Funding & the Functional Mobility Assessment: Q&A with Greg Packer, U.S. Rehab

Funding & the Functional Mobility Assessment

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Greg Packer, president of U.S. Rehab, on why it’s critical to prove the efficacy of complex rehab technology (CRT).

Q: Why is it important to have evidence that CRT works?

Greg Packer: Funding for complex rehab technology (CRT) continues to be cut by Medicare and Medicaid. We have gone to Washington, D.C., for years, telling our stories of how CRT is important. While members of Congress do care about stories, they continually ask for the data to show that CRT works and is appropriate for certain disease states.

It is very hard to understand how to do a double-blind study in wheelchair use. It also is very difficult to determine after a patient has a pressure sore why they received it. We believe that the Functional Mobility Assessment (FMA) will provide the data to quantify the outcomes received.

Our aim is to provide evidence that CRT does decrease overall spending on patients over their lifetimes. We hope to show that providing the appropriate cushion, wheelchair and accessory keeps patients active, integrated into society, working, and most importantly, healthier and out of hospitals. The FMA is a quality-assurance tool for ATPs. With the data we have already collected, we are starting to see some correlation that when an ATP is involved in the selection and fitting of the mobility intervention, hospital readmissions decrease.

There is no evidence currently of how important an ATP is when properly fitting a patient to a mobility intervention. Without data in the CRT industry, it is easy for the Centers for Medicare & Medicaid Services (CMS) to cut funding. We want to reduce the drive-to-the-bottom mentality that CMS has; showing them data is the only way that we can get this done. Evidence-based data is where we can affect policy and price proportionally in the healthcare arena.

Q: Healthcare today works on an evidence-based system. Is it important for CRT to keep pace with this metric?

Packer: It would be nice to be able to do double blind studies, and it would prove the point. But with wheelchair users and/or scooters, canes or crutches, how do you tell someone that they are not able to get a chair and [then ask] if they can just walk anyway? With placebo studies, you can see a true evidence-based difference.

Q: How could evidence impact funding source decisions?

Packer: True evidence-based research with the true arm’s length, de-identified relationship that VGM has with University of Pittsburgh should be impactful when enough data is collected to show correlative information. Like how many falls patients are having with properly fitted equipment utilizing an ATP. How does a seat elevator help with transfers? These are a few of the items we are seeing.

Q: Do you think the push for evidence-based practices and outcome measures will continue?

Packer: Outcomes will continue to be important. The medical industry is shifting to a performance-based pay system. Proof of better care can be done through outcomes data. Hospital readmissions is one item tracked on the FMA. If we can show that providing quality equipment from a quality provider who has ATPs on staff makes an impact on readmissions, we will solidify the need for CRT.

With that said, it is incredibly important that the entire industry use the same outcomes measurement system. Without a standard outcomes tool, CMS will see all data collected as invalid and selfserving at best.

Q: What are the challenges to proving that CRT works?

Packer: One of our biggest challenges currently is getting enough data to be able to support the research behind this quality-assurance program. Sample sizes are definitely a concern. Since our industry is so unique and our clients have a variety of disease states, it is necessary to collect a large volume of data before an analysis is done. To be able to show statistical significance in certain areas, we need hundreds of clients with similar circumstances.

For example, we may want to look at ALS patients who are prescribed a Group 3 power wheelchair and what it does to their FMA score. A large sample size is necessary to find hundreds of patients that match these specific characteristics and to show statistical significance.

This article originally appeared in the March 2017 issue of Mobility Management.

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