"Upcaring" in wheelchair seating and positioning
by Brandon Sykes
April 3, 2018

At a time when all home medical equipment (HME) providers are looking to reduce operational costs and maximize revenue, some believe quality may need to take a back seat to quantity in order to keep mobility business moving.

However, this simply isn’t this case. In fact, when it comes to wheelchairs, purposefully providing appropriate accessories helps both the patient
and provider.

When a provider supplies what is commonly referred to as a “naked” wheelchair—without any of the vital comfort and safety accessories—an important opportunity has been missed. “Upcaring,” or optimizing a product with tailored and appropriate accessories, will improve the patient’s overall comfort, safety and independence, as well as increase reimbursement for the provider.

To upcare, providers need to be the experts in the health care supply chain that can accessorize each wheelchair they deliver, adding options such as adjustable height armrests, anti-tippers, wheel lock extensions, positioning belts and seat cushions when appropriate. By mindfully upcaring wheelchairs, not only will the quality of life of wheelchair users be enhanced, but providers will be cash flow positive in the first month of a 13-month capped rental. They will also earn a brand name synonymous with “expert in mobility” and the opportunity to win a disproportionate share of business.

Of course, not all patients are covered by Medicare, but following these wheelchair basics can help bolster any company’s brand in the marketplace. HMOs want to hear that their members are properly taken care of and will be compliant in their equipment use. Below are some ways to upcare for patients.

Adjustable-Height Armrests

Adjustable-height armrests are a necessity for almost all patients, allowing proper, comfortable positioning for the arms and shoulders. This comes into play even more when seat cushions are used, increasing the patient’s distance from the arm to the armrest. Proper adjustment of the armrest to facilitate a 90-degree angle at the elbows improves patient comfort while increasing reimbursement to the provider by $102 per armrest pair on average as a purchased item under Medicare.

Anti-Tippers

Anti-tippers are essential to preventing the wheelchair from tipping backward, which can happen on a steep incline or if the user propels too quickly. Every patient who qualifies for a manual wheelchair also qualifies for anti-tippers, which are reimbursed the first month upon delivering the wheelchair at an average rate of $57 per pair.

Wheel Lock Extensions

Wheel lock extensions are ideal for increasing functionality, especially for users with limited dexterity. A wheel lock extension lengthens the handle by either six inches or eight inches, allowing the user to engage the lock with much less force than a standard wheel lock. These extensions are also reimbursable the first month of delivery, and reimburse at an average rate of $39 per pair.

Positioning Belts

Incorrect positioning in a wheelchair can lead to trunk instability and uneven pressure on a patient’s bony prominences, which can lead to tissue destruction. When used properly, wheelchair positioning belts allow for proper positioning of the pelvis, assist with trunk control, and help prevent slipping out of the wheelchair. Proper use of a positioning belt enables the patient to function efficiently, especially when exerting extra energy while self-propelling. Positioning belts are reimbursed the first month at an average rate of $23 each.

Wheelchair Cushions

If a wheelchair is used for most of the day, the constant pressure can cause sores, skin breakdown and even pressure ulcers. Wheelchair sling seats are not designed to be sat in for an extended period of time. They are designed to be used with a wheelchair cushion to help patient posture and evenly distribute pressure to ensure the patient is comfortable.

Wheelchair cushions are prescribed for comfort, increased sitting tolerance, and postural support while using the wheelchair. They can also give the patient greater stability and can prevent the patient from sliding forward, which in turn allows the patient to better self-propel a wheelchair.

Wheelchair cushions are also reimbursed the first month at an average rate of $40 each.

Accessorizing every wheelchair order with these five options, providers have an opportunity to turn a profit the first month of delivering the wheelchair versus the fourth or fifth month. For example, a K0002 wheelchair reimburses $38.74, on average. With the cost of a K0002 wheelchair upwards of $150 or higher, a provider may only make $4 to $5 per chair in the fourth month of the rental. Instead, the same wheelchair can be accessorized with adjustable height armrests, anti-tippers, wheel lock extensions, positioning belt and a seat cushion, and a provider can turn a profit of $149 on average, along with first-month reimbursement on the 13-month capped rental.

Studies have shown that if a wheelchair is not properly fitted to a patient’s daily needs, it can lead to noncompliant wheelchair use, and ultimately injury. In many instances, the patient may become less social and is at a higher risk for depression. Following this model can lead to improved clinical outcomes for
your patients. Not only are patients more likely to use the wheelchair because it is more functional, safe and comfortable, but providers can ensure optimal results the clinicians expect.