Tomorrow's RTS

Where Will the Next Generation Come From?

On an episode of a recent TV dramedy, a veteran political insider told an eager newbie, "The pay sucks, but don't worry. The hours are terrible, too."

Rehab technology suppliers: Does that sound familiar?

RTS's often spend long hours not only creating one-of-a-kind seating and mobility systems, but also securing the documentation needed to ensure that funding sources will, one day, pay for those systems. The irony is that in rehab, the mobility systems that take the most time to create — hours of measuring, cutting, parts ordering and adjusting, not to mention copious amounts of Velcro — can be the ones toughest to get paid for in full.

Clinical expertise has been replaced by a bean-counter mentality. —Gerry Dickerson

It's enough to make an RTS to ponder the possibility — as a well-known rehab industry veteran has pointed out more than once — that working a hot dog cart might be a whole lot easier. Think of it: Customers paying cash! At the same time that they get the hot dog! And if they want to pile on the mustard, onions, peppers and pickles… well, customers make those "adjustments" themselves and have only themselves to blame for the heartburn that comes later!

Jokes aside, rehab veterans know their profession offers a sense of satisfaction that peddling hot dogs likely can't. But how are funding and documentation challenges affecting the morale of veteran RTS's? Are those challenges likely to discourage the next generation of RTS's? And what can today's industry do to help ensure high-quality RTS's will exist tomorrow? New Campus Curriculum: RTS 101?

Mobility Management asked two rehab technology suppliers and two executives of The MED Group and U.S. Rehab for their thoughts.

Q: Veteran RTS's have so much valuable experience and knowledge. How might the rehab industry recruit and encourage the next generation?
The thought of RTS's being part of an aging industry has been discussed for several years now. Our veterans have paved the way to new technologies, new ways of thinking and designing functional seating, and have definitely been leaders in our defense when it comes to regulatory and legislative issues that affect our daily business. It's that expertise alone that is our greatest recruiting tool. After all, it's their drive, their personalities, their intuitiveness and their sense of caring that we want to see in the newer generation. —Jerry Keiderling, VP, U.S. Rehab
A: The complexities and issues surrounding our industry make it very difficult to explain what we do to someone who might be interested in our field. Just over the past few days, another young person (who was quite good at his job) and I were speaking. He was leaving the industry to go into commercial tile sales… he just couldn't take the Medicare/Medicaid craziness anymore. The assault on the industry over the last few years is going to make recruiting the next generation of RTS's very difficult. I don't think there is an easy answer to this. —Gerry Dickerson, CRTS, Medstar, Inc., College Point, N.Y.

Q: Do funding issues such as competitive bidding and Medicare/Medicaid budget cuts take a toll on RTS morale? Might incoming RTS's feel discouraged in their efforts to provide highly customized seating & mobility systems?
Not only do I think incoming RTS's are discouraged, seasoned RTS's are also discouraged. Clinical expertise has been replaced by a bean-counter mentality. It is no longer possible to do the best possible intervention for your client — you need to see whether or not they have the proper ICD-9 code and whether or not the seating intervention decided on is at a reasonable reimbursement rate. Our hands are tied by funding, preventing us from doing the best possible for those we serve. —G. Dickerson
A: Every RTS feels like they are being held back from being able to do what they do best due to funding issues. It's the nature of the beast called 'rehab.' It's to what extreme that is the real factor in how an RTS feels about their career and its effects on their morale. Some who have been in the industry a long time simply look at it as a challenge every day! —J. Keiderling
A: Those companies and individuals that have the knowledge and willingness to navigate through the changes will succeed. Reimbursement changes have hit our industry for years. Some of these changes have actually helped us be more efficient. For example, the new coding has allowed us to electronically submit PA requests and claims to some payors. Providers and RTS's have weathered many storms over the past 20 years. We need to succeed. People with disabilities are counting on us to be there to service their equipment needs. —Paul Bergantino, ATG Rehab, Newington, Conn.

We possess a great deal of responsibility to guard our own future. —Jerry Keiderling
A: If someone isn't concerned and a bit frustrated, there's something wrong with them right now. With everything that's going on, I think it's human nature to shake your head and say, "You know, it just shouldn't be that hard." But I think what is important and what drives that true rehab person is that passion for that individual who needs that chair or needs that seating system. If you dissect a true rehab person, their core being is to serve that person who's dealing with a disability in day-to-day life… That commitment is what drives you to work your way through the frustrations and paperwork, so at the end of the day — or the end of six months — that customer got the piece of equipment they deserved. —Don Clayback, VP of networks, The MED Group

Q: How do we answer that discouragement?
Education, education, education needs to continue and be ramped up in some cases. Our staff, legislators/regulators and payors need to be educated on the funding issues and informed of the value of our services… we are NOT just equipment jockeys! —P. Bergantino
A: My way of dealing with it is to fight back. I stay involved in the industry: NRRTS, NCART, RESNA, the Clinician Task Force, VGM, NYMEP. And I encourage others to get involved also. I also encourage consumers and clinicians to get involved. We must band together to fight back, to make our issues heard. —G. Dickerson
A: (The degree of industry change) depends a great deal on how our industry handles already proposed changes such as national competitive bidding, power mobility device documentation, coding, etc. The more that get involved, speak their minds and take part in our current legislative battles, then the less change is imminent. Our future is not totally dependent on CMS initiatives. It is more dependent on our involvement in these proposed changes and how well we can communicate to them the clear need for our services, our expertise and our ability to provide quality care to their beneficiaries at a reasonable rate of reimbursement. —J. Keiderling

Q: Will the RTS job description and skills set change drastically in the next two years? Five years?
The job description of the RTS has changed forever. In the short term, much more time and energy must be placed on the significant issues facing all of us. Involvement on a state and national level is everyone's job. In the long term, being more politically active will be a constant part of the job. —G. Dickerson
A: Rehab, assistive technology, seating and accessibility products and services will be around either until the end of time, or until a miracle cure is found for every debilitating disease known to man. RTS's will always be needed, maybe not in the roles they play today, but definitely taking a major role in managing functional mobility. The role of an RTS has changed dramatically over the last five to 10 years, so logically speaking, it will change even more. —J. Keiderling
A: Rehab equipment providers and RTS's have evolved over the years and become more sophisticated. RTS's are an integral part of the clinical team: helping to specify product, work through reimbursement obstacles, coordinate the appropriate documentation, train the users and caregivers, all while balancing a busy schedule. They all work to provide the appropriate product, accurately fit to help our consumers maximize their function and independence. I do not see this changing. —P. Bergantino

A Changing Skills Set: What Tomorrow's RTS Will Need to Know

New Campus Curriculum: RTS 101?

When do most consumers learn about RTS's? When they need them, either for help with their own medical diagnoses, or diagnoses of parents, children or friends.

That "as-needed" timing doesn't necessarily work well for RTS recruiting purposes. Are there other ways to expedite the process — to go looking for future RTS's? For instance, might the rehab industry be missing out on creative, technically minded, people-centered high school and college students because they don't know the RTS career path exists?

"Very few programs exist today that are designed to prepare individuals for a career in rehab," says Jerry Keiderling, VP of U.S Rehab. "Not too many people have ever told their high school counselor that after graduation they want to sell or service wheelchairs because they care about the people who need them. It doesn't mean that they don't want to. It just means they didn't know they could."

At ATG Rehab's annual business meeting to bring together personnel from all 13 branch offices, RTS's both lauded their cumulative experience and wondered aloud how to pass on that knowledge. Asked that specific question — as well as how to recruit new RTS's — ATG Rehab president Paul Bergantino, Newington, Conn., offered some very specific ideas and asked a few questions of his own.

"There are several places to recruit new RTS's," he says. "With the ATP program, we could encourage adaptive equipment classes to be taught in more junior colleges (JC). JC graduates are a great resource: two years of college with an (associate) degree." Bergantino also suggests, "Could we encourage some trade schools to add 'RTS' to their offerings? Could the rehab industry, perhaps through NCART (National Coalition for Assistive & Rehab Technology) and NRRTS (National Registry of Rehab Technology Suppliers) develop a type of PR program for high school and two-year college degree students to actively recruit for the industry — similar to what nursing and the military do?" Bergantino also suggests Internet recruiting, pointing out, "This seems to be the place many young people start to look for jobs."

Home-Grown Candidates

Don Clayback, The MED Group's VP of Networks, also suggests looking for RTS's closer to home. "When you talk about where RTS's come from and when you look at a good RTS and see what the evolution has been, the skills set you need is someone who knows the technology, is good at working with people with disabilities and also can manage the process, the paperwork," he says. "Not that they have to be the reimbursement expert, but they have to be comfortable in that environment in terms of what are the funding requirements and what are the criteria I need to have."

Clayback acknowledges that those sorts of skills aren't part of a typical college curriculum. "Someone doesn't acquire that going to school. A lot of that experience is on-the-job training. I would break that down to two things: Either working with another RTS, or within your company you start working with some less complex clients, and you work your way up to more complex clients."

Bergantino agrees that an important source of future RTS's is right in front of us. He suggests "developing RTS's within our company… growing and developing technicians or others to move into an RTS role. The RTS can definitely help with this by setting the example of strong, customer-focused service combined with strong, ethical, clinical knowledge."

Industry clinicians might be looking to make a move into the RTS field, Clayback suggests. "Or maybe you've got a good repair technician who's looking for a career path, has some mechanical aptitude and is working in seating clinic settings or other settings in the store, so you can sense how well they work with customers. If they have the basic skills, then I think you can put them on a career path within your business. You can team them up with one of the RTS's and start doing a couple of basic evaluations. Some companies have, formally or informally, that kind of system, where you home-grow your RTS's."

"Good RTS's are hard to find," he concedes. "You either grow them yourself, or you hire them from the competition. And hiring them from the competition isn't always a good thing for several reasons, so I think the home-grown approach is the preferable one. It also requires a company to have a plan in place, and to have a career path for people who have those skills."

Growing Your Own RTS: A Checklist

Maybe you're thinking about opening another branch office. Maybe your senior RTS with decades of experience is starting to plan his retirement move to a desert island. It takes time to "grow" your own RTS, so even if your need isn't imminent, you should be ready to act should a worthy candidate appear. This checklist can help if you spot an RTS in the making.

  1. Create a Job Description: Have a ready-to-print document listing RTS job functions, responsibilities and required skills.
  2. Prepare Your Scouts: Make managers in all departments aware of RTS job requirements so they can alert you to potential candidates among their new hires.
  3. Be Ready to Teach: Look for educational opportunities for candidates, including free or low-cost classes given by rehab manufacturers, and larger-scale opportunities such as Medtrade's Continuum of Care.
  4. Find a Mentor: Are any of your current RTS's "natural teachers"? Ask if they'd be interested in mentoring up-and-comers by allowing potential RTS's to participate in selected evaluations and working, under supervision, with clients (while following all HIPAA regulations, of course).

A Changing Skills Set: What Tomorrow's RTS Will Need to Know

Being an RTS requires more than a thorough understanding of human anatomy and assistive technology. Being an RTS also requires great people skills and a big heart.

But the same big heart that turns clients into friends can also cause problems on the business end. How many RTS's, when faced with clients who can't secure the right funding, let equipment go out the door at a reduced cost or no cost at all?

If that sounds too familiar, beware. Shrinking profit margins and budget cuts to Medicare and Medicaid programs can mean those charitable acts could have dangerous repercussions.

"I think things are changing," says Don Clayback, VP of networks, The MED Group. "Reimbursement reductions are going to continue, and as people are looking at the levels of service that companies can afford — those things are requiring businesses to make changes."

"Being more involved in the 'other' side of the rehab business will be a necessary part of the skill set," says CRTS Gerry Dickerson, Medstar, Inc., in College Point, N.Y. Asked how RTS requirements will change in the near future, Dickerson also adds, "On the clinical side, greater educational and continuing educational requirements will be needed in order to 'raise the bar' of the RTS. We need to increase the core educational and field experience skills of the profession. The RTS community must become more professional and visible in the medical community."

"RTS's need to be informed/smart in both business and the application of product," says ATG Rehab's Paul Bergantino, Newington, Conn. "The today/future RTS is an individual who has the business and clinical skills to be an integral part of the medical team, provide equipment solutions to the disabled individual within the funding criteria and — starting with the evaluation — clearly understand the 'path' that the transaction will follow, so the RTS can help 'drive the process.' This additional focus will result in a timely, accurate delivery of product.

"Our industry has fewer rehab equipment providers today versus just five years ago," Bergantino adds, "and over the next few years, we will have even less. I view the necessary 'mindset' for an RTS to be similar to any business owner/manager… To be able to balance key drivers of the business: providing high levels of service with the financial needs of the company — revenue, expense management, cashflow. If too much focus or weight is applied to either side, the business will not have the stability to operate long term."

"The challenge is not to abandon all levels of service, so to speak," says Clayback. "It's more a triage. As I look at my customers, how can I best service them? If I have someone who needs some basic mobility, here's (an employee) that I can use to service their needs. If I've got someone who just had a car accident two months ago and is coming out of the hospital with a spinal cord injury, here's the type of (employee) I need to help them with their needs. There are going to be two kinds of (RTS) based on their expertise and their experience."

Clayback admits that making an effort to most efficiently match up RTS's and clients can be a challenge, especially once the phones all start ringing at once and the daily frenzy kicks in. "It's cumbersome," he says. "But successful companies are going to have to manage that."

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

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