Obtaining new equipment, as discussed in our last blog “A little preparation goes a long way,” is a multi-step process. This week we are looking at the team involved and what part they play to help you get the equipment you need. Specifically, we will explore the physician’s referral and assessment, the occupational therapy (OT) / physiotherapy (PT) evaluation and interventions, as well as the support provided by the equipment supplier/dealer/provider.
Your Physician
Last time, we discussed the initial step of preparing for your visit. The next step is to have an in-depth discussion with your physician, nurse practitioner, or physician's assistant as to why you may need changes to your current wheelchair, or a new wheelchair altogether. It is important to discuss what has happened medically or functionally that would support the need for new equipment. In the U.S., this is called a “face-to-face" appointment. This is a specific appointment about your wheelchair needs. In the U.S., there are a few insurance rules about this appointment. It must be performed in person, AND be a specific appointment designated to be focused on your wheelchair needs, thus not a conversation added onto a typical check-up appointment.
During this appointment, a prescription specifying either "OT or PT for Wheelchair/Seating Evaluation" should be written and sent to the therapy team who will be performing your wheelchair evaluation.
It is worth noting that not all provinces in Canada require a physician referral or a prescription for a mobility equipment evaluation. Typically, in Canada, the physician will refer you to a prescribing therapist that could be based at a seating clinic or community based. If you are accessing private insurance funding for your mobility device, you will likely require a doctor’s prescription for the device.
OT/PT Specialty Evaluation
Once the referral to the therapy team is in place, it is time for the OT/PT specialty evaluation. This thorough assessment will examine your medical/surgical history, your posture, range of motion, muscle strength, muscle spasms/spasticity, balance, skin integrity, as well as your mobility. You will most likely need to transfer out of your chair, so having your necessary transfer equipment or the care team who assists you will be helpful. Since the equipment will be custom configured for you, you will be asked for your height and current weight. Knowing your weight is necessary to ensure that the prescribed equipment suits your specific needs.
This in-depth evaluation is a critical piece of the medical and functional justification for the recommended equipment, which the funding source requires before approving equipment. Depending on the complexity of your equipment needs, this step could require multiple appointments to include equipment trials and finalization of recommendations.
Provider Selection
Choosing the right equipment provider is crucial. These providers work for companies that specialize in Complex Rehabilitation Technology (CRT) and may also be referred to as dealers or suppliers. If you have private insurance in the U.S., it is essential to know which equipment providers are in your network. Additionally, it is important to understand the provider's service policy and know the physical location of their office.
The equipment provider often attends the PT/OT appointment and assists with equipment trials. To ensure the recommended device will meet your functional needs in your home there will be a discussion about home accessibility or barriers such as doorway widths, entry access, and the layout of your home. In the U.S. in home measurements are a requirement to be performed by your provider.
Further, in the U.S., the equipment provider has the responsibility to collect all medical documentation required by insurance to obtain authorization for the recommended equipment. Many companies now have on-line client portals which allow you to log in and check the status of your equipment order. In Canada, this process is typically managed by the prescribing therapist.
Join us next for the next blog where we discuss the challenges of funding and additional helpful resources for this process.
Do you have more questions on wheelchair seating and mobility equipment? Check out our digital version of the Wheelchair Handbook.
Catherine Sweeney, PT, ATP/SMS
Regional Clinical Education Manager
Catherine Sweeney, PT, ATP/SMS joined Permobil as Regional Clinical Education Manager in 2019. Prior to this, she spent the bulk of her career at Providence Portland Medical Center, where she co-founded the outpatient seating clinic program in 2004. As lead seating specialist, Catherine worked to expand access to wheeled mobility services through staff education in OP satellite clinics, home health, and outlying Providence hospitals.
Catherine served as the RESNA PT SIG co-chair, and is co-founder of the Northwest Assistive Technology Access Coalition with a passion for improving Oregon Medicaid recipients access to assistive technology. She has presented at both the RESNA and International Seating Symposium conferences 2021.
Stefan Morin, OT
Regional Clinical Education Manager
Stefan Morin, OT, is a registered occupational therapist who graduated from the University of Toronto in 2008 with a master’s degree in Occupational therapy. Stefan joined Permobil in July 2021 as a Regional Clinical Education Manager for the Atlantic Provinces and Quebec. From 2008 – 2012 Stefan practiced at the Lyndhurst Centre Brain and Spinal Cord Rehabilitation Program, located in Toronto, Canada working both as an inpatient OT as well as in the outpatient Seating Clinic providing complex seating and mobility solutions for a variety of clientele. In 2013 Stefan moved to Moncton, New Brunswick Canada and worked in the community, providing complex seating and mobility solutions, home modification solutions, as well as working with veterans with mental health and addictions issues.