Negotiating a United Front

Straight Talk from Suppliers and OTs/PTs on Building a Better Relationship

Conflict happens to the best duos. Sonny and Cher. Simon and Garfunkel. But for suppliers and OTs/PTs, breaking up is not only hard to do; it's simply not an option. The two merge clinical education and product knowledge into one unstoppable mobility team. Yet, for many, meeting on common ground amidst the challenge of ever-changing technology and funding issues sometimes presents a problem. The key to staying together is mutual respect. Successful suppliers have learned to harness the power of the OT/PT factor. Likewise, OTs/PTs have strengthened the outcomes of their clients by relying on skilled suppliers to provide the best mobility option.

So, what are the major obstacles to a positive relationship? Mobility Management asked the experts — a panel of suppliers and clinicians.

Key: Blue=Supplier; Green=OT/PT

Communication

To me, the supplier/clinician relationship is probably one of the most important working relationships that are involved in the industry because both have a critical role to play in providing the needed equipment … When you take either one of those two individuals out of the picture, the probability of having success … is much less likely.
— Dan Lipka, M. ED., OTR/L, ATS, Miller's Assistive Technologies, Akron, Ohio, NRRTS past president

My big thing is to make sure that the clinicians know that we all have to work together to make sure the end-user's ultimately taken care of. And sometimes egos get a little bruised. I think an understanding that egos don't really play a role in the situation when we're having to deal with end-users, that's the challenge.
—Patrick Meeker, MSPT, clinical applications manager, The ROHO Group, Belleville, Ill.

I think one of the biggest problems that exists in the provider/clinician relationship is just flat-out communication, a clear understanding of what is and what is not a possibility.
— Cody Verrett, ATS, director of clinical and education development, Quantum Rehab, Exeter, Pa.

I think the biggest thing is an open line of communication between both the clinicians and the suppliers, making sure that the clinician is not afraid to admit (that) they don't know everything about all the different products, number one, and number two, making sure the supplier is up to speed on all the different things they need to have from the clinician to make sure these claims get paid for.
—Meeker

I've seen that as a big mistake that providers go into different places assuming that they understand everything and not taking the time to listen to what the clinician is looking for. They jump to conclusions.
— Kevin Gouy, RTS, program manager, United Seating & Mobility, Earth City, Mo.

I think when there's a breakdown it's probably because you don?t have that communication and the team approach because, especially nowadays, there has to be a balance between the business aspect and what's clinically needed.
— Jan Furumasu, PT, Rancho Los Amigos National Rehabilitation Center, Downey, Calif.

I always ask the clinician what their expectations are of me as a supplier. If we don't know what that clinician is looking for and what their expectation is, it's hard to be on the same page and look at the same goals.
—Scott Lopez, OTR/L, ATP, director of business development, United Seating & Mobility, Earth City, Mo.

(So when) situations come up, there's no surprises. When your hands are tied, this is a situation that we've talked about and we were ready for it if the communication was there.
— Dan M. Eilerman, PT, Clinical Education Specialist, VARILITE, Seattle

Recognizing (the clinicians') needs is equally important. Knowing that, for example, it's inappropriate to just drop in and do a cold call, which is a common thing that a lot of salespeople do. But for many therapists it's very disrespectful of their time. And we're in day in age in which therapist time in terms of productivity is really critical.
—Lipka

I think if providers and clinicians had a better understanding of the obstacles that each (faces), they could kind of communicate a little bit better as to how to overcome those obstacles.
— Jay Brislin, MSPT, general manager, Quantum Rehab custom group, Exeter, Pa.

The providers and clinicians that have been in this business for a long time are not typically the providers and clinicians that have poor relationships with each other. Typically, they've already worked through their interpersonal differences and understand where the other party's coming from. There's clear lines of communication and access to each other for questions.
—Verrett

When we're going to do an evaluation, we try to collect information prior to a client's visit so that we can get an idea of the equipment that's worked for them, the equipment that's not worked for them and the reason that they're coming to the clinic. That helps us work with the supplier before the client even walks through the door so that we can have some demonstration equipment available to try.
— Laura Cohen, PT, Ph.D., ATP, co-coordinator of the Clinician Task Force, Shepherd Center/Crawford Research Institute, Atlanta

Funding

When there are funding issues, I think that's where people are having miscommunications … The clinician is uncomfortable because they feel that the provider is steering them toward equipment that might be more profitable, but (clinicians) just (need) that understanding that funding sources can sometimes make it a little bit more difficult, but that we're always going to make sure the client gets what they need.
—Gouy

I think a lot of times we get preconceived notions that there are people out there just trying to make a buck. And then there are people out there that are really trying to do a good job and also have to remain profitable. And that's a fine line because in the business we're in, a lot of times there's a line between being a missionary and being a business person and you have to kind of balance those two.
—Meeker

Probably one of the most important things that clinicians need to know is … what's going on in terms of funding and reimbursement. Unlike therapists, suppliers only get paid when they sell something or they only pay their bills when a product is sold and provided. So it's vital for suppliers to be able to continue to have sufficient justification, support and all of that that's necessary in order to get a claim filed.
—Lipka

I don't think there's a therapist out there that doesn't understand that a dealer certainly at the end of the day has to get paid for their services and … I don't think there's a therapist out there that's going to ask a dealer to eat the cost every single time on a cushion knowing that it will never be reimbursed for that dealer. So, I think it comes down to just being quite frank with the therapist and having that relationship in the first place to be able to tell them that as much as I'd like to be able to do this, financially, I can't do it. And then, hopefully, be able to offer alternatives to that that are still clinically appropriate.
—Eilerman

It's a real good time right now for everybody to work and learn together and come up with strategies for some success. … I think collectively there are core groups of clinicians and core groups of suppliers that understand funding issues, and then by and large other suppliers and other clinicians have no idea. And that creates some huge problems.
—Gerry Dickerson, ATS, CRTS, director of rehabilitation technology, MedStar, Inc., College Point, N.Y.

With the new national coverage decisions, the suppliers are likely to be the ones that understand this coverage policy better than any physician or therapist ever would, even though Medicare seems to think that physicians and therapists know all about this. The truth is we probably don't, and (suppliers) can be a tremendous resource to therapists.
— Mark Schmeler, MS, OTR/L, ATP, director, Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh

Clinicians just don't study the funding always. They may know what it takes to get a rehab eval funded … and they also don't understand that some equipment just can't be funded period but there may be alternatives and to rely upon the RTS or CRTS or ATP, whomever is doing the eval with them, to help them find those alternatives.
— Larry Rice, COO, In Home Products, Inc., Dallas

(Clinicians need to) ask questions and ask them from lots of sources, because with the way Medicare and Medicaid funding changes, it seems on an hourly basis, there's lots of stuff we need to make sure that we understand.
—Meeker

It's not (the clinician's) fault; it's the vendor's fault for not letting them know. … Every time the coverage determination changes, we in-service. Every time there's a policy change, we in-service.
—Rick Graver, ATS, CRTS, owner of Medtech Services, Inc., Reno, Nev.

I think the biggest change that I've seen is Medicare coding and the effects that that has had on what a therapist and a dealer can and can't do. The therapists' hands are often tied by the limitations that Medicare puts on them.
—Eilerman

Sometimes (clinicians) might want a specific type or piece of equipment and it doesn't fall within what that funding source will pay for. … I think the best relationships are when the clinician says, "I want a mid-wheel-drive chair with a molded seating system," and they don't pick the chair and they don't pick the molded seating system. They realize that we have an obligation to provide the correct equipment, but we also have the obligation to get the correct funding so that we can be healthy as an industry and provide services after the equipment is provided.
—Lopez

I think just fair business practices too (are necessary) that we don't just give all of the business to one supplier. We give everybody a fair chance to get access to business. But again, they also know that we expect a lot of them and we expect them to behave like health care professionals, follow a standard of practice, be ethical.
—Schmeler

Education

I think there is a notion at least when someone has yet to develop a relationship with a supplier that the supplier is primarily interested in selling them something. I think when there's a person that has a credential like OT or maybe even like a CRTS or RESNA credential, I think they recognize that the person is more likely to have an interest in appropriately serving the client's needs.
—Lipka

Because suppliers don't always have a clinical background, there are again misperceptions by the clinicians that they don't always understand the needs of the clients.
—Schmeler

I think that as that credentialing is happening and as more people are seeking those credentials, I think that a lot of clinicians are seeing that hey, these guys aren't just suppliers that they're fellow professionals, that they have their unique area of expertise as that professional.
—Lopez

Professionals need to recognize their scope of practice and when something is beyond their level of expertise and know who and when to refer on to someone else.
—Cohen

We're as serious about what we do as the therapists and their education. We're not just salespeople anymore.
—Rice

The other advice I'd give to suppliers at this point is to really embrace the concept of universal credentialing and eventually licensure as a health-care professional. And with that will come a lot more respect and more than likely better reimbursement for what they do and what they provide.
—Schmeler

(My advice to suppliers is) education, education, education. Get involved with their associations, get involved with NRRTS, get involved with RESNA, get involved on list servs, attend conferences, get involved.
—Dickerson

I think too over the past few years as you see a lot more trade shows and training seminars and different industry events that are being put on, there's a real big focus on education, which I think has helped the relationship between all three parties quite a bit.
—Brislin

The clinician will become more comfortable working with you as soon as you can begin to explain to the clinician how your product will help reduce the effect of posterior pelvic tilt. The clinician understands posterior pelvic tilt.
—Graver

Understand that clinicians are not necessarily trained well in the application of assistive technology. It's part of a larger curriculum. There's a lot of things we need to know in order to graduate and practice, get our license. And it's only those that have the opportunity to specialize in the area that really know. So, we would say that (suppliers) need to get the point across that they're there to help the clinician, support the clinician, that they bring a set of knowledge and skills in wheelchair seating and mobility that can complement what their knowledge is.
—Schmeler

Even up until maybe seven, eight years ago, many of the therapists felt that we were trying to be therapists and didn't realize that we had a great mass of product knowledge (and) that we could help them achieve the physical seating and mobility goals of that client. And now with the certification and the fact that we spend a lot of time educating therapists, I think they now appreciate that.
—Rice

I would tell (a clinician) to invite the supplier to be present at an evaluation with the patient and with the clinician so everybody is on the same page so that they understand the client's needs, the medical aspects of the disability, the functional aspects, so that the dealer will be better informed to make the appropriate match for technology.
—Furumasu

This article originally appeared in the May 2006 issue of Mobility Management.

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