Sunday, December 31, 2006

Q. To ensure patient access to the right PMDs, should Medicare require that providers be RESNA certified?
A. The most recent coverage determinations for powered mobility devices states that effective April 1, 2008, certain devices will require the involvement of a RESNA-certified ATP and ATS. These devices are higher-end devices for people who have more complex needs associated with their diagnoses, such as neuromuscular disorders.
Several questions do arise with this policy. Should these credentials be required for all mobility assistive equipment? Are there enough RESNA-certified practitioners and suppliers? Will this create an access issue?
As a clinician, I support CMS's efforts to raise the bar. I cringe every time a client rolls into my office in a K0001 manual wheelchair or a low-end K0010 or K0011 power chair because a physician, therapist, supplier or discharge planner made a bad call based on limited knowledge or the desire to opt for the path of least resistance.
This leads me to believe that a RESNA-certified or some qualified person needs to be involved in the assessment and provision of all MAE. There are just too many opportunities to put people in bad equipment. Physicians and therapists have a lot of training, but they do not learn enough about this equipment, so the responsibility to identify the right device is often deferred to suppliers.
At the moment, there are probably not enough qualified ATPs or ATSs out there to meet the need of the growing population of mobility impaired people in this country. There are, however, no other real means for CMS to identify qualified providers other than the ATP, ATS or NRRTS's CRTS. So we shouldn't throw the baby out with the bath water. Instead, we should figure out ways to increase the number of certified providers.
RESNA has begun to do this. It's working to refine a knowledge and skills set for wheeled mobility and seating. It also plans to increase the frequency of its exams in 2007. hme
Mark Schmeler, Ph.D., OTR/L, ATP, is on the faculty of the Department of Rehabilitation Science & Technology at the University of Pittsburgh. Reach him at