Packer Perspective: Defending the True Need of the Standing Frame Chair

Published in Complex Rehab on Monday, January 13, 2020

“An appeaser is one who feeds a crocodile, hoping it will eat them last.” – Winston Churchill 

I have written about a lot of items over the last few years, and today I want to write about one that we are seeing happen quite often with the standing frame chair. We see that Medicare and Medicaid across the country like to deny and push payment out for these medically-necessary devices. You hear of very few folks that are kept from the right medication or the right surgical procedure to get them back to good health. In the custom rehab technology space, we hear about denials on a more frequent basis. We know there are quite a bit of denials on standing equipment based on all of our members’ experiences. Over time, this has just pushed the communities to stop trying to get them for some patients. This is very tragic when CMS and/or providers have given the market the impression that it is too hard and time consuming to get a patient a medically-necessary piece of equipment. We must push back on this while also educating ourselves on what is taking place in the market to help overcome this obstacle. 

Does everyone qualify for a standing frame? No, but there are some interesting studies out there that show the great benefit for patient populations. Our body has a specific function and structure that is needed to maintain a healthy state, and the respiratory dysfunction of some patients can cause greater risk for advanced disease states in the patient population. Standing can help prevent this from happening in specific cases, and this reduces the opportunity for a greater potential for deterioration that would reduce lung capacity and breathing capabilities. 

It is interesting to see just what facts are out there about people with:

  1. Rheumatologically conditions, which involves a degree of restrictive ventilator impairments due to stiffness of the rib cage and spine. 
  2. Neurological conditions, which means patients typically suffer restrictive impairment due to paralysis of the respiratory muscles in this case. 
  3. Congenital and hereditary neurological disorders, often leading to the development of scoliosis, which further restricts respiratory function. 
  4. Respiratory impairment, which is often more vulnerable to various pulmonary complications. 

It is a benefit for many people with these conditions to stand and reduce the risk of these symptoms from setting in early in life. It is very well documented that standing reduces pressure on internal organs and lung volume improves. With an increased lung volume, blood oxygenation improves and breathing overall will be easier. Enhancing blood circulation is another great benefit of standing and is shown to help improve overall health and wellness. Standing also improves bladder function by reducing the potential for urinary tract infections and/or other complications. Many other complications are very well documented for those who have a disability, and any time a patient can reduce the potential complications, they reduce their probability of being hospitalized. It is this type of cost up front that seems to be overlooked by insurance providers. Along with all the health benefits, there are many social benefits to being able to stand and ambulate with the equipment just like an able-bodied person. Being able to perform a function of any sort at eye-level is quite beneficial for a user’s psychiatric health.

I have done quite a bit of research in the area of benefits from standing seat elevation and other device controls that help the CRT industry keep patient populations healthier. It is so fulfilling to see patients who are able to go through the process without months of deliberations on why they need a product that is really medically beneficial to their future life. Hearing of clients not being able to receive the equipment they need and that will give them the most medical benefit for future preventative actions continues to alarm me. I have taken a great deal of data from the paper from Permobil called, “The Advantages of Standing with Wheelchairs.” Click here to view the paper.   

The outcomes from our FMA program also show that seat elevation and standing are quite beneficial for the reduction of specific conditions that cause costs to be driven up over time, so please take the time to read this study and ask about the FMA in the future if you are not using it today. 

U.S. Rehab has a great relationship with Permobil and Motion Concepts, and both make very nice standing frame equipment for the patient population. I highly encourage you to check out these providers on our vendor page to see how their equipment can benefit your customers.

Finally, if you are having trouble getting approvals for standing wheelchairs, please let us know, as we have a team who will work with you to help make sure you are giving the best possible products for your customers’ needs. We are happy to help our members and your patient population achieve the best healthcare outcomes available in the market place.

Greg Packer 

President, U.S. Rehab 

800-987-7342 

[email protected] 


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