What Do Your Customers Know About Pricing?

Reimbursement Special

Ask a few adults the price of a Starbuck's cafe latte, a laptop computer or a fuel-efficient, four-door sedan, and they'll probably come up with relatively accurate estimates.

But what would they say if you asked the price of an ultralightweight manual chair or a rehab power chair with a powered seating system? Would they know, even if they use such equipment or have a family member who does?

And while consumers can probably explain pretty easily how PCs and cars are funded, could they accurately tell you how funding works in the rehab industry? How well do they understand documentation requirements, Medicare's in-the-home restriction when determining beneficiary eligibility, and competitive bidding?

"With all the recent policy changes for mobility products, there is a lot of confusion surrounding mobility products," says Invacare's Jim Stephenson. "Consumers/clients/caregivers generally do not concern themselves with the hows and whys. They trust that their physician and their supplier understand the processes and will take care of them. As for clinicians, they have a pretty good understanding of the funding process and medical necessity, but the documentation requirements are still sketchy for most."

"In the world of '1-800-dial-a-chair,' Internet blasts and late-night TV commercials, the end-user is often preyed upon by fly-by-night providers," says Permobil's Darren Jernigan. "This type of marketing blurs the line between high-end rehab and what is needed for a person with bad knees that simply wants to go to the mall. End-users rely heavily on the provider, often giving information such as a Social Security number and how to reach their doctor. After that, the end-user waits for a delivery date."

Manufacturers agreed that the more complex the issues are, the less likely consumers are to understand them.

"From a consumer perspective, I think their knowledge is limited, compared to a clinicians' knowledge or a provider's knowledge," says Pride Mobility Products' Kevin Quaglia. "Consumers' knowledge is especially limited when it comes to competitive bidding — I don't think consumers have much knowledge base at all on that front. And (regarding) medical necessity and prescription requirements — I think it's a limited knowledge base."

"I think consumers rely heavily on the practitioner, whether it's the physician, clinician or therapist," says Pride Mobility's Seth Johnson. "They really rely on them to say what they qualify for, potentially."

So is their ignorance a problem?

When Access Is Denied

"The potential negative if (consumers) aren't educated is that they may not know that they could have obtained equipment or they could have qualified for something," Quaglia points out.

Consumers typically become aware of retail pricing and the factors behind it when that pricing begins to adversely affect them. Rehab clients and mobility consumers are likely to pay closer attention to funding in this industry when they have trouble getting the equipment they need.

"Unfortunately, the impact is usually realized once a consumer is denied access to products that they need in order to be fully functional and independent," says Rita Hostak of Sunrise Medical. Asked how aware clients are about such funding issues as competitive bidding and documentation requirements, Hostak says, "Policies are in a steady state of flux. For the most part, consumers are not well versed in the processes or policies necessary to obtain product. In many cases, consumers expect to be provided the appropriate products. Once access is denied, consumers or family members have more reason to want to understand the funding process."

Jim Stephenson agrees: "Generally, consumers are unaware of the issues that affect whether or not they will be able to obtain the equipment they need. 'In-the-home' and national competitive bidding are issues that are very familiar to people within the industry, but this information is generally not shared with consumers unless it directly affects whether they can or can't get the equipment they need."

And that lack of understanding definitely can cause headaches for suppliers, Hostak says: "Consumers typically do not comprehend that the inhibitor is the policy. Unfortunately, the supplier will often be interpreted by the consumer as the bad guy."

That "bad guy" image is exacerbated by a couple of other false, but common consumer beliefs: That suppliers alone determine the price to charge for a wheelchair, and that the profit margins on a $30,000 power chair are huge.

Being Part of the Solution

So what's a supplier to do when consumers get angry over funding and equipment access decisions that are out of the supplier's hands?

While many manufacturers do not educate consumers directly, they do offer dealers some helpful tools. Invacare, Permobil, Pride Mobility Products and Sunrise Medical all have funding sections on their Web sites to teach consumers about reimbursement issues and/or to help suppliers get the word out.

Is the Price Right?

And manufacturers agree that no matter how challenging the funding landscape is, consumers are better off knowing than not knowing.

"Suppliers need to be forthright with consumers and clinicians in explaining the recent changes in qualifying consumers for mobility equipment," Stephenson says. "The problem is suppliers fear they will lose referrals with the clinicians and sales with the consumers by explaining the new complexities."

"It is important for our dealers to continue to make consumers aware of the technology that is available vs. what funding pays for or policy allows," Hostak adds. "This knowledge enables consumers to advocate for policies that allow access to the equipment that could increase their independence and improve their quality of life. If they do not understand the issues that impact access, they are denied the chance to get involved and be part of the solution."

"I don't think too much information is a bad thing at all," Quaglia says. "I think the method in which the information is communicated is what's important. You have to tailor your education to your target audience. From a consumer perspective, I think it needs to be tailored so they have a basic understanding of what they're entitled to, what's potentially covered. The more information, the better."

Ultimately, says Permobil's Tara Gentile, consumers who take the time to learn will be better prepared to fight for their rights. "Many times consumers are not aware of their options and are limited by what they do not know," she says. "Consumers need to ask questions and appeal all denials!"

Consumers Push to Change 'In-the-Home' Restriction

Consumers Push to Change 'In-the-Home' Restriction

For years, Medicare's policy of funding home medical equipment only if it is needed within the walls of a beneficiary's home has been a roadblock to people with disabilities who could be active in their communities, go to work, attend school, etc., if they received some help from assistive technology.

Advocates wanting to remove that "in-the-home" restriction have long argued that it flies in the face of other federal policies, including the Ticket to Work Program and the New Freedom Initiative, both of which seemed to encourage people with disabilities to seek employment.

On July 18, Senators Jeff Bingaman (D-N.M.) and Rick Santorum (R-Pa.) introduced legislation to modify the in-the-home restriction, after a July 2005 Congressional sign-on letter failed to change Medicare policy.

The new bill would expand a beneficiary's Medicare coverage to include mobility devices "used in customary settings for the purposes of normal domestic, vocational and community activities..." The current Social Security Act policy simply defines DME as equipment used "in the patient's home."

The proposed legislation, called the "Medicare Independent Living Act of 2006" (S.3677), is potentially a huge victory for consumer groups such as the ITEM Coalition, which has advocated tirelessly for such a change. For more information and updates, go to www.itemcoalition.org.

Is the Price Right?

When consumers ask about equipment pricing or funding issues — such as "Why can't I get that all-terrain wheelchair so I can work in the backyard?" or "I gave you the doctor's prescription, so what's the holdup now?" — are you ready to answer? Here are three ways to help consumers understand and navigate the funding maze:

  1. Use the manufacturers' tools. Many mobility and rehab manufacturers have funding information on their Web sites, so check them out, then print out Web addresses on a flyer that you can hand out to customers.
  2. Tell consumers about consumer organizations. Restore Access to Mobility Partnership (RAMP) and Independence Through Enhancement of Medicare & Medicaid (ITEM Coalition) give end-users the opportunity to get involved and discusses funding issues from a consumer point of view. Tell your customers about the ITEM Coalition (www.itemcoalition.org) and RAMP (www.rampcoalition.org).
  3. Send them to www.nrrts.org. The Web site for the National Registry of Rehab Technology Suppliers includes a Consumer Info section that addresses such topics as the importance of working with a qualified RTS — but funding and pricing are ancillary topics. For instance, the NRRTS site says, "If you develop a pressure sore and are hospitalized because you were provided with a wheelchair that did not include appropriate seating, the cost for hospitalization and doctor expenses to the insurance company could cost from $10,000 to $30,000. This does not include your pain, lost time from work or school, and other related expenses for additional medical treatments."

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

In Support of Upper-Extremity Positioning