Stephanie Harrington PT MPT ATP Meredith Ford PT DPT CNDT Objectives Identify and evaluate for when DME is required Recognize custom durable medical products in the field Understand recent advances in ID: 678186
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Slide1
Custom Durable Medical Equipment
Stephanie Harrington, PT, MPT, ATP
Meredith Ford, PT, DPT, C/NDTSlide2
ObjectivesIdentify and evaluate for when DME is requiredRecognize custom durable medical products in the fieldUnderstand recent advances in custom DME
Discuss
related insurance nuancesSlide3
WheelchairsPatient mobilization limitationsDoes the patient have strength, endurance, range of motion or muscle tone limitations?Does the patient have the capacity to independently propel themselves?
Does patient have cognitive ability and safety awareness in order to control a power chair?
Type of transfer – How to get in and out
Can the patient ambulate with assistance or by self?
Is a sliding board required for transfer?
Frame transportation
What type of vehicle does the patient have?Is there an installed lift system?Account for growth in pediatric casesInsurance requirement for 20% growth in seat width and depthRequired to account for approximately 3-5 years of equipment use
Considerations for Pediatric CareSlide4
WheelchairsTilt in Space ChairsAccommodate tone abnormalities, posture deformities (scoliosis), weakness, respiratory and cardiac impairmentsFreedom®
NXT,
Quickie®
Iris
Upright Manual Chairs
Use when patient has good sitting balance, self propulsion, possible backup for a power chair
Folding chairsQuickie® 2Rigid chairs – lighter and more energy efficientTiLite® Aero Z, KI Little Wave Clik
Manual ProductsSlide5
WheelchairsAccessories for Manual ChairsSmart DriveEasy on and offCompatible with folding and rigid frames
Must trial prior to ordering
11 Pound drive
Emotion Wheels
Compatible with folding and rigid frames
Drive on wheels – 20 pounds/wheel
Power Assist ProductsSlide6
Wheelchairs
Wheel Type
Front wheel drive – indoor and outdoor use
Mid wheel drive – use in tight or confined spaces
Rear wheel drive – used in a variety of environments
Drive Type
If there is a functionally controlled movement, the patient can drive.Hand, head array, Sip n Puff,
MicropilotPower Products
Power Seat Functions
Power tilt indication - Does the patient have the ability to perform a pressure relief by themselves?
Power seat elevator indication – Can the patient perform a level transfer by themselves?
Power recline indication – Does the patient struggle with prolonged upright sitting?
Power elevating leg indication – Is the patient unable to lift legs or has risk of swelling?
Power stand indication – Is the patient a client for standing and can perform an independent level transfer?Slide7
Seating
Considerations for pediatric care
Variety of seating options for postural deficits
Cushions - Pressure relief, patient positioning, ease of use (ROHO®)
Sport backs – Mild postural deficits, weakness or tone abnormalities (Jay® 3™)
Solid seating – Moderate postural deficits, ability for customization (Freedom Seating System)
Custom molded – Most severe postural deficits: scoliosis, pelvic obliquities,
Gibbus
deformities (Contour-U)
Seating options on stroller are typically ‘off the shelf’
Wheel chair seating is more readily customized
Insurance will not pay for seating system changes within 6 months of equipment deliverySlide8
Strollers
Considerations for pediatric care
Tilt in Space and/or Recline
Consider when
t
one abnormalities, weakness, posture deformities, respiratory or cardiac deficit, or endurance impairments are present.
Is there a need for medical equipment transportation?
Most
products are capable for transport.
Zippie
® Voyage™,
Kimba
® Neo
UprightTypically used when patient is unsafe in wheelchair – behavioral issues, cannot physically or is not cognitively aware to propel wheelchair.Convaid EZ RiderSlide9
Imperative that there is an evaluation of the home environment – Q&ADiscussion at time of evaluation to assess:Is the patient in own bath area or sharing with others?Layout and type of bath/shower equipment?Patient capabilitiesIs the patient capable of independent transfers?
Does patient demonstrate good head and trunk control and sitting balance?
Bath Equipment
Rifton® Bath Chair
Drive Tub Transfer Bench
TubBuddy
™ Transfer SystemToilet EquipmentRifton® HTSColumbia™ Medical Commode Chair
Bath and Toilet
Considerations for pediatric careSlide10
Beds
Considerations for pediatric care
Hospital Bed
Does the patient require head and foot elevations due to a medical condition?
Respiratory or cardiac deficit, impaired oral-motor function, seizures
Allows
for head and foot articulation and/or bed height
adjustment
Enclosed Safety Bed
Use indicated when patient is at risk to themselves or others.
Lack of cognitive or safety awareness to stay in bed – climb, scoot, roll out of bed.
Combination Hospital/Enclosed OptionsSlide11
Car Seats
Considerations for pediatric care
Patient Limitations
Consider postural limitations in seat selection
Commercial restraint has been out grown
Impaired safety awareness – patient able to unbuckle self
Weight requirements dictate equipment selection
Vehicle Requirements and AccessibilityYear of manufacture and installed safety equipmentSeat requires proper securing – top tether and seat beltAll adaptive car seats/beds/booster seats must be installed by a technician certified in car seat
installationSlide12
Car Seats
Considerations for pediatric care
Weight Requirements
The Hope
Car
Bed ™
by EZ Tether – 4.5-35
lbs
Traveler Plus Car Seat by Snug Seat – 22-105
lbs
Recaro
PerformanceSport – 20-120 lbsThe Roosevelt™ Car Seat by EZ Tether – 35-115 lbsSpirit™
Car Seat by Columbia™ – 25-130 lbsThe Churchill™ Backless Booster by EZ Tether- 65-175 lbsE-Z-On® Vests by EZ On Products – 20-168 lbs
The Jefferson ™ Car Seat by Merritt Mfg. – 7.5 – 40 lbsSlide13
Standers, Gait Trainers, Walkers
Considerations for pediatric care
All accessories require insurance justification
Must have growth built into system
Recommend trial prior to ordering
Insurance denies simultaneous Stander and Gait Trainer at same time
Insurance will not
allow for changes or replacement within 6 months of equipment deliverySlide14
Standers, Gait Trainers
Commercial Products
Standers
Supine – Rifton®, Squiggles,
Superstand
, Zing™
Prone – Rifton® Prone, Lecky
ProneStander
,
Jenx
Sit-to-Stand – Bantam™, Evolve™
Gait Trainers
Rifton® Pacer
KidWalkUp n Free™GrilloSlide15
Other Equipment
Considerations for pediatric care
Collars
Provide support for anterior neck muscle control
Adaptive to multiple equipment platforms
Adaptive tricycles
Not usually an insurance covered expense – charity and supplemental funding needed
Feeding, positioning, activity chairsSlide16
Insurance Considerations
Medicaid Nuances I
Custom manual and power wheelchairs/adaptive strollers
Requires PT or OT present with the Assistive Technology Practitioner (ATP) at the time of any new custom evaluation or major
modification
Requires the
same
ATP to be present at time of equipment deliveryNo payment for changes to current or new equipment until 6 months post equipment purchase
Eligibility for seat elevator on a custom power wheelchair
Must be able to preform level transfers or be able to perform level to unleveled surfaces with the use of a seat
elevator
Adaptive car seats and booster seats
Pays based on medical or functional
needNot based on weight or height limitsMust be installed by vendor provided certified technicianSlide17
Insurance Considerations
Medicaid Nuances II
Adaptive
strollers
Must be age appropriate
Must have growth options
Must have firm seating
systemStanders and Gait trainersRequires justification for each accessoryPower bedsPatient must be able to independently physically transfer high-low function as well as operate remoteHead and
foot articulation
Must be medical justification for this feature
Seizures, cardiac, respiratory, oral motor justificationsSlide18
Insurance Considerations
Private Key Points
Therapist Presence
PT/OT not required for custom manual wheelchair or stroller evaluation
PT/OT must be present for Group 3 or higher custom power wheelchair evaluation
Insurance Coverage
Transit options and trays are typically not covered
May not cover bath/potty, car seat, and stander plan dependent coverageSlide19
Insurance Considerations
Alternate Funding Sources
Medicaid Waiver Program (MDCP and CLASS)
Must have Medicaid denial first
MDCP – Family must call to get 3 quotes for item requested
Texas Department of Assistive and Rehabilitative Services (DARS)
Charity Program
Texas ELKSJunior LeagueSlide20
Durable Medical Equipment
Stephanie Harrington, PT, MPT, ATP
Meredith Ford, PT, DPT, C/NDT
Questions?