“I wasn’t taught about ordering wheelchairs in nurse practitioner (NP) school - Part 1”
I wasn’t taught about ordering durable medical equipment (DME) in my Masters of Science in Nursing (MSN) program, so I am self-taught from experience on the subject, with help from friends and from patients of course. I don’t use a wheelchair but I think about wheelchairs and talk with people (consumers, vendors, manufacturers and insurers) about wheelchairs and I appreciate good wheelchairs! If this article smooths the way, dear reader, for your next wheelchair, I will have succeeded.
The Players
Who is involved in a wheelchair order? Well, first of all YOU. Your story - your history, your present circumstances and your preferences - must be translated into medical documentation for the purpose of a wheelchair order. That’s why if there are any barriers to communication, it’s best to anticipate those. For example you might bring someone whom you trust to your wheelchair appointments, someone who can take notes and, if needed, can also fill in details and emphasize important issues.
The following are some examples of what you and your team will need to express and understand for the wheelchair order:
What you want and need to be able to do (to stay healthy, to get around, to transfer)
Where you will be using your wheelchair, i.e. at home, at work, at school, in rugged or gentle terrain
What you are currently able to do (transfers, accessibility at home, etc.)
How your body feels and how it behaves, (spasticity, comfort, etc.)
Team Wheelchair!
Here’s the line-up of YOUR wheelchair team: You will have face-to-face visits with two licensed professionals: a healthcare provider (HCP) and a wheelchair mobility and seating specialist. The healthcare provider is usually a primary care provider (PCP) but it could also be a Physical Medicine and Rehabilitation (PM&R) doctor or a specialized rehabilitation nurse practitioner (NP). The wheelchair seating specialist might be a certified Assistive Technology Professional (ATP) or an Occupational Therapist or Physical Therapist (OT or PT).
Again, we are talking about two separate visits: one with a healthcare provider and one with a wheelchair mobility-and-seating specialist. You’ll see your healthcare provider once for the purpose of your wheelchair order (even if you see them for other things at different intervals). You’ll see the wheelchair specialist at least once and that person should be very knowledgeable about wheelchairs and assistive technology. The more experienced both of these professionals are, the better. If you are doing all of this while still in Acute Rehab, these professionals will be well known to you as your rehab team and they will seek you out for the purpose of starting your wheelchair order. When you do this as a community member, YOU will have to seek these people out in outpatient clinic settings where you’ll have to call up and schedule an appointment.
Show me the Money
Who else is involved in a wheelchair order? Why, the payer of course. This is most often state or federally administered insurance, but could also be another state program such as Vocational Rehabilitation or a Regional Center, or a program such as the U.S. Department of Veteran Affairs (VA). Sometimes, a consumer will experience the “kicking in” of Medicare right in the middle of a wheelchair ordering process. It is very important that any change in your insurance carrier be reported immediately to your healthcare provider. Why? Because if the payer drops the order but the ordering healthcare provider doesn’t hear about it, this can lead to a long delay as the order is basically dead in the water.
Next, we have the people who broker the deal: the DME vendor and the wheelchair manufacturer. Your own healthcare provider or wheelchair seating specialist may have suggestions of specific DME vendors to use, their “go-to’s. You may have a preferred vendor but keep in mind that not all vendors are contracted with all insurers.
Below are a few helpful links where you can find information about assistive technology and funding sources:
http://resna.org
https://abilitytools.org/
https://nls.org/disability/
OK, we’ve covered the “who” for a wheelchair order. Next time: What are the steps of a wheelchair order?
Rebecca Hummel-Moore, MSN, NP-C is a nurse practitioner and Advisory Board member for NorCal SCI. She practices in Berkeley, CA and has 12+ years working with people with SCI/D in both inpatient and outpatient settings.