The National Registry of Rehabilitation Technology Suppliers (NRRTS) has released practice guidelines for Complex Rehab Technology (CRT) service, preventive maintenance, and repair.

In a Sept. 16 announcement accompanying the release of the guidelines, NRRTS Executive Director Weesie Walker, ATP/SMS, said, “Difficulties in providing and receiving CRT service and repair have become challenging to all stakeholders. The various influences that challenge access to necessary service and repairs are the subject of much discussion, and it is difficult to reach understanding between those most impacted.”

Walker referenced a number of challenges, including “repair times, level of reimbursement for service and parts, in-home service capacity and feasibility, hiring and securing qualified staff, [and] procedural complexity.”

“Considering the reported loss of revenue associated with repairs, increased complexity of power wheelchair designs, and onerous policies regarding repairs, it is understandable that suppliers are under significant pressure, and consumers are dissatisfied,” Walker added.

A Multi-Faceted Path Forward

Walker’s message made clear that all stakeholders — not just CRT providers and manufacturers, who are most often mentioned in news reports about broken equipment — will need to work together for the best outcomes.

Guideline suggestions included CRT suppliers establishing best practices for repair and investing in training their technicians, while manufacturers have been called upon to improve wheelchair owners’ manuals to include recommended preventive maintenance, “including the level of technical expertise required to perform each step.”

Funding sources are called on to scrutinize prior authorization requirements and to streamline or eliminate them; to simplify and standardize their repair documentation requirements; and to communicate with suppliers concerned with inadequate reimbursement for replacement parts, time and fuel used while commuting to consumers’ homes, and time spent diagnosing and servicing the equipment.

“All stakeholders, suppliers, manufacturers, clinicians, consumers, and payors should work together to identify barriers to timely and professional repairs and agree on initiatives to influence positive change,” Walker said in her remarks.

The first step in this lengthy process, she added, is the standards document, created by NRRTS in collaboration with the University of Pittsburgh.

A Broad Range of Responsibilities

Authors of the guidelines are Mark R. Schmeler, Ph.D., OTR/L, ATP; Jack Fried, MRT; Richard M. Schein, Ph.D., MPH; Gede Pramana, Ph.D.; Madelyn Betz, MRT, ATP; Weesie Walker, ATP/SMS; Mark Sullivan; and Rita Stanley.

The guidelines address three main areas within the topic of wheelchair service: efficiency, documentation, and prevention and replacement.

The document covers the subject of CRT service methods, including discussion about the most efficient venue for wheelchair repair (i.e., the provider’s office) and other options (e.g., use of mobile repair vans) when the provider’s office isn’t possible. The guidelines also discuss the role of remote service and its ability to give providers a virtual first look at the equipment needing repairs.

The standards discuss the benefits of preventive maintenance and repair, and how different stakeholders — consumers, providers, manufacturers — would play a role in optimizing clear communications, expectations, and knowledge of, for example, reasonable useful life expectancies of components. The document also discusses the types of systems and components that would be included in a preventive maintenance model, and which components (e.g, batteries, casters, upholstery) would be expected to need replacing due to normal wear and tear.

Funding sources’ responsibilities, as suggested by the guidelines, would include developing documentation requirements that would be consistent across different payers, as well as amending prior authorization and documentation requirements for “wearable items” (e.g., forks, bearings, batteries) that are “expected to fail periodically,” and providing payment for preventive maintenance as described by wheelchair manufacturers.

Read the standards and Weesie Walker’s opening remarks here.

The standards were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90REGE0001).