My 2 cents follows:
As part of my private practice, I've done many, many w/c evals. These
evals range in complexity from children with SEVERE CP to older adults
with mild mobility limitations. And even those people who wanted a
scooter ONLY so they can go grocery shopping. {FYI, Medicare REQUIRES
there be an in-home need for powered mobility}
Over the course of these evals, there have been a few that I KNOW I was
not the most qualified. However, the vast majority of these evals have
required very few ATP skills. Instead, they have been functional
evaluations of a person's strength, ROM, endurance, etc. Coupled with
an understanding of Medicare rules/regs, including the MAE Algorithm,
these evals are definitely within the realm of an advanced OT.
Personally, I believe that the ATP credential is WAY over-kill for many,
many powered mobility evals. But, I also feel that it is essential for
a few of the high-tech evals requiring advanced positioning needs.
I don't know what the best solution is. Obviously, having an AOTA
certification that is NOT recognized by Medicare is useless. I will NOT
pursue ATP certification so if this is a required credential in the near
future, I will no longer be doing powered w/c evals.
Ron
----- Original Message -----
From: Mary Alice Cafiero <[EMAIL PROTECTED]>
Sent: Tuesday, October 30, 2007
To: [email protected] <[email protected]>
Subj: [OTlist] ATP
> I have to say more on this subject. Sorry if I'm boring some of you!
> Unless things have changed dramatically in OT schools since I
> graduated, OTs do not come out of school with knowledge of seating
> and positioning or function-based wheelchair assessment. I have
> spoken with many students on their internships in the past 7-8 years,
> and they report that they still get the 1/2 to 1 day education on
> what a wheelchair is but nothing more in depth than that.
> Do I think OTs are the best profession ultimately to be doing this
> type of assessment? Absolutely! BUT, I don't think being an OT
> automatically makes you qualified to be recommending complex rehab
> equipment and advanced seating.
> RESNA respects and requires hours of direct experience in the field
> before you are even qualified to take the exam. Currently AOTA does
> not have a way to acknowledge or recognize OTs that are specialists
> in this field. How can AOTA expect CMS to turn to them for
> definitions and qualifications of who should be performing this type
> of evaluation?
> I'm not just trying to be stubborn and disagreeable, but this is an
> area that I feel passionate about. Recommending equipment that is
> inappropriate for a client can cause harm. Recommending equipment
> that will not accommodate a client's needs for the next 4-5 years can
> cause the patient to be "stuck" because funding will not cover
> another mobility device.
> Mary Alice
> On Oct 30, 2007, at 2:01 PM, Chuck Willmarth wrote:
>>
>> I'd like to address part of this discussion. There was no request
>> from
>> CMS to provide our qualifications to evaluate chairs prior to the LCD
>> draft issuance. We LONG advocated for OTs to be specifically
>> recognized
>> as qualified to do this, starting with when CMS began the process of
>> disseminating the National Coverage Decision, but CMS' response to us
>> repeatedly (in writing and on calls) was that they were going to leave
>> the decision of who would be qualified to another process. They
>> didn't
>> identify the DMERC Medical Directors as the group tasked with
>> determining who would be qualified until very late in the game, a few
>> months before the draft LCD was issued.
>>
>> We commented on the draft LCD and subsequently requested
>> reconsideration
>> of comments. We had a conference call with the DMERC Medical
>> Directors
>> last week to make our case. We should know something by mid-November.
>>
>> Here are some articles that discuss the issue in more detail.
>>
>> http://www.aota.org/Archive/NewsA/FedReimbA/39756.aspx
>>
>> http://www.aota.org/News/AdvocacyNews/fedreim/39739.aspx
>>
>> http://www.aota.org/Practitioners/Reimb/News/Letters/40713.aspx
>>
>> http://www.aota.org/Practitioners/Reimb/News/Announcements/40727.aspx
>>
>>
>> Chuck Willmarth
>> Director, State Affairs and Reimbursement & Regulatory Affairs
>> AOTA
>>
>>
>> -----Original Message-----
>> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
>> Behalf Of Mary Alice Cafiero
>> Sent: Sunday, October 28, 2007 11:35 AM
>> To: [email protected]
>> Subject: Re: [OTlist] ATP
>>
>>
>>
>> Medicare first looked to AOTA and APTA to ask what the standardized
>> education and monitoring was for therapists who performed high end
>> wheelchair evaluations. Neither organization had an answer, so
>> Medicare
>> expanded it's search to RESNA (Rehab Engineering Society of North
>> America), some of the top manufacturers (Sunrise-who makes Quickie
>> chairs, Invacare, Permobil, and Pride) to ask the same questions. The
>> only credential available to show that a therapist has specific
>> knowledge of assistive technology is the ATP exam through RESNA. There
>> is also an ATS exam/credential for suppliers. RESNA requires that you
>> have a certain number of hours in the AT field before you can take the
>> exam and also requires continuing education applicable to the area in
>> which you practice to keep your credential current.
>>
>> Medicare isn't going to require an ATP for every power eval. It is
>> only
>> for Group 2 chairs with a power function such as tilt or recline
>> and any
>> Group 3 chair. Group 3 is for more complex rehab and, in my opinion,
>> should always require a therapist's evaluation. It is a good
>> checks and
>> balances system as well as a good way for clinicians and suppliers to
>> collaborate. I personally think the therapist should be involved in
>> the
>> delivery of higher end equipment every time.
>>
>> So, after all that, my answer to your question is that, yes, it is a
>> good idea to require the ATP.
>>
>> Mary Alice Cafiero, MSOTR, ATP
>>
>>
>> On Oct 27, 2007, at 7:19 PM, Ron Carson wrote:
>>
>>> Hello All:
>>>
>>> Mary, your recent message and your credentials prompted to write this
>>> message.
>>>
>>> Starting in 2008, Medicare will require the ATP credential for
>>> certain
>>
>>> types of wheelchair evals.
>>>
>>> How do list members feel about this? Is an ATP credential necessary
>>> to satisfactorily evaluate a patient for power mobility?
>>>
>>> Thanks,
>>>
>>> Ron
>>>
>>>
>>> --
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>>
>>
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