CRT Trends: Big Data

Quality Assurance & the FMA: Secondary Health Conditions & Environments

How CRT Impacts Client Activities & Re-Admissions

• Aug 01, 2018

In the July issue of Mobility Management, we reported on how well wheelchair users said they functioned in 10 everyday situations, from carrying out daily routines to transferring, being mobile indoors and being mobile outdoors.

Those questions are from the Functional Mobility Assessment (FMA), a 10-question survey of wheelchair users who self-reported their abilities on a scale of 1 (Completely Disagree) to 6 (Completely Agree).

Ultimately, the answers to those questions can also answer another critical question for the industry:

Does complex rehab technology (CRT) work, especially when the building and fitting of complex rehab products are performed by Assistive Technology Professionals (ATPs)?

Quality Assurance Answers

So far, the results of the FMA — developed by a team at the University of Pittsburgh, including Mark Schmeler, Ph.D., OTR/L, ATP, Associate Professor, Department of Rehabilitation Science & Technology — say yes.

U.S. Rehab, a division of The VGM Group, has worldwide rights from Pittsburgh to “commercialize and collect data with the FMA,” U.S. Rehab President Greg Packer said. Although FMA papers will be submitted for publication in scientific journals, Schmeler is emphatic in stating that the report cannot be called research until that point.

“This is quality-assurance work,” Schmeler said. “VGM has members who are businesses, and they need qualityassurance metrics to be certified, just like Uber drivers need a rating. Quality-assurance metrics are part of society and part of what we do.”

U.S. Rehab members using the survey have collected clients’ answers for years and currently use the scores to determine which consumers need closer follow-up and tracking after their CRT has been delivered. Participating clients use a range of primary insurance carriers, from Medicare (the most common payor, at 55.75 percent) to Medicaid, private insurance/fee for service or HMO, worker’s comp, vocational rehab and Veterans Affairs.

The FMA also captured the 10 most commonly reported primary diagnoses of participating clients. They range from Stroke/Cerebral Vascular Accident (the most common diagnosis, with 17.53 percent) to Other Neuromuscular or Congenital Disease (14.9 percent); Cerebral Palsy (9.91 percent); Multiple Sclerosis (9.74 percent); Spinal Cord Injury/Paraplegia (8.55 percent); Spinal Cord Injury/Quadriplegia (5.93 percent); Osteoarthritis (4.49 percent); Amputation (3.64 percent); Morbid Obesity (3.39 percent); and Spina Bifida (2.88 percent).

Last month’s charts showed that clients say they are more functional while using their wheelchairs than they are without them, and that clients say they are more successful when ATPs are involved with the CRT procurement process than when ATPs are not involved.

The next logical question: How does increased functionality impact clients’ activities? How does improved mobility impact other health conditions and how consumers interact with their environments?

Before CRT & After

Chart 1 shows how often clients fell within the last three months. The baseline number (in blue) shows fall frequency — from zero falls to 5 or more falls — before clients received wheelchairs. Green follow-up numbers show how often clients fell after receiving their chairs. This chart shows that 47.8 percent of clients had no falls prior to receiving their wheelchairs. Once they had their wheelchairs, that “no falls” percentage rises to 75.84.

Chart 2 shows skin breakdown before (in blue) and after (in green) clients received their wheelchairs. The occurrence of skin breakdown shows a visible change.

Chart 3 shows how often clients left their homes in a week before (blue) and after (green) receiving wheelchairs.

Chart 4 shows how often clients were readmitted to hospitals before (blue) and after (green) receiving their wheelchairs. The graphs show a visible reduction in hospital readmissions.

Accountability to Payors

While some FMA before-and-after results have not yet been statistically analyzed, results strongly suggest a trend.

Clients report that they are more functional with CRT than without it, and before-and-after data such as how often they experience falls, how often they’ve experienced skin breakdown, and how often they’ve been readmitted to hospitals support those beliefs.

So what are the potential effects of knowing that CRT — particularly complex rehab wheelchairs provided with the help of ATPs — does improve client outcomes?

As more and more data is collected, future wheelchair users — and their insurance payors — could have more accurate information on which technology has yielded the best results in particular situations.

“Patients will be able to do their homework and look at different options,” Schmeler said. “They’re doing that now already, but they’re relying heavily on advertising or on information that may not be vetted. We have that problem a lot in clinic, where somebody comes in with a printout of a wheelchair that they saw in a CNN news story, and this is the one that they want. Then you have to spend time explaining to them why that doesn’t work.”

Schmeler added that data-driven ATP follow-up with clients — already being performed by U.S. Rehab members participating in the FMA program — is crucial on the quality assurance front.

“In the world of accountable care and pay for performance, we have to do this,” he said. “The funding sources are not only interested to know they’re spending their money wisely on the right equipment, they also want to know that you’re being preventive by checking in with people.”

That preventive mindset, Schmeler added, is right in line with what CRT seeks to achieve.

“The reason health plans send you [preventive care] notices,” he explains, “is they don’t want you in the hospital, because that’s expensive. And they don’t get paid when you’re in the hospital. They get paid when you’re healthy and living in the community. That’s where rehab technology has a huge opportunity.

“Hospitals are now figuring out that they don’t get paid for full beds anymore. They’re going to get paid for empty beds, so they’re trying to figure out who they can partner with to keep their beds empty. One way to keep beds empty is to make sure people don’t get sick. If you’re looking at a population like we have — this top 10 diagnostic bucket — these are the highest-risk, highest-potential-cost members on a health plan.

“From a Medicare perspective, this is the population that’s going to cost them the most money.”

CRT could therefore be a great tool for Medicare and other payors, especially if the industry can point to positive outcomes.

FMA in the Future

As the industry collects more data on how its technology is being used — that includes manufacturers that capture information via chairs being used in the field — the end result could include more educated and empowered consumers as well as more educated spending by payors.

“What we’re doing is just scratching the surface of what we’re going to be doing in the future,” Schmeler said. “Manufacturers use instruments in their chairs now, so we’re going to have better information on how far they go, where they go. We’ll know how much they’re tilting. You put this all together in a battery of outcomes, and we’ll have a really good idea of what works and doesn’t work.

“This is no different than what the car companies do. Your car tells you when it needs an oil change; your car tells you when you need air in your tires. These are simple, preventive things that you can do to make sure that the equipment’s working. Managed care organizations want this. They’re investing $30,000 in a power chair. They want to know that the patient’s using it, and they’re using it correctly, and we’re going to cut down on secondary problems like pressure sores and falls. We’re going to know how often they’re leaving their house, how often they’re using it.”

In the end, outcomes measures can be win-win-win for consumers, payors and the CRT industry working to demonstrate its key role in the healthcare continuum.

“At the ground level, we know what we do works,” Schmeler said. “We don’t necessarily understand why we have to measure this; it’s so obvious. Well, in the world of accountable care, it doesn’t matter how good you think you are. Everybody has stats attached to them.”

This article originally appeared in the August 2018 issue of Mobility Management.