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S. Taylor1,2, G. Hoo1, E. Imrich1, R. Smith1, M. Klonowski1, D. Brewington1, A. Hindelang1, M. Mittenthal2, A. Shea Klipstein2
1Shirley Ryan AbilityLab, Chicago, United States, 2Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, United States
Background: The process for occupational therapists (OTs) and physical therapists (PTs) to order durable medical equipment (DME) (ex. walker, basic wheelchair, commode, hospital bed, and hydraulic lift) is very complex. It requires extensive knowledge in documentation, justification, the ordering process, and insurance guidelines for DME coverage. This quality improvement project was developed to complete a further needs assessment to better understand the limitations of clinicians’ knowledge of ordering DME.
Purpose: To complete a quality improvement project including a needs assessment of inpatient OTs, PTs, therapy managers and case managers (CM) level of knowledge of DME processes. Needs were assessed through electronic medical record review of equipment orders and through participation in focus groups.
Methods: Three, 40 minute focus groups were completed with 24 clinicians comprised of OTs, PTs, therapy managers, and CM to assess their current knowledge of the DME ordering process. A chart review of 1,392 equipment progress notes (EPN) also known as letters of medical necessity (LMN) written by OTs and/or PTs between 1/1/2020 and 6/24/2020 was completed to determine if medical justification of DME was missing.
Results: Staff focus groups identified that additional training was needed in the following content areas: medical justification for various types of DME, documentation requirements, insurance guidelines, cost of equipment, knowledge to be able to answer questions and guidelines for conversations with patients/family members/caregivers regarding DME, and the DME ordering process. A total of 3% (44) errors were noted in the EPN requiring revisions to ensure proper medical justification.
Conclusion(s): The ability to advocate for patients and obtain the proper DME to ensure safe discharge home from inpatient rehabilitation is critical. PTs and OTs play an active role in this process and need to be properly educated on this to guarantee it occurs in a timely manner. It is imperative to optimizing the education on DME for therapists by completing QI research to reduce the potential out of pocket cost for patients for DME by properly justifying equipment.
Implications: QI projects are an excellent way for clinicians to take on leadership roles in their respective organizations and make a lasting footprint through innovative and impact research that in turns impacts improves the ability to get proper equipment for patients.
Funding, acknowledgements: This work was funded by the Innovative Catalyst Grant Program from the Shirley Ryan AbilityLab Chicago, Illinois, United States.
Keywords: Durable Medical Equipment, Quality Improvement, Inpatient Rehabilitation
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Northwestern University
Committee: Institutional Review Board has declared project is not human research
Ethics number: STU00211754
All authors, affiliations and abstracts have been published as submitted.
