Poster 267: Power Wheelchair Lease Provision in Terminal Illnesses: A Humane and Cost-Effective Solution to a Difficult Problem

Abstract

Objective: To determine if an alternative methodology of procurement and service delivery is better and more economically able to supply the wheeled mobility needs of terminally ill patients. Design: Cohort study, parameters pre- and postservice provision paradigm change. Setting: Major university wheelchair assessment clinic in cooperative collaboration with insurance provider and durable equipment vendor. Participants: Patients with life-expectancy of less than 24 months. Intervention: Initial equipment was provided based on conventional assessment, approval, and delivery methodology. Subsequent equipment was provided on a lease basis. Power wheelchairs that could be adapted to meet the patient’s decline were used. Use of advanced control mechanisms and ventilator adaptations were considered. Rental basis was established at $750 a month for 15 months and a 1-month allowable charge every 6 months after. The vendor’s investment was limited to 2 new chairs and demonstration chairs in its inventory but was required to provide all necessary repairs and upgrades as a provision of the lease. Main Outcome Measures: Time to delivery of equipment and overall cost. Results: Conventional delivery showed 12 who never received the prescribed equipment and 6 others were forced to wait an average of 6 months. The lease program delivery time was reduced to 1.4 months. The initial 3 rental cases who died used their devices for an average of 4.8 months at a cost of $10,725. Conventional provision of these devices would have cost $61,350. Additional cases are still in the process of their disease progression with continued independent mobility options. Conclusions: Conventional provision of durable medical equipment is poorly suited to the maintenance of independence in the terminally ill patient. The lease model of equipment provision to this cohort showed substantially improved delivery times (thus improved utility) and significant cost savings to both vendor and insurance company.