One at a Time
- By Laurie Watanabe
- Nov 01, 2018
I imagine it gets very tiring to continue to define and defend complex rehab technology (CRT) and its critical role in the healthcare continuum.
Several funding specialists I’ve talked to this year said CRT’s message is getting through, that many more members of Congress, Senators and their healthcare staffs now know what CRT is and who needs it. This achievement is something to be proud of.
So why do we need to keep talking the talk about CRT?
Here’s a case study from News12 in Connecticut (connecticut.news12.com). On Sept. 2, its Web site published a story titled, “Woman says insurance won’t pay to replace wheelchair’s bald tires.” In the video, we see 48-year-old Tracey Fuller, whom a reporter said has “severe arthritis.” Fuller uses a power chair that News12 reportedly helped her attain in 2016 after her insurance company denied her claim.
Fuller freely acknowledged she can walk on crutches inside her home. Now her power chair tires need replacing.
You can guess why the insurer denied her original power chair claim, and why it also refused to buy new tires for this chair it hadn’t purchased. Up to this point, I was thinking both patient and physician needed education on funding policies, including the need to determine if a less complex product (e.g., those crutches) would work.
Dr. Lee Forest, VP of the Fairfield County Medical Association in Connecticut, told the reporter it’s a “torture-fest to get insurances and Medicare and Medicaid to pay for things for patients, especially durable medical equipment: wheelchairs, hospital beds.” Fair enough. Do crutches provide mobility on par with a power chair? Honestly, no. So I’m thinking this is a policy issue: Maybe this consumer should qualify for a wheelchair, even if she gets around her house just fine using crutches.
Then, a weird detour. “Big Business,” Dr. Forest said, “is ramping the prices up on everything and the little guy loses out.”
Whoa. If “the little guy” is the beneficiary, does that make us “Big Business” in the doctor’s eyes? That made me furious, as I’m familiar (as the doctor obviously is not) with the actual profit margins in CRT.
When I calmed down, I realized: This is why we need to keep teaching, keep explaining what CRT does and how this industry increasingly has outcomes measures to show that CRT works for everyone, from insurers (who save money on hospitalizations and facility placements), to society in general (which benefits from active CRT users working and paying taxes), to of course, consumers and their families. So keep on keeping on. And maybe the CRT industry will educate the masses one reporter, one referral source, one payor and one beneficiary at a time.
This article originally appeared in the November 2018 issue of Mobility Management.
Laurie Watanabe is the editor of Mobility Management. She can be reached at firstname.lastname@example.org.