In April, the Centers for Medicare & Medicaid Services (CMS) announced Medicare coverage for personal exoskeletons.
ReWalk (DBA: Lifeward), an exoskeleton manufacturer, praised the decision: “The Centers for Medicare & Medicaid Services has officially revised its April 2024 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule to include a final lump-sum Medicare purchase fee schedule amount for personal exoskeletons with a ceiling-to-floor range from $109,238 to $81,929, and an established rate of $91,032 for each state. CMS states that it calculated this final payment amount by averaging pricing information for exoskeleton devices from Lifeward and other manufacturers.”
Good news for exoskeleton stakeholders, but ….
That’s good news for people who use exoskeletons. Any technology that supports, optimizes or promotes personal mobility, independence and function … huzzah!
Another mobility example: prosthetic limbs. Huzzah!
But I’ll bet that upon learning of Medicare’s exoskeleton fee schedule, seating and wheeled mobility professionals had mixed feelings.
I’ll bet they were happy for their clients who could benefit from exoskeleton technology.
And I think that seating specialists looked at those fee schedule amounts and calculated how many robustly configured ultralightweight chairs could be purchased with $91,032.
Or how much a Group 3 power chair with robust powered seating options costs.
I’m guessing they also calculated the immense amount of work involved in justifying tilt, recline, seat elevation, power assist, alternative driving controls, complex seat cushions, dynamic backs, etc.
And at this point, I’ll bet they got angry.
Walking has always been the gold standard
Again: I’m not casting aspersions on exoskeletons, and I’m not giving the side-eye to prosthetic limbs.
I’m just wondering for the umpteenth time why walking seems to be defined as the ultimate and best mobility goal, with everything else seen as a poorer, lesser substitute.
Yes, wheelchairs. I mean wheelchairs.
I’m not a clinician or Complex Rehab Technology (CRT) provider. I’m not an Assistive Technology Professional (ATP). But I’ve heard from those specialists, again and again over the last two decades, that for many, many clients, wheelchairs are as functional or more functional than walking would be.
For example, I’ve heard of many people living with limb loss — especially amputations above the knee — who have prosthetic limbs, but prefer to use their wheelchairs when traversing longer distances and/or negotiating uneven terrain.
And a person with a spinal cord injury who wears an exoskeleton to walk across a smooth, level stage to receive a diploma might choose to use a wheelchair to get through the university parking lot and across campus into the auditorium where that stage is.
I can think of plenty of instances in which a wheelchair is just as or more functional than other mobility devices, particularly when crossing distances, navigating different types of terrain, or simultaneously carrying objects.
So why do seating professionals, clinicians, consumers, caregivers, etc., have to fight so hard and so often to get a $3000 ultralight chair when CMS will pay $90K and up for an exoskeleton?
Because walking is valued above rolling. “You can’t put a price on a person’s legs,” we hear over and over from policy-makers who gladly pay in the high five-figures range for a prosthetic leg. That’s fantastic, but too many of these same people quibble over paying for a more functional backrest or for a power-assist that could proactively prevent injuries.
The best mobility should be the goal
Ultimately, shouldn’t the goal be to provide the client with the best possible functional outcomes?
If for one client, that means walking … great! But if for a different client, that means rolling in a wheelchair … we should also applaud that and fund the wheelchair accordingly.
We should not assume walking to be the best answer for every person, because it isn’t. Walking isn’t even the best answer for every situation. If your workplace were 20 miles from home, would you choose to walk to work every day, or would you choose wheeled transportation?
The best mobility answer for people with complex mobility needs should be left to each seating team, comprising the consumer, caregivers, seating clinicians, providers, CRT manufacturers, speech-language pathologists, school-based therapists, personal aides, transportation aides, recreation therapists, etc.
If the best functional outcome is the funding source’s goal, then payers should embrace all potential technology, including the wheeled kind.
One last question: If indeed our society loves upright mobility so much, isn’t it time for CMS to start the Medicare coverage determination process for power standing wheelchairs? Asking for some friends.
