Funding Case Study

The Powerful Potential of Power Assist
Q&A with Jim Papac & Christopher Veatch, NEXT Mobility

Q: Explain the benefits of a power-assist system, and who could benefit from using it.
Chris Veatch: Often, we take for granted the machines that make our lives better. Escalators make climbing stairs easier; power steering lets us control our cars, and power shavers keep us silky smooth. So the application of power to a manual wheelchair makes a lot of sense.

Control of a manual wheelchair requires significant amounts of strength to negotiate everyday obstacles. The ramp to a van or a simple curb-cut can be major obstacles to users with many different medical conditions (listed below). Until power assist, the only solution has been a power wheelchair, which requires a substantial change in the user’s lifestyle and is often accompanied by the loss of the sense of independence. Also, studies have proven that long-term manual wheelchair users can suffer from upper-limb pain and repetitive strain injuries. These injuries can adversely affect the physical health of manual wheelchair users and increase the cost of their health care.

These conditions include spinal cord injury, muscular dystrophy, cerebral palsy, severe rheumatoid or osteo-arthritis, multiple sclerosis, traumatic brain injury, amyotrophic lateral sclerosis, Guillain-Barré syndrome, quadriplegia, paraplegia, cerebrovascular accident (stroke).

Q: In your experience, what sorts of diagnoses/situations have qualified for power-assist funding? Can you give examples of what funding sources have paid for power assist?

Chris Veatch:
Our experience is almost any wheelchair user who can self-propel in a manual wheelchair is a candidate for a power assist. Anyone who looks at the ramp to his or her van or a curb-cut and thinks it might as well be the road to the top of Pikes Peak and anyone who decided not to attend a child’s soccer game because of the grass is a perfect candidate for power assist.

What power assist does is make all surfaces equal, and it literally flattens out the hills.
So you might say, “Why don’t these people just get a power chair?” The answer is simple. Power chairs are not as convenient and still have a negative stigma attached to them for those who can self-propel. Power assist truly is a hybrid; it’s a power chair that can be a manual chair when it needs to be. Those of us in the power assist business believe it is the future of the manual wheelchair and one of the market segments that will continue to grow.
All that being said, it is still necessary to state a case for power assist. Funding sources will want to know why it is a medical necessity.

As for examples of funding sources that have paid, VA’s are at the forefront of patient care and are often the leaders in mobility product technology. Since they have their own funding sources and are not bound by HCPCS codes, they have been very accepting of the power assist technology as a way to provide improved lives for veterans.

Workers’ comp also has been accepting of power assist and don’t always require codes for reimbursement. Since workers’ comp is one of the few funding sources that will modify a person’s home for the acceptance of a mobility device, they realize major home modifications may not be necessary for a manual wheelchair with power assist.
The Medicare code for a power assist is E0986, which would also require an additional K0005 wheelchair built to accept the addition of power.

Q:
OK, we understand that medical necessity is required to qualify for power assist funding, but based on what you’ve seen, what types of manual chair users have qualified? What have those users had in common?

Jim Papac:
There are two major areas that we see: Repetitive injury – rotator cuff, carpal tunnel in the wrists, etc. And then, people who for whatever reason can no longer even propel an ultralight chair, but they don’t want to go to power. These are people who are just tired at the end of the day.

We’ve had well-known therapists say that (newly injured) patients should be in power assist, but you can’t get it funded for new injuries. Who can use power assist? Almost everybody. But how do they get them funded? One, if they have repetitive injuries. And two, new injuries if they’re lower quads. It’s the medical necessity thing: Even though a new para could benefit from this, it’s not medically necessary.

Q: So you’ve seen power assist funding success for a newly injured, client with lower-level quadriplegia, where he doesn’t have repetitive motion injuries yet, but because propelling his chair is very difficult, by lunchtime he’s wiped out?

Jim Papac:
Yes, that’s what you have to hit hard: He doesn’t have (good) grip, his pushes are less efficient than a para’s.
Chris Veatch: Oh, absolutely less efficient. I’m paraplegic myself; you could take the front casters on my chair and Superglue them up, and you would inconvenience me, but you’re not going to stop me. I’m just going to push, and they’re not going to roll. I’ve seen people do it, where the bearings are completely worn out, but they’re still pushing it. But take lower quads and the ramps to their vans: They can’t get up them.

If you’re in a power assist, you don’t have to necessarily remodel your whole house. The obvious question is why not just go to a power chair, so when you’re trying to get somebody a power assist, you may have to make a case against a power chair. And it might be that transportation or whatever their living environment is would be an example of why a power chair’s just not right.

This article originally appeared in the Seating & Positioning Handbook: March 2009 issue of Mobility Management.

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