Trends in wheelchair recommendations in a dedicated seating department.

Introduction: In the early 2000 s, investigators at the federal government noted growing Medicare expenditures for power mobility devices, which were related to high profit margins and fraudulent activity. Medicare responded with policy and program changes, and stakeholders in wheelchair service delivery have noticed an impact on their services and changes in wheelchair user access to needed equipment.

Methods: This study examined 4,252 wheelchair clinical recommendations made by full-time wheelchair seating department therapists between 2007 and 2017 through a retrospective chart review. Demographic counts and percentages were examined in relationship with equipment over time.

Results: The number of recommendations increased over time in all age groups, but most for people aged 19-64. Fifty percent of people with Medicare were younger than 65, and 63% of Medicare recommendations were for complex wheelchair bases. Overall, decreased recommendations were noted in 2008, consistent with the economic recession. An increase in recommendations occurred from 2014 to 2017, consistent with the onset of the Affordable Care Act.

Conclusions: Most change occurred for middle and older age groups, complex manual wheelchairs, and standard power mobility devices. This study supports the need for a separate Medicare category of Complex Rehabilitation Technology for those with severe disabilities.