Wheelchair and Complex Rehabilitation Technology Suppliers Share Opinions on the Efficiency of Wheelchair Repair Services

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

In the United States, approximately 13.7% of adults have mobility disabilities which may seriously impact their ability to walk or climb stairs. Some may rely on mobility devices such as wheelchairs to engage in daily activities; provide pressure relief or postural support; or to sit in different positions to aid in digestion and respiration. Wheelchairs can be manual or powered versions that can be modified to accommodate these needs. Wheelchairs are considered complex rehabilitation technology (CRT) and classified as durable medical equipment (DME) by the Centers for Medicare and Medicaid Services (CMS).

More complex wheelchairs may be prone to breaking down and needing repairs more frequently than basic or lightweight models. Simple repairs, such as replacing a headrest, can be completed relatively quickly. Complex repairs like breakdowns in the electrical or control systems may require more time in a repair shop. Studies have shown that wheelchair breakdowns have doubled in recent years and repairs can take up to six months to complete, leaving the user without their essential equipment if they do not have a backup chair. In order for wheelchair repairs to be reimbursed by CMS, a physician must state that the patient needs the wheelchair, and a supplier must say that the wheelchair repairs are reasonable and necessary--which can delay the needed repairs. During the repair process, people with disabilities may experience adverse health events without their device.

In a recent NIDILRR-funded study, researchers wanted to explore the views of CRT suppliers who repair mobility devices. Researchers wanted to know which areas of the repair process the CRT suppliers felt were performing well and which areas were inefficient. The researchers also wanted to learn, from the CRT suppliers’ perspective, how to improve the CRT repair process.

Researchers at the project Assessment and Investigation of New Coverage Policies for Complex Rehabilitation Technology (CRT) Within a Contemporary Accountable Care Environment surveyed 127 CRT supplier representatives about their experience with the wheelchair repair industry. The participants answered demographic questions, including their years of experience in the repair industry, and questions about their company and its services such as how they tracked repairs, how much time they spent on repairs, and how repairs were paid for by insurers or customers. The participants also provided their opinion on several statements regarding administrative and operational factors in the repair process as well as future opportunities to improve the repair process. Participants ranked their agreement with each statement on a scale of 1-6, 1 being completely disagree and 6 being completely agree. 

The researchers found that a majority of the participants (66%) had worked at least 16 years in the repair industry and 22% had over 30 years of experience. More than 42% of the participants were from small, independent suppliers. Nearly all of the participants reported that their company used some type of electronic system to track repairs. More than 80% of participants reported that the majority of their clients used insurance to pay for repairs.

When the researchers looked at the responses to the opinion questions, they found that the results highlighted dissatisfaction felt among participants regarding several aspects of the wheelchair repair service industry. They agreed on several areas where the industry was performing well:

• Prioritizing quick repairs: Simple wheelchair repairs were completed faster than complex repairs.
• Efficient scheduling and tracking: Repair scheduling and tracking systems led to improved CRT repair operations and tracking of replacement parts. Electronic documentation systems made the process more efficient.
• Competent staff: Technicians were trained well and had the competencies to perform their jobs.
• Positive outlook: Participants had a generally favorable outlook for the future of the industry; they agreed that telehealth could lead to more efficiency in wheelchair maintenance and repairs.
• Additional Coverage: Participants strongly agreed that receiving coverage for preventative maintenance could significantly decrease the need for repairs.

The participants also detailed a number of different areas that contributed to inefficiency in the industry:

• Insufficient compensation: 58% of participants reported not being compensated for more than half of the time of total repair. They also disagreed that insurance companies reimbursed repairers appropriately for the repair parts they provided.
• Travel time adds to repair cost: Participants strongly disagreed with the statement “Technician travel time for repairs does not contribute very much to the overall cost of doing a repair.”
• Documentation adds delay: Delays in repairing wheelchairs were partly due to the fact that Medicare and private insurers require a physician and supplier to sign off on documentation prior to starting the repair process. 

The authors noted that simple repairs may be treated differently by insurers and approved faster than complex repairs. Respondents agreed that they could respond to simple repairs in a timely manner, but other research has shown even simple repairs can take weeks or even months to complete. The authors noted that CRT suppliers may be operating at a loss in their repair services, since the total cost of repair can include uncompensated technician travel time, and insurance companies may not fully reimburse companies for the cost of parts. However, the authors also noted that these companies may continue to provide these services to support and retain their customers.

The authors suggested that funding routine preventative maintenance programs and incentivizing quality and long-term maintenance of equipment could lead to cost-effectiveness and a reduction in unnecessary replacements. The authors suggested that reimbursement models successfully used in other industries could offer alternatives to the lengthy prior approval process, such as those that allow suppliers to begin needed repairs while awaiting approval from CMS.  Finally, the authors recommend conducting more surveys that include people with disabilities who use CRT as well as clinicians and policy makers in order to improve the wheelchair repair process.

To learn more

The website for the project on Assessment and Investigation of New Coverage Policies for CRT within a Contemporary Accountable Care Environment includes the latest findings from the projects’ studies, along with interviews featuring project staff, news on the CRT industry, and more.

The University of Pittsburgh Model Center on Spinal Cord Injury is currently developing and testing a web-based training program aimed at improving wheelchair maintenance skills. The training is available, along with factsheets with tips on wheelchair maintenance and preventing breakdowns in rigid and folding manual chairs and in powered chairs. 

The Model Systems Knowledge Translation Center offers evidence-based information and resources for people with spinal cord injury, traumatic brain injury, and burn injury, including a maintenance guide for users of manual and power wheelchairs.

To learn more about this study:

Ruffing, J.J., Schmeler, M.R., Schein, R.M., Mhatre, A. (2022) A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services. Disability and Rehabilitation: Assistive Technology. This article is available from the NARIC collection under Accession Number J90269.