and clinicians and formatted a regime he has stuck with for over 40 years! From movement and isometric exercises to complete bladder and bowel programs, he learned them and stuck to them no matter how mundane and tedious. He had only one other visit to a rehab facility that he could remember, and that was for a custom manual wheelchair he was still using because he had actually regained so much strength in his arms he wanted to be able to self propel himself. He actually had not used his power wheelchair in so long he wasn’t sure he wanted to go back to it! By the way, it was a belt driven E&J Marathon that still looked like it came right out of the box! All of John’s equipment was over 15 years old! But, all of it had been regularly maintained and was in absolutely new condition!

While we were talking, John continually lifted himself up with his forearms to relieve pressure from sitting. I asked him about it and he told me it was so common to him now he actually never realized he was doing it! He explained it was just so automatic now as well as his hand, arm and leg stretching he would do while we were talking that he actually apologized! I told him I was so impressed with him and that I had never met anybody like him that had actually been so “compliant” for so many years without just giving up to boredom or depression and that he was in such great physical shape his injury not withstanding!
He told me that it was very hard in the beginning to stay “compliant” with everything he had been taught and prescribed, especially the seating on his wheelchair because it did “feel” uncomfortable. But, he said he was so glad his therapists, clinicians and wheelchair supplier so long ago drilled into his head to stick to it and be “compliant” and he could still has a fulfilling, productive life. John did just that. He worked a job and retired after almost 30 years, he became self sufficient but most of all he was “compliant” with what he was taught and implemented those ideals which has kept him extremely healthy both mentally and physically for over 40 years after suffering a devastating injury. Needless to say, I did not change a thing for John, nor did I make some outlandish suggestion about a new power or manual wheelchair. I did supply a new cushion cover for him, as his original had finally worn out!

I believe the moral or point of this story would be that even though we specify and supply specific types of equipment to individuals for their specific needs, we need to emphasize why we are doing it and most importantly that it is for their benefit and how important it is that they utilize it for their health and well being.

Robert Spitzmesser ATP
Active American Mobility
San Antonio TX

Telemergency Device: An Alternative to “I have fallen and can’t get up”

Wednesday, October 19th, 2011

by Bonnie Trihus
Active American Mobility and Medical Supply

Have you ever worried about yourself, a neighbor, a friend, or someone in your family with health problems ? Do you wonder if your loved ones were at home alone and something happened to them that they may not be able to get to a telephone to call for help? I have personally experienced the anxiety of worrying about my loved ones.

Well……there is a solution to all of your concerns. The Telemergency Alert Device is a light weight pendent that you wear around your neck. In time of an emergency, you just press a button on the pendent that automatically dials 911 and/or up to 5 additional telephone numbers of your choice.

All that needs done to install the Telemergency Alert Device is simply spelled out in the installation guide. You must first connect the unit to your telephone line and then connect the AC adapter. Then you need to make sure that the Switch is moved to “normal” and set the 911 switch to “on”. Also, the speaker switch should be moved to “on” and finally the power switch must be “on”. After you have placed the switches in the appropriate position, you are ready to program the necessary phone numbers.

You have the choice to have 911 called first, and then the other phone numbers next. Or you can have your friends/family called first, and if noone responds 911 will be called automatically. During set up, you pre-program a message to be played when you press the pendent button. When an emergency occurs and if you are within hearing distance of your telephone base, you can communicate back and forth with the responder on the other line. If not, your pre-program message is played to indicate you have an emergency and are in need of assistance.
There is a battery backup (9 volt alkaline)available, but it is not included in the Telemergency Alert Device packet.
For those who are technically challenged and find the instruction guide to be too complicated, the Telemergency company will provide an “Installation for Dummies Guide“.

You truly no longer have to worry about your loved ones’ safety! For about $189.99, you can provide your loved ones with a Telemergency Unit and be relieved of your worries of them not being able to get help in time of an emergency. AND……there are NO MONTHLY FEES. The $189.99 covers the entire cost of the unit and for those who reside near one of the Active American Mobility store locations, the price includes the installation and set up of the unit.

We all have worries and concerns in our day to day lives, but if one of those concerns involve the safety and well being of our loved ones why not omit those fears from our life?

Bonnie Trihus, Marketing Representative
Active American Mobility and Medical Supply

Multiple Sclerosis Drug Novartis Gains FDA Approval

Wednesday, October 19th, 2011

By ThirdAge News Staff
Posted September 22, 2010 1:00 PM.
Multiple Sclerosis drug Novartis has been approved by The Food and Drug Administration. Federal health regulators have approved the first pill to treat the underlying causes of multiple sclerosis, a debilitating nervous system disorder that has traditionally been treated with injectable drugs. The Food and Drug Administration approved Swiss drugmaker Novartis’ treatment Gilenya to reduce relapses in patients with multiple sclerosis, who experiences loss of balance, muscle spasms and other movement problems.

There is no cure for the disease, but steroids can reduce the duration and severity of symptoms in the short term, and seven treatments on the market have had success in reducing recurrence of symptoms.

All involve daily or regular injections, which doctors say discourages some patients from keeping up with their treatment.

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Dealing with pain of osteoarthritis without drugs

Wednesday, October 19th, 2011 contributor Fred Phillips offered this article on how those suffering from osteoarthritis may be able to manage their pain without the use of drugs.

Osteoarthritis affects millions of people and is the most common form of arthritis in the United States. Osteoarthritis can severely limit a person’s ability to perform routine daily activities and tasks. The disease is detrimental to one’s enjoyment of life and can cause further complications such as weight gain and depression.

People who have osteoarthritis have limited movement, joint stiffness and pain because the cartilage in their joints begins to erode and eventually wears completely away. Once the cartilage is gone, there is nothing to protect the bones from rubbing together. This friction will cause increased pain and a reduction in range of movement. As the bones continue to rub together, bone spurs (osteophytes) build up which leads to more severe pain, greater stiffness, and a further decrease in range of motion.

According to Web MD, the chance of developing the disease increases with age and most people over 60 have some level of the disease. Unfortunately there is no known cure for osteoarthritis; sufferers can only hope to manage the pain and slow the progression of the disease.

The principle symptoms of osteoarthritis are:

• Joint discomfort and pain
• Limited range of motion in the joints
• Swelling in the joints
• The formation of osteophytes (bone spurs)
• Increased pain and stiffness upon waking
• Joint stiffness

Treatments to Manage Osteoarthritis Pain

The American College of Rheumatology (ACR) offers guidelines for the treatment of osteoarthritis which include pharmacologic (drug) and non-pharmacologic treatments. They specify 16 non-drug treatments to help control the pain from osteoarthritis.

Non-Drug Treatments

1. Weight reduction and control
2. Stretching and range of motion exercises
3. Exercise – both cardio and strength training
4. Hot and cold therapies
5. Stress reduction and control
6. Acupuncture

Drug Treatments

• Acetaminophen (Tylenol, etc)
• NSAIDs (ibuprofen, naproxen, etc.)
• COX-2 inhibitor (Celebrex, etc)
• Over-the-counter topical gels and creams
• Injections into the affected joint (corticosteroids, etc.)

Attempting non-drug therapy first is advisable due to the potential for side effects with any medication. A few of the more common non-drug treatments are exercise, weight reduction and control, hot and cold therapy, and stress control.

Exercise and Weight Reduction For Osteoarthritis

Being overweight, even moderately, can have severe consequences for the weight-bearing joints and can contribute to the pain and progression of osteoarthritis. Dr. Jason Theodosakis, author of The Arthritis Cure, says that “The more weight you’re carrying, the more force you’ll put on your joints.”

Dr. Theodosakis also warns that “there is also a metabolic factor in overweight people that causes destruction of cartilage in non-weight bearing joints.” Losing weight is one of the best therapies for osteoarthritis and a weight loss program should be started immediately after being diagnosed with osteoarthritis.

Exercise should be an integral part of any weight-loss regimen. Daily exercise helps shed excess weight, helps to maintain a range of motion in the joints, and is essential in keeping the muscles strong. Walking, bicycling, yoga, and swimming are all excellent forms of exercise for someone who is suffering from the pain of osteoarthritis. Both strength and cardio exercises should be included in any good workout program. A proper fitness program will also include stretching.

Stretching will help increase and maintain range of motion in the joints and reduce overall stiffness. Before beginning any exercise program it is advisable to check with a doctor first. It can also be helpful to work with a personal trainer or physical therapist in the beginning; these exercise experts can help design and implement an appropriate fitness program that may help relieve the pain of osteoarthritis.

Hot and Cold Therapy

Hot and cold therapy is often useful in a pain management program. Some people respond better to cold therapy while others experience more relief with heat therapy. Cold therapy can be used to reduce inflammation and decrease the pain in a stiff joint. Heat is often utilized to encourage blood flood to tendons and ligaments, relax muscles, and decrease pain prior to exercise.

Heating pads or hot packs can be placed over painful joints

Heat should always be applied at a comfortable temperature

Ice and cold packs should never be applied directly on the skin

Ice or cold packs should not be used for more than 20 minutes at a time

Ice or any type of reusable cold packs can be applied directly to the painful area

Stress Control

Emotional anxiety and stress generally cause more problems with rheumatoid arthritis, but controlling stress can still have positive benefits for those people who suffer from osteoarthritis. Repeated stress from money issues, family problems, work hassles, and other stressful events or activities can contribute to an increase in joint pain and reduction of the positive effects of pain management efforts.

The following techniques will help reduce the impact of stress:
• Time management
• Exercise
• Journaling
• Learn coping skills and assertiveness training
• Social support with family and friends
• Self-hypnosis
• Breath control and breathing exercises
• Muscle relaxation


Though some people are horrified at the mere thought of needles being stuck into their bodies, there is some evidence that acupuncture can help reduce the level of chronic pain. According to the National Center for Complementary and Alternative Medicine (NCCAM), there is some evidence that acupuncture is efficacious in alleviating chronic low-back pain and the pain from osteoarthritis of the knee.

The Bottom Line on Treating Osteoarthritis

According to the Arthritis Foundation is it important to get osteoarthritis diagnosed as early as possible. Once diagnosed, treatment should begin as quickly as possible. It is best to do research about each type of non-drug treatment and consult with a doctor or therapist to determine which treatment offers the highest chance for success. Before attempting to manage chronic pain with drugs or surgery, non-drug treatments should always be considered.
Warm towels, baths, showers, hot tubs or other moist heat can help relieve pain

Medicare Clarifies PMD (Power Mobility Device) Documentation Requirments for Power Wheelchairs and Scooters

Wednesday, October 19th, 2011

By Patrick Boardman

Active American Mobility and Medical Supply is a Complex Rehab company in Houston and San Antonio Texas.

CMS released a clarification letter with respect to PMD documentation requirments. The letter came out on September 10th.

The following is a copy of that September 10th letter:

Power Wheelchairs and Power Operated Vehicles Documentation Requirements
September 2010
Dear Physician,

In order for Medicare to provide reimbursement for a power wheelchair (PWC) or power operated vehicle (POV) (scooter), there are several statutory requirements that must be met:
1. There must be an in-person visit with a physician specifically addressing the patient»s mobility needs.
2. There must be a history and physical examination by the physician or other medical professional (see below) focusing on an assessment of the patient»s mobility limitation and needs. The results of this evaluation must be recorded in the patient»s medical record.
3. A prescription must be written AFTER the in-person visit has occurred and the medical evaluation is completed. This prescription has seven required elements (see below).
4. The prescription and medical records documenting the in-person visit and evaluation must be sent to the equipment supplier within 45 days after the completion of the evaluation.
The in-person visit and mobility evaluation together are often referred to as the ≈face-to-face examinationΔ.
The complete history and physical examination typically includes:
• History of the present condition(s) and past medical history that are relevant to the patient»s mobility needs in the home:
• Symptoms that limit ambulation
• Diagnoses that are responsible for these symptoms
• Medications or other treatment for these symptoms
• Progression of ambulation difficulty over time
• Other diagnoses that may relate to ambulatory problems
• How far the patient can walk without stopping and with what assistive device, such as a cane or walker
• Pace of ambulation
• History of falls, including frequency, circumstances leading to falls, and why a walker isn»t sufficient
• What ambulatory assistance (cane, walker, wheelchair) is currently used and why it isn»t sufficient
• What has changed to now require use of a power mobility device
• Ability to use a manual wheelchair
• Reasons why a power operated vehicle (scooter) would not be sufficient for this patient»s needs in the home
• Description of the home setting and the ability to perform activities of daily living in the home
• Physical examination that is relevant to the patient»s mobility needs
• Weight and height
• Cardiopulmonary examination
• Musculoskeletal examination


Arm and leg strength and range of motion
Neurological examination
Balance and coordination

If the patient is capable of walking, the report should include documented observation of ambulation (with use of a cane or walker, if appropriate)
Examples of vague or subjective descriptions of the patient’s mobility limitations include:

• upper extremity weakness
• poor endurance
• gait instability
• weakness
• abnormality of gait
• difficulty walking
• SOB on exertion
• pain
• fatigue
• deconditioned

These types of statements are insufficient and do not objectively address the mobility limitation or provide a clear picture of the patient’s mobility deficits. Objective measurements should be provided.

The evaluation should be tailored to the individual patient»s conditions. The history should paint a picture of your patient»s functional abilities and limitations on a typical day. It should contain as much objective data as possible. The physical examination should be focused on the body systems that are responsible for the patient»s ambulatory difficulty or impact on the patient»s ambulatory ability.

It is important to keep in mind that because of the way that the Social Security Act defines durable medical equipment, a power mobility device is covered by Medicare only if the beneficiary has a mobility limitation that significantly impairs his/her ability to perform activities of daily living within the home. If the wheelchair/POV is needed in the home, the beneficiary may also use it outside the home. However, in your evaluation you must clearly distinguish your patient»s mobility needs within the home from their needs outside the home.
You may elect to refer the patient to another medical professional, such as a physical
therapist or occupational therapist, to perform part of the evaluation √ as long as that individual has no financial relationship with the wheelchair supplier. However, you do have to personally see the patient before or after the PT/OT evaluation. You must review the report, indicate your agreement in writing on the report, and sign and date the report. If you do not see the patient after the PT/OT evaluation, the date that you sign the report is considered to be the date of completion of the face-to-face examination.
You should record the visit and mobility evaluation in your usual medical record-keeping format. Many suppliers provide forms for you to complete. Suppliers often try to create the impression that these documents are a sufficient record of the in-person visit and medical evaluation. Based upon our auditing experience, most of them are not. That is because they typically contain check-off boxes or space for only brief answers and thus do not provide enough detailed information about the patient»s ambulatory abilities and limitations to allow the Medicare contractor to determine if coverage criteria have been met . Forms such as those developed by the Texas or Florida Academy of Family Physicians are designed to gather selected bits of information and are almost always insufficient. What is required is a thorough narrative description of your patient»s current condition, past history, and pertinent physical examination that clearly describes their mobility needs in the home and why a cane, walker, or optimally configured manual wheelchair is not sufficient to meet those needs.
You may write a prescription for a power mobility device ONLY after the visit and examination are complete. This prescription must contain the following seven elements:
1)Beneficiary»s name
2) Description of the item that is ordered. This may be general √ e.g., ≈power operated vehicleΔ, ≈power wheelchairΔ, or ≈power mobility deviceΔ√ or may be more specific.
3) Date of completion of the face-to-face examination
4) Pertinent diagnoses/conditions that relate to the need for the POV or power wheelchair
5) Length of need
6) Physician»s signature
7)Date of physician signature

You must forward a copy of the face-to-face evaluation and your seven-element prescription to the supplier within 45 days from the completion of the face-to-face mobility exam. You should also include copies of previous notes, consultations with other physicians, and reports of pertinent laboratory, x-ray, or other diagnostic tests if they will help to document the severity of your patient»s ambulatory problems.
After the supplier receives your order and the face-to-face information, they will prepare a detailed product description that describes the item(s) being provided including all options and accessories. You should review it and, if you agree with what is being provided, sign, date and return it to the supplier. If you do not agree with any part of the detailed product description, you should contact the supplier to clarify what you want the beneficiary to receive.
This information is not intended to serve as a substitute for the complete DME MAC
local coverage determination on Power Mobility Devices. It is only a synopsis detailing the highlights of documentation. Refer to the complete LCD and Policy Article on the CMS Web site at for additional information.
Medicare does provide you additional reimbursement (HCPCS code G0372) to recognize the additional time and effort that are required to provide this documentation to the supplier. This code is payable in addition to the reimbursement for your E&M visit code.
Your participation in this process and cooperation with the supplier will allow your patient to receive the most appropriate type of mobility equipment. We appreciate all your efforts in providing quality services to your Medicare patients.

Paul J. Hughes, M.D.
Medical Director, DME MAC, Jurisdiction A
Robert D. Hoover, Jr., MD, MPH, FACP Medical Director, DME MAC, Jurisdiction C
Adrian M. Oleck, M.D.
Medical Director, DME MAC, Jurisdiction B
Richard W. Whitten, MD, MBA, FACP
Medical Director, DME MAC, Jurisdiction D