There are two annual indicators that spring is right around the corner. One is the impending arrival of the International Seating Symposium (ISS), which is the impetus of our annual Seating & Positioning Handbook in this issue.

The other is the arrival of Girl Scout cookies.

David Kopf — editor of our sister publication, HME Business, and an allaround good guy — has two daughters in Girl Scouts and thus arrived at the office this morning holding a cookie sign-up sheet. I nearly tackled him. After a couple of minutes of poring over the cookie roster and peppering Dave with questions — “What does ‘carmelized’ mean? Does that mean they taste like ginger snaps?” — I ordered one box each of classic shortbread, peanut butter patties, Lemonades, and chocolate-dipped Thanks-A-Lots.

At $4 per box, I owed David’s daughters $16.

“Do I pay now or when the cookies are delivered?” I asked.

Interestingly, turns out the Girl Scouts now give a Girl Scouts troop a higher profit margin if the girls’ parents pre-purchase the cookies, rather than taking orders. Accordingly, David and his wife had bought and paid for a large number of boxes of cookies, which I imagine are stacked to the ceiling in their home.

“You’ll get your cookies tomorrow,” he said. “Instant gratification.”

Before David arrived with his order form, I’d been writing a Medicare news story. That gave me an idea:

“Give me the four boxes tomorrow, and I’ll start eating them as soon as I get the boxes open. But I’ll pay in installments. Like, one payment per month for 13 months.”

“I already had to pay in full for the cookies,” David pointed out.

“This is the Medicare way of doing things,” I countered. “I’ll give you my first month’s payment, and you hand over all my cookies.”

“Oh, but you’ve chosen the first-month purchase option,” Dave decided. “I’ll deliver the cookies tomorrow, you pay, and you’ll own your cookies outright.”

“I’d rather pay over 13 months, so if I accidentally drop a box before I finish paying you off and some cookies break, you’ll replace them for free.”

“Yeah, you’re buying your cookies outright. Thanks.”

Accepting the fact that Girl Scout cookies are not capped rental items, I wrote Dave a check for $16. As I handed my payment over, we discussed what Medicare’s elimination of the first-month purchase option for standard power chairs and other DME reimbursement reductions are doing to the industry. Cumulative cuts over the past decade are resulting in reimbursement levels so low that eventually, it may be impossible for Medicare to find enough equipment suppliers to meet beneficiary demand.

Surely, the idea is not to “save” so much money that Medicare prices its beneficiaries right out of high-quality, professional services and technology?

The motto of the Girl Scouts is Be Prepared. In this issue, our policy and funding experts discuss the current state of mobility and complex rehab technology, just in time for kicking off the rehab show season. ISS and other venues always impress and inspire with their technological and research advances. I hope that Medicare and other payors understand that such advances do require everyone’s investment, and are prepared to do their part.