C LI NI CA L E DITOR IAL
DON’T SKIP THE MAT ASSESSMENT! Written by: MICHELLE L. LANGE, OTR/L, ABDA, ATP/SMS
This Clinical Editorial is a new feature in (DIRECTIONS). This column provides an opportunity for expert clinicians in our field to not just provide clinical information on a subject but also clinical opinion. Things may get a bit spicy at times! After many years of practice, these opinions are invaluable! I’m going to kick things off with my thoughts on the mat assessment. In 2020, I had the opportunity to participate in my first ever podcast. The topic was “Top Ten Mistakes Clinicians Make During Seating and Mobility Evaluations" (OccupationalTherapy.com). That was a surprising easy list to create! First on the list was “Skipping the Mat Assessment.” The mat assessment takes time, but it is critical in determining available range of motion for seating. These results, in turn, determine critical seating angles such as trunk to thigh and upper leg to lower leg. The mat assessment also determines where and how much support is required to maintain the identified seated position and optimize stability and function without undue pressure. So why do team members skip the mat assessment? I think there are four main reasons: 1. I don’t have time. 2. I don’t get reimbursed enough to include this. 3. I don’t have access to a mat table. 4. I don’t know how. Let’s talk solutions. And I mean real solutions. I have certainly presented courses that included mat assessment information, as have many others. How do we really make a difference?
1 & 2: I DON’T HAVE TIME & I DON’T GET REIMBURSED ENOUGH TO INCLUDE THIS. Let’s take these two together. Many settings have unrealistic productivity requirements and time limits on these complex evaluations. Including a mat assessment adds, I would estimate, about 15-30 minutes to a seating and wheeled mobility evaluation, depending on the complexity of the client. This is time well-spent. Skipping this portion of the evaluation means the team doesn’t really know the cause of seating challenges they are seeing, for example, why Mrs. Smith sits with a posterior pelvic tilt. Jumping
42
DIRECTIONS 2022.1
to solutions without knowing the cause leads to poor outcomes. And that means we will spend as much time on the back-end fixing problems that could have been addressed on the front-end. That does not save time. So, what is the solution? Continued education of clinicians as to why the mat assessment is so important, and we need to push back (politely). Push back when administrators say we can’t spend that much time in an evaluation and explain why this time is needed and is even time efficient in the long run. Some of our evaluation codes provide only a flat reimbursement rate, no matter how long the evaluation is. This is where the AT Assessment code (97755) comes in. This code is time based to provide more reimbursement for more time spent in a complex evaluation. So, what is the solution? Continued education of clinicians on use of this code and encouragement to inform their workplaces this code will allow for longer evaluation times.
THIS CLINICAL EDITORIAL IS A NEW FEATURE IN DIRECTIONS. THIS COLUMN PROVIDES AN OPPORTUNITY FOR EXPERT CLINICIANS IN OUR FIELD TO NOT JUST PROVIDE CLINICAL INFORMATION ON A SUBJECT BUT CLINICAL OPINION.
