The BIG Rehab List

Technology You'll Talk About in 2011…& Why

• By Laurie Watanabe
• Nov 01, 2010

This year hasn’t exactly been sedate for the mobility and complex rehab industries. Providers have seen the Medicare competitive bidding program’s first-round “redo” and the extreme reimbursement cuts expected to follow…not to mention a slew of new geographical regions being added to the controversial program’s second round. Plus, the industry received confirmation that the first-month purchase option for standard power wheelchairs will indeed be eliminated. Therefore it’s rather stunning to think that ultimately, 2010 may be looked back upon as the calm before the storm. But that’s exactly what the forecast is thus far for 2011. Here, industry insiders share their thoughts on what’s to come for complex rehab’s major product categories, next year and beyond. And because diversity is being more and more frequently hailed as a sound business plan, we also check in with the home and automotive accessibility portions of the industry via commentaries by Gary Nowitz of EZ-ACCESS and members of NMEDA. — Ed.

Consumer (Standard) Power

This segment continues to be the one most often seen in industry headlines, having been the focus of a double hit: competitive bidding and the upcoming elimination of the first-month purchase option. Many providers not involved in the first-round rebid are nonetheless bracing for competitive bidding’s round two, which will envelope most of the rest of the country.

Q: What can consumer power chair suppliers not involved in the round 1 rebid learn from the information that the Centers for Medicare & Medicaid Services (CMS) has released thus far? How can or should a supplier in round 2 apply those lessons to his or her own business?

A: In anticipation that round 2 will go forward, providers should exercise caution in making any comparisons between round 2 and the round 1 rebid until CMS fully releases all round 1 rebid information and provides the details for round 2, including the products to be competitively bid and the ZIP codes that will encompass the Competitive Bid Areas (CBAs).

That said, no two businesses or markets are alike; therefore, if they have not done so already, round 2 providers need to fully understand all aspects of their cost of doing business in the market they currently serve before they can put together a bid that is sustainable for a three-year contract across the entire competitive bid area. This includes acquisition cost of the products in addition to the operational costs to provide the products and services to the beneficiaries throughout the anticipated CBA.

While there is no confirmation that standard power wheelchairs will be included in round 2 bidding, if they are it is likely to include a new cost of doing business that most providers do not incur today, as 95 percent of Medicare beneficiaries elect to purchase their power wheelchairs in the first month, and these items were bid as a purchase in round 1. Bidding for rental standard power wheelchairs will require providers to factor in their cost to repair and/or replace the power wheelchair, at their cost, during the rental cycle. They will also need to determine all costs associated with retrieving, refurbishing and re-issuing standard power wheelchairs throughout the CBA. — Julie Piriano, director of rehab industry affairs, Pride Mobility Products Corp.

A: With knowledge of current round 1 bid prices, providers in other markets can determine how to work within the new allowables and adjust their current business operations where necessary. — Julie Jackson, director of rehab product management, Invacare Corp.

Q: Elimination of the first-month purchase option is expected to cause cash flow and other financial challenges for providers. What can providers do right now to plan for the elimination and lessen its impact?

A: Providers should research all financing options and pay bills appropriately to achieve best terms and discounts available. Also, staying with proven, durable products is the best way to go. Consolidating purchases to one manufacturer will also help to run a more efficient business in terms of reduction of parts to inventory, invoices to pay, etc. — Julie Jackson, director of rehab product management, Invacare Corp.

A: The financial impact of the elimination of the first-month purchase option is twofold. While it may appear to be attractive to purchase extremely low-cost or used products to lessen the impact of the negative cash flow created by the extended time it takes to recover the initial acquisition cost of the product, this is likely to add to the financial burden incurred by the provider who adopts this plan. Why? Because Medicare supplier standard number 14 states, “A supplier must maintain and replace, at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.”

There are several things a provider can do in preparation for the mandatory rental of standard power wheelchairs:

• Look for new, economically sound, rental-friendly products that will not add to their cost of doing business during the 13 months a beneficiary rents to own. This will allow a provider to realize a 5-percent increase in the reimbursement of the product over the lump-sum payment amount in the 13th month without incurring additional expenses.

• Screen customers to identify individuals with a lifetime medical need and life expectancy of greater than 13 months to receive new, rental-friendly products and reserving previously rented units for individuals who are not likely to rent the standard power wheelchair through the 13th month to ownership. This will allow providers to maximize their reimbursement with a minimum of expense.

• Understand all operational costs associated with a rental program, including re-rent calls, billing, collecting and reconciling accounts on a monthly basis, inventory management, and the retrieval and refurbishment of previously rented units. This will allow providers to build checks, balances and efficiencies into their rental program to minimize labor and other operational costs.

• Providers should also choose a mobility manufacturing partner that they trust and is best suited to efficiently help them make the transition as seamless as possible through products and programs they offer. — Julie Piriano, director of rehab industry affairs, Pride Mobility Products Corp.

Q: From innovative designs to increased functionality to technological advances, what is the good news about the consumer (standard) power mobility segment?

A: The patients needing these products will remain so; relying on manufacturers who provide durable, quality products will help strengthen the business. — Julie Jackson, director of rehab product management, Invacare Corp.

A: On January 1, 2011, the first baby boomers begin turning 65, and the wave of them, 80 million strong, will carry on for the next 18 years. These are not your typical “senior citizens” of the past. These are self-reliant, technology-savvy, image-conscious individuals who own their own homes and do not want products that remind them of their age. They are active, independent, influential and know the value of a dollar. They also reflect a lifetime of invention, innovation, social and cultural change. Therefore, they will expect the design, development and technological advances that standard power wheelchairs can provide to allow them to remain safe, mobile and independent in their own homes and communities to be as forward thinking as they are. — Joe Chesna, national sales director, standard power, Pride Mobility Products Corp.

Complex Rehab Power Chairs

Q: They’re carved out (at least, the Group 3 models are) of future competitive bidding programs, and the first-month purchase option remains valid for this segment. So is complex rehab power relatively “safe” from reimbursement threats? Should manufacturers and providers in this segment feel a certain amount of freedom?

A: I don’t believe that we can consider it a relative freedom. We still have complex rehab equipment that has seen cutbacks in amounts paid for the equipment. We also tend to be an industry often under scrutiny, so there really is no relative freedom for manufacturers and providers. We still have to ensure that we as an industry are being paid appropriate amounts so our consumers can get the equipment they need. — Jay Brislin, MSPT, director, Quantum product and clinical development, Pride Mobility Products Corp.

Q: Are there other potential or pending funding or policy issues that could impact this segment and therefore need to be monitored?

A: The reimbursement reductions in accessories is one to monitor: for example, the tightened reimbursement for power center-mount legrests. Although the power center-mount utilizes one actuator, the functionality and clinical benefit is similar to individual power legs. Reimbursement should not be halved for this accessory. — Julie Jackson, director of rehab product management, Invacare Corp.

A: With complex rehab, there are still plenty of funding issues to address. This is still a category which has equipment classified as durable medical equipment, but it serves a very different population who has greater medical needs. We need to address this issue as an industry by making sure that separate codes and standards are applied to the complex rehab category so that we can always supply the appropriate equipment to our consumers and ensure we will receive proper payment.

Beneficiaries are getting equipment from a system that is based on diagnosis. Very few fit perfectly into this mold. We need to work to ensure beneficiaries get the equipment they need based on their functional level and their level of need, not just because they have a certain diagnosis. The complex rehab portion of our industry has seen many cuts in funding over the years. This has to stop, and we as an industry need to ensure that this constant eroding of complex rehab funding is addressed so beneficiaries can get what they need from qualified professionals who know how to properly supply this equipment. — Julie Piriano, director of rehab industry affairs, Pride Mobility Products Corp.

Pediatric Mobility

While much of the reimbursement attention this year has been focused on Medicare — e.g., competitive bidding and the elimination of the first-month purchase option for standard power chairs — the worldwide economic slowdown has also hit Medicaid programs extremely hard. Among the results of drastically shrinking state budgets have been funding cuts for pediatric seating & mobility, a segment whose providers are already and traditionally challenged to build systems that will be continue to be appropriate and comfortable even as children grow taller and heavier, change environments, and experience functional and cognitive changes. How can providers fight back?

Q: If providers are noticing cutbacks in funding — i.e., more denials from Medicaid programs — do they have any recourse? What advice would you give to these providers?

A: Of course, budget shortfalls and increased demands for Medicaid assistance continue to challenge states, and a typical response is to seek ways to reduce spending. However, it is important to remember that there are legislated mandates regarding Medicaid coverage. Suppliers should make sure they are aware of which actions taken by a Medicaid program are challengeable and which ones are not. There can be many different reasons for a denial. Some denials, particularly those that relate to documentation related to medical necessity, require steps on the part of the supplier, physician or clinician. In other situations the action is more appropriately taken by the recipient, the one being harmed by the lack of access to the requested technology.

Suppliers should remember that the strongest voice is the voice of the recipient: the consumer of the equipment. Individuals with disabilities and their families are in the position to fight for what they need. Suppliers should take steps to inform their customers regarding what is available to them and what technology best meets their individual needs in terms of improving or maintaining function, as well as independence and self-care. Where there is disparity between what can be provided and what is needed, the consumer should be made aware of what is blocking appropriate access. Suppliers should provide information that would assist an individual in obtaining the appropriate advice regarding strategies to fight for what they need. — Rita Hostak, VP government relations, Sunrise Medical

Q: Growability, increased functionality, improved family-, user- and environmental-friendliness…what are the most important considerations driving pediatric mobility design and innovation today?

A: These are all critical components to pediatric designs. Products must be caregiver friendly, useful in the child’s environment and the ability to grow the product with the child’s needs are fundamental. — Julie Jackson, director of rehab product management, Invacare Corp.

A: Children have many different challenges that the adult population doesn’t always have to deal with. Of course, children will grow; now it is important to take the option or ability of growth and have it not inhibit their access to mobility.

In years past, many people would add width or depth into the product to hope they would cover any growth during a period of time. Given this and the size of a child, it could have (cost) their ability to access the wheels for better independence. Many times, the child could not propel efficiently, and they may have formed poor positioning to help themselves access the wheels.

Other issues with growth is to be cautious of the weight to add this option. Children’s weight-to-chair percentage is much higher than an adult’s in a chair — i.e., a child’s weight is 40 lbs. and chair is 19 lbs., which means the child pushes approximately 50 percent their body weight vs. an adult who is 165 lbs. and chair is 17 lbs. So they are pushing 10 percent of their body weight.

The other important consideration is the geometry of the frame size to options. We can certainly make a 10x10” frame accommodate a 24” wheel, but to not have caster interference, you would need to lengthen the overall frame. This then becomes more difficult to maneuver independently as well. We try to minimize the frame and options to position the child the best we can for the best maneuverability. There is only so much space with small sizes.

What is really exciting is when you marry all those items and get the chair right for the size needed. We have seen children that were considered marginal propellers possibly needing more assistance become completely independent propellers. The excitement and motivation for the child, family, school and friends has been outstanding. Getting the child positioned accurately and able to independently push with the right size and weight will also have better long-term health and shoulder preservation. — Christy Shimono, product manager, pediatrics, Sunrise Medical

A: All of these factors are major contributors to pediatric design and innovation. The unique challenge with pediatrics is that depending on the specific situation, the main requirement for each case can be very different. This is why it is very important that the development of pediatric mobility equipment is versatile and can accommodate multiple needs from seating to function to transport to growth adjustments. In addition, providing equipment to maximize a child’s functional level is very important as an entire industry. Allowing a child to be independent early in life has a huge effect on them for the rest of their life. — Jay Brislin, MSPT, director, Quantum product and clinical development, Pride Mobility Products Corp.

Ultralightweight Manual Chairs

What will tomorrow’s consumers expect from the ultralightweight product segment, and how are manufacturers answering the call? If yesterday’s ultralight mantra was “Weight, weight, weight,” today’s new engineering abilities are enabling the creation of new designs that better take the sciences of motion and propulsion into account. So perhaps that very important question — “How much does it weigh?” — needs to now be accompanied by another: “How well does it roll?”

Q: Manufacturers are pushing design and manufacturing envelopes to create ultralightweight chairs that are not only lighter than previous models, but able to outperform them as well. What are the main factors that push ultralight design today? And what’s coming up next?

A: A critical issue for the industry is that unlike SADMERC, PDAC doesn’t view K0009 as a realistic wheelchair code. They will not be issuing K0009 for any more wheelchairs. For example, all of the titanium wheelchairs currently on the market as K0009 if coded today would be coded as K0005. With a retail price over $3,000, suppliers would not normally accept K0005 payment, thus making the current “state of the art” in wheelchairs unattainable for the majority of current users. What we will see then is manufacturers who have received these codes will not discontinue these products, but redesign using the same name, as the code is aligned with the product name. New manufacturers will be restricted from designing products in this area, as they won’t be able to get codes.

The main market requirements that push ultralight design today are chair weight and performance. Within these requirements, manufacturers try and juggle different materials, manufacturing techniques and geometric shapes — the question being “What is the optimal combination?” Tomorrow, consumers will expect ever-increasing performance and even lighter weights, even though there is an everrestrictive reimbursement environment.

So — how?

I see the biggest gains will be made within the components, not the frame materials. So, work on designs that improve the performance and reliability of the critical structures and components on the chair is the focus. This is not glamorous, but can be effective.

In almost every industry, the newest and most innovative products tend to be more expensive. Yet we are challenged by a reimbursement environment looking for low cost, not increased performance. Because not all consumers are constrained by reimbursement, manufacturers will continue to search out innovative materials and manufacturing technologies that will improve the performance characteristics of the frame. After a recent round of innovative product launches, most manufacturers are in the early stages of their next development project. Some will look to match their competition; some will strive for something new. Our market is very slow to evolve, so most will be incremental. — Doug Munsey, president, Ki Mobility

A: As a manufacturer, we believe that the primary factor driving the ultralightweight wheelchair segment today is finding balance between technology and reimbursement. Advancing technology is addressing the needs of the user in an attempt to minimize the risk of Repetitive Strain Injuries (RSI) through lightweight designs that increase efficiency of propulsion as well as maneuverability. However, we are challenged to provide premium products to users who are often constrained by payor sources and what is deemed medically necessary.

Tomorrow’s consumers expect superior quality and performance in the lightest, most durable package possible. Manufacturers will continue to push the design of current and new materials to improve performance, while at the same time considering options and aesthetics that meet each individual’s unique style. — Tammy Sammom, associate product manager, adult manual, Sunrise Medical

A: The main factors in ultralightweight design are structure, stability, durability, responsiveness, weight and aesthetics. — Julie Jackson, director of rehab product management, Invacare Corp.

Bariatric Mobility

In our October 2010 wheelchair survey of mobility and complex rehab providers, bariatric mobility was the product segment for which survey participants most wanted to see more product choices and innovations.

Q: What innovations and advances can we expect to see next in this niche? How will bariatric chairs of the future differ from the designs and functions we have today?

A: The bariatric mobility and seating & positioning options currently available on the market are not as vast as they are in other categories. Providers continue to ask for bariatric products that have a smaller power base footprint, have suspension and allow for better seating and positioning components. — Joe Chesna, national sales director, standard power, Pride Mobility Products Corp.

This article originally appeared in the November 2010 issue of Mobility Management.