Much of the anxiety of choosing the width/depth/height for a seating system stems from payors’ insistence that the system last a certain amount of time — a period that continues to lengthen as budgets and allowances continue to shrink.
Tricia Garven, PT, ATP, clinical applications manager for ROHO Inc., says durability expectations for seating systems and components are increasingly being applied even to seat cushions. In the past, funding sources were relatively amenable to replacing cushions more often than wheelchairs, for example. But now, more payors are holding cushions to the same five-years-of-usage parameters that wheelchairs have.
“It is getting tougher,” Garven says. “[There’s a] five-year replacement rule even for cushions, which typically were sort of an exception. Maybe the [five-year] idea kind of existed, but the enforcement never did, for sure.”
Garven adds that the trend is occurring among various payors.
“If anything, some of the insurances are even tougher than Medicare,” she notes. “We sort of treat Medicare like they’re the worst ones, and they are definitely trend-setters. Lots of people copy them, but there are plenty of insurances and Medicaids in different states that are even tougher. Or their allowables and such are even lower. It’s definitely going that way for whatever funding source isn’t there yet.”
One of the translations for ATPs might be choosing seat cushions and mobility components with greater durability, Garven says, so the products can last through five years of rigorous use.
“Patient education is important for making it last that long. Choose a product that you expect to last that long, and if [they’re] a really hard and heavy user, anticipate that in your frame selection. If the cushion needs to last this long, it needs to be cleaned often. Choose something that can be cleaned often, whatever that might be.”
Knowing differences between products and codes could also be crucial for sound decision-making.
“General-use cushions have a 12-month warranty; that’s the Medicare standard, that they have a 12-month warranty,” Garven says. “Twelve months to 60 months — quite a difference. [General-use cushions] are not expected to last that long, so if somebody does qualify for a better, longer-warranteed-type product, get it. They’re going to be using the chair for two or three or four or five years, so understand that you have to choose the correct width, but also the durability.”
