After his first week as the new administrator for the Centers for Medicare & Medicaid Services (CMS), Mehmet Oz, M.D., shared four goals that embody the “Make America Healthy Again” mandate of President Donald Trump.
Here’s #4: “Shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management.”
If Dr. Oz wants prevention, he should love Complex Rehab Technology (CRT).
Disabilities as chronic conditions to be managed
At last month’s International Seating Symposium in Pittsburgh, keynote speaker Peter W. Thomas, J.D. — managing partner at law firm Powers Pyles Sutter & Verville PC and co-coordinator of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition — talked about “wins, losses, and what we’ve learned.” Thomas — who has used prosthetic limbs since childhood and also uses a wheelchair — listed threats to Medicaid and Affordable Care Act funding, as well as to funding for critical research.
“We are really taking some fire right now,” he acknowledged.
But Thomas also said that the political and policy pendulum “always swings back and forth.” And he noted that new Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. wants to focus on managing chronic illnesses.
So, Thomas wondered, could disabilities be managed as chronic conditions under the new administration?
The seat cushion vs. flap surgery example
Think about how CRT, when chosen and configured by a qualified seating and wheeled mobility team, can manage chronic conditions such as pressure injury risk and also slow or prevent musculoskeletal conditions such as scoliosis.
A common example is a wheelchair seat cushion with skin protection and positioning features. It optimally distributes the wheelchair rider’s weight. The cushion also helps to maintain the rider’s position to facilitate efficient ultralightweight wheelchair propulsion.
That cushion could help to reduce the risk of pressure injuries and repetitive stress injuries to the shoulders/arms/wrists/hands from inefficient propelling. Investing in this type of cushion could help a wheelchair rider avoid pressure injuries and the hospitalization, surgeries, and immobility that follows. Ditto for avoiding rotator cuff or carpal tunnel surgery.
CMS could buy a lot of prevention by funding a cushion for around $600.
CRT as a preventive measure
Imagine CMS fully funding CRT and therefore spending less on pain medications, surgeries, hospitalizations, lengthy rehab facility stays, and long-term admissions to skilled nursing or other residential facilities. For example:
— Power seating functions, including tilt, recline, elevating/articulating legrests, seat elevation, and power standing: Perform weight shifts to reduce pressure injury risk while supporting the safer, more efficient performance of mobility-related activities of daily living (MRADLs). Can reduce pain, help preserve range of motion. Can facilitate safer transfers.
— Power assist for manual wheelchairs: Reduces propulsion effort, conserves energy, lowers risk of repetitive strain injuries to shoulders, arms, wrists, hands.
— Standers and gait trainers: Redistribute weight and relieve pressure; can improve respiration, digestion, circulation, bowel function; can preserve or improve range of motion; can help to prevent contractures.
— Seating systems: Can manage or slow the progression of asymmetrical postures, scoliosis, etc. Can support safer swallowing and saliva management. Can improve respiration. Can prevent neck injuries by eliminating hyperextension.
— Lying posture care management: Slows or helps to prevent development or progression of scoliosis and asymmetrical postures. Reduces pain that disrupts sleep and daytime activities. Can improve respiration, can reduce risk for contractures, can preserve range of motion.
From a purely financial perspective, optimally configured CRT is a cost-effective way to manage chronic conditions, to slow or prevent contractures or asymmetries, to slow or prevent pressure injuries and repetitive strain injuries, and can also impact other critical functions such as respiration, digestion, swallowing and saliva management, and MRADL performance. (Yes, there’s documentation and research to back this up; position papers from the Rehabilitation Engineering and Assistive Technology Society of North America [RESNA] are a good place to start.)
At present, we cannot prevent multiple sclerosis, amyotrophic lateral sclerosis (ALS), or muscular dystrophy. We cannot prevent all accidents and incidents that result in spinal cord injuries and limb loss. We cannot prevent all cases of stroke, spina bifida, or cerebral palsy.
But CRT that’s chosen, configured, and provided by expert seating and wheeled mobility professionals “fosters prevention, wellness, and chronic disease management,” as one of Dr. Oz’s goals states. Even if saving money is CMS’s top priority, with patients’ physical and mental well-being a distant second, CRT is a sound investment.
Seating and wheeled mobility professionals have great answers to what you’re looking for, Dr. Oz. I bet they’d love to chat.
Image: Pixabay/Gerd Altmann
