Project Leader:  Mark R. Schmeler, PhD, OTR/L, ATP

Co-Leaders:  Brad E. Dicianno, MD, Carmen DiGiovine, PhD, ATP/SMS, RET, & Richard M. Schein, PhD, MPH

Other Project Personnel: U.S. Rehab, UPMC Health Plan, National Seating & Mobility, & Permobil

Overview

The value-based care (VBC) approach to healthcare has not been fully assessed for a CRT policy model. Several attributes of such a model will be assessed in Projects R1, R2, & R3 and used in this project. Therefore, the overall objective of this final project is to synthesize the information gathered in other projects, compare it to the elements of VBC, design a new CRT model, and determine the feasibility for future implementation. The precise nature of this model can be determined only once the necessary information is gathered from other projects.

The aims of the project include the following:

Aim 1: Establish the elements and attributes of a new CRT policy model based on assessment of other models and stakeholder group consensus (R1); documentation strategies (R2); and data analytics (R3).

Aim 2: Based on all stakeholder group input, develop and describe the new CRT policy-model and its core attributes in relation to a VBC approach.

Aim 3: Perform a feasibility analysis of the new CRT policy model compared to the current model focused primarily on time and resource burdens.

Aim 4: Perform an initial cost/benefit analysis of outcomes between the two models.

Update

As of May 1, 2025

Sub-Project #1: Establish the elements and attributes of a new CRT policy model based on assessment of other models and stakeholder group consensus (R1); documentation strategies (R2); and data analytics (R3) – COMPLETED 

• Developed initial set of elements and attributes
• Presented elements and attributes to various stakeholders at conferences and business meetings
• Reaction positive with valuable feedback

New CRT Model Attribute	Method/Outcome
Standardized Assessment/Documentation	· Clinician completes Seating Mobility Index (SMI)Supplier completes standardized environmental assessment · Consumer needs are clearly documented
Standardized Outcome Measures	· Baseline scores and Uniform dataset are collected and documented
CRT intervention identified and finalized	· Supplier uses a consistent / industry-accepted method of itemizing the order
Fitting & Delivery	· CRT intervention delivered with appropriate training and clear process for follow-up
Data Management	· Agreed upon standardized outcome measures and UDS to be shared in a registry for quality assurance and research purposes. · Support research and evidence-based practice
Routine scheduled follow-up every 6 months	· Outcome measures repeated · In-person, telephone, telehealth, Connected Wheelchair, Smartphone app, data logger, or other strategies · Maintenance/repair provided as needed
Performance Standards	· Outcome assessments repeated · Routine follow-up providedPreventative measures/maintenance performed and confirmed
Payment Model	· Scheduled payments based on performance standard · Pay for Performance (P4P) vs Value Based Care Model · Partial payment at delivery
Payment Fee Schedule	· Incremental payments based on expected cost of repair/maintenance and resources associated with providing follow-up · Bonus payments for meeting performance standards · Device acquisition cost and set-up fee at delivery

Sub-Project #2: Develop new CRT policy-model and its core attributes – In-Progress

• Policy Model core attributes have been drafted and prepared into 10 statements – see sub-project #3

Sub-Project #3: Perform a feasibility analysis of the new CRT policy model – In-Progress

• Core team members meet on a weekly basis to discuss survey development, dissemination, and next steps
• 10 statements drafted based on sub-project #1 along with what was found in Projects R1, R2, & R3 related to new CRT coverage policy 
• Received IRB approval that the survey is not human subjects research
• Thirteen (13) internal team members evaluated the statement for clarity and relevance along with overall feedback 
• Core team members reviewed and revised the statements based on feedback
• A Stakeholder Dissemination table was mapped out with 20+ organizations representing clinicians, consumers, suppliers, manufacturers, and payors
• Survey was disseminated on Apr. 12, 2024 and will close on Jun 14, 2024
• Total sample of 515 responses with consumer/caregiver (n=201), supplier (n=146), and clinician (n=130) the three largest represented stakeholder groups, and with manufacturer (n=37) and technician (n=15). The payer stakeholder group was not represented in this survey.
• Manuscript titled, ‘Investigating Stakeholder Perspectives on the Attributes of a New Policy for Complex Rehabilitation Technology’ submitted to American Journal of Physical Medicine and Rehabilitation – working on second round of revisions which will be submitted prior to the reporting period
• Quantitative analysis conclusions: Stakeholders mostly favor the proposed attributes of a new CRT policy and accept the need for a CRT policy reform. The caregiver/consumer group prioritizes a policy that supports their involvement during the process and all stakeholders agree with a policy that reimburses providers for preventative maintenance services. More information is needed to determine how these attributes can become part of standard policy.
• Initial qualitative analysis of 123 comments from the online surveys are currently being analyzed using epistemic network analysis to identify and quantify connections across comments. 
  • Manuscript in development and to be submitted for journal review before the end date of grant

Sub-Project #4: Perform an initial cost/benefit analysis of outcomes

• A datacode was developed to assist with data collection and analysis
• Research team working with Univ of Michigan to review twenty cases over a 5-year period reviewing outcomes 
  • met with staff to review initial cases, provided feedback and will continue review

Other Project Dissemination Activities

**Schmeler, M.R., Schein, R.M. DiGiovine, C., Pramana, G., Busquets, M.P., Zhu, H., & Dicianno, B. (2025). Elements of a Value-Based Approach to Complex Rehabilitation Technology Service, Policy, and Payment. Instructional Course Presented at the 39th International Seating Symposium. Assistive Technology, 37:sup2, S25, https://doi.org/10.1080/10400435.2025.2463822

Dr. Mariana Pacheco Busquets, current NIDILRR ARRT Fellow with the research team, was selected to present as part of the NIDILRR ARRT Fellows Symposium for the 2025 American Congress of Rehabilitation Medicine Conference to be held in person on October 27-30, 2025 in Chicago, IL. 

** Schmeler, M.R., Schein, R.M.., & Morrow, C. (2024, June). Estimating the Reasonable Useful Life Cost of Complex Wheelchairs Using Real-World Datasets. Instructional Course presented at European Seating Symposium, Dublin, Ireland. 

**Schmeler, M.R., Morrow, C. Schein, R.M. (2024, June). Estimating Life-Cost of Complex Rehabilitation Technology Using Real-World Data. Instructional Course Presented at VGM Heartland Conference. Waterloo, Iowa.

**Schmeler, M.R., DiGiovine, C.P., & Schein, R.M. (2023, June). Assessment and Investigation of an Equitable Wheelchair Coverage Policy. Instructional Course Presented at VGM Heartland Conference. 

**Schein, R., Schmeler, M.R., DiGiovine, C.P., & Hibbs, R. (2023, July). Steps Taken into the Assessment and Investigation of an Equitable Wheelchair Coverage Policy. Paper Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). https://www.resna.org/Events/RESNA-2023-Annual-Conference/Program-by-Track/SM-Seating-and-Mobility-including-CRT/323-steps-taken-into-the-assessment-and-investigation-of-an-equitable-wheelchair-coverage-policy  

**Schmeler, M.R. & Hibbs, R. (2023, September). Development of an Equitable Coverage Policy for Complex Wheelchair Seating and Mobility Devices. Paper Presented at the Academy of Spinal Cord Injury Professionals (ASCIP).

**Hibbs, R., Schein, R.M., Schmeler, M.R. & DiGiovine, C.P. (2023,November). Towards an Evidence-Based Coverage Policy for Complex Wheelchair and Seating & Mobility Devices. Paper Presented at the Oceania Seating Symposium. Melbourne, Australia

**  above dissemination activities were paper presentations at conference/symposia in collaboration with other project updates