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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
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
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
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.