Schmeler: Rehab Can “Emerge Bigger & Better”

This fall, Dr. Mark Schmeler was named the director of continuing education for the University of Pittsburgh’s Department of Rehabilitation Science & Technology, which coordinates the International Seating Symposium (ISS) when it is in the United States in alternate years. We asked about his ISS plans, and his thoughts on other rehab topics for 2008.

Q: As the new director of continuing education, what are your priorities?

A: My first priority is to ensure the continued viability of the RSTCE program that I am fortunate and honored to have inherited from my colleague, Elaine Trefler. Elaine is one of the pioneers in our field who was one of the original founders of ISS back in the early 1980s. She and many others have significantly contributed to the advancement of education for seating and wheeled mobility.

I have several other priorities for building our program: Staying abreast of what is going on in the field, understanding people’s continuing education (CE) needs, and identifying new and innovative mechanisms for the delivery of continuing education content, especially now that the Internet has become such a viable option.

Another important priority is to ensure that CE content includes the most valid and current information based on whatever evidence we have available…whether it is research-based, clinical practice guidelines, position papers, or just the sound experience or expertise of the people delivering the content. In these unprecedented times, it is now even more important that we show that the kind of equipment we provide is the most cost-effective, reasonable, and safe alternative for the people we serve.

Q: How does ISS help RTS’s and clinicians?

A: Continuing education is one of the pillars of professional practice whether you’re a supplier, a practitioner, a researcher or a manufacturer. There are now many options for professionals to receive this education. However, face-to-face networking with colleagues at an event like ISS is one of the most effective methods of gaining knowledge and building critical relationships.

ISS strives to bring together all factions of the field, including clinicians, suppliers, consumers, researchers, advocates, policymakers, payors, manufacturers, etc., who all focus specifically on wheelchair seating and mobility under one venue. Our aim is to provide quality education, while fostering professional interaction and collaboration. Regardless of the external threats to this field, ISS will continue to strive to be a focal point of face-to-face continuing education delivered in the most cost-effective manner to all stakeholders.

Q: Invacare and Permobil will not attend Medtrade 2008, but will increase support of shows such as ISS. Do you anticipate increased interest in ISS or similar “focused” events?

A: I certainly hope major players in the industry will continue to support ISS and other similar venues. I would also certainly like to see ISS grow. The challenge is that we need to secure the meeting and hotel facilities to host the conference 2-3 years in advance at a time when the field is in such turmoil.

Medtrade has always been a great event and is still one of my favorite venues for education and product review. Unfortunately, as a business “trade show,” Medtrade is vulnerable to the shifting times. Methods of doing business are changing drastically, so I can appreciate where these key exhibitors are coming from. We are in a time where we need to find more cost-effective ways of reaching out to the customer base. I am confident that ISS can respond to and meet the needs of all professionals working in the field of seating and wheeled mobility.

Q: What issues will you be watching in 2008?

A: Obviously, I am paying close attention to policy. But as a clinician first and foremost, I am paying attention to the needs of the practitioners and suppliers on the front line who are trying to make sure their clients are being served appropriately.

I do not think we can expect the cavalry to come in and save us, although I really hope I am wrong. In 2008, we will be addressing many of the same issues we struggled with in 2007, which will likely continue until we get through the election campaigns and transitions toward new leadership.

I see us taking what has been handed to us on the chin for another year or two. So in the meantime, we need to focus our attention on what needs to be done to show that what we do is reasonable and necessary for the individuals we serve. We then emerge bigger and better in the eyes of CMS.

Q: What do you think of requiring ATP/ATS involvement when rehab power chairs are being considered?

A: Essentially, CMS is trying to find an objective means through this certification to demonstrate that the clinicians and suppliers providing certain mobility devices are qualified to do so. This helps assure people get the right equipment based on a sound assessment by qualified professionals rather than just answering an ad on TV. The goal is to protect the tax payer and consumer.

At this point the ATP and ATS certification is the only documentation available relative to assistive technology expertise. These credentials were developed by RESNA over 10 years ago to represent an entry-level generalist set of knowledge and skill in the field. The certifications were not intended to stamp people as experts specifically in wheelchair seating & mobility. While expert knowledge is not necessarily demonstrated by this certification, it does assure that people with these credentials should be following the RESNA Code of Ethics & Standards of Practice. We as a field still have a lot of work to do to define the standards of practice in wheelchair seating & mobility, and Medicare knows that. But until we define these standards and come up with a specialty certification, the ATP/S is the best credential out there.

The OT and PT associations have successfully argued that any therapist is qualified to recommend any type of mobility device purely by the nature of their training. But in reality they are not against supporting specialty certification, but are against government policy that restricts a therapist from practicing and billing for services in any given area of therapy. Both associations offers their own specialty certification in different areas such as pediatrics, neurology, etc., for therapists to identify themselves as experts, but do not support the credentials to restrict who can do what. As professionals we are supposed to police ourselves by ensuring that we only practice within our scope of expertise and refer out to others when we don’t know. We all know well, however, that there is not enough in our basic entry-level curriculums to encourage this level of competency beyond the very basics related to wheelchairs. This further demonstrates why post-professional continuing education plays a critical role in educating professionals in our field.

There is a shortage of qualified ATPs at this time, so a delay would have been more favorable. We should not disband the concept, but rather we should embrace the fact that CMS did at least finally recognize the complexity of this area and the need to address assistive technology differently than off-the-shelf DME.

RESNA saw a record number of therapists and suppliers sit for the exam in 2007. The University of Pittsburgh has provided review courses to assist professionals to prepare for this exam because we support the ATP/S credentials and encourage people to seek them regardless of policy.

I will further support an advanced specialty certification in seating & mobility for therapists, as well as support the suppliers in developing an entry-level, academic-based curriculum so that they can be better recognized for the critical role they play in the health-care continuum of care.

This article originally appeared in the January 2008 issue of Mobility Management.

About the Author

Dr. Mark Schmeler has been a member of the University of Pitsburgh faculty since 1996 and has been in the assistive technology field for nearly two decades.

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