Why Does Active Mobility Center need a Business Coach?

The Active Mobility Team

Running Active Mobility Center for 20 years, we were confronted with tunnel vision at a time with great changes in our industry. We know we are good at what we do, but are we the best at what we do? Are we offering the best experience to our customers so they are fans and will spread our message to the world?

In 2012, we were faced with these decisions as well as how to grow our business. Sure we are Accredited and comply with required regulations, but were we efficient, were we growing, were we the leader in what we do, and most important are we having FUN? 

We discussed the possibility of hiring a consultant, as the trade magazines are filled with Industry consultants who will come in and show you what you are doing wrong, and provide a plan/recipe on what to follow.  With all the changes in the industry, we had concerns with getting advice from within the Medical Equipment industry which was suffering from industry pressures.

We were looking for an outside observation of our company and to see what we were successful with and where we needed improvement.   After extensive research, it was obvious that Action Business Coaching with its association with Success Magazine and several other business oriented groups was the right decision.

In late 2012, we met with Michael Dill from Action Coach and started what has been a sound business decision.  At first it was hard to listen to someone stating what we were not doing correctly; and how this was impeding the growth of Active Mobility Center.  As with all change, we were slow to adopt it, however once we began improving our systems and aware of what was slowing us down; and seeing good things happen- there has been no looking back.

A huge lesson for me was with Personal Growth. Prior to 2012, I was not familiar with the term.  I have read more books in the past  year than I have in the last decade. This journey has made me a better person, and a better leader. It has taught me put others first and to live above the line with Integrity, Ownership, Accountability and Responsibility.  

Carey Britton w/ Michael Dill Receiving IronMan Award

Today I was awarded with an Iron Man Award, this award issued by Action Coach, demonstrates the commitment to the system, and the commitment to improve and persevere over all obstacles. 

In reflecting over the past 9 months that we have been with Action Coach, I am not sure what the biggest benefit has been.  Immediately I would say becoming a better person has helped my relationships in business, with family and friends; it has helped Active Mobility Center Grow, and has helped me be a better leader.

If that was not enough, I find Action Coach to be a marketing tool as when people find out we are using a business coach, they applaud us.  They understand that we are doing this to improve our internal systems, our methods of business all to improve the level of care we provide to our customers. In a time where companies are cutting costs, we are committed to improvement. We are committed to our making Active Mobility Center stand out, and to be the best in the industry.

When we were re-accredited by HQAA, the surveyor was very pleased that we were using a business coach. He mentioned that if more companies used a business coach that his serfvices would not be needed.

We are far from being finished with this process, but are on track to exceed our goals and expectations.  I would recommend Action Coach to any business wanting the edge on their competition.

This article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center, he can be reached at cbritton@wheelchairguys.com or by phone at (800) 326-4463.

Scooters and Powered Wheelchairs: Not All Batteries are Created Equal

As you have noticed, the price on Scooter and Powered Wheelchair batteries have increased over the past few years. With the increase in Fuel, and Lead combine with the weight of batteries and transporting them to their destination; batteries have almost doubled in price.  Unfortunately other battery technologies have not been accepted; and we are stuck with using Lead based batteries as a power source.

You should only be using Gel batteries in your Medical Equipment (Powered Wheelchairs and Scooters). There is some misconception by wheelchair users that sealed lead acid batteries are the same as gel batteries. Additionally Gel techology is different in batteries. This is why you will see batteries less expensive on the internet than in the local Medical Equipment company.  Your Local company has to stand behind the battery, and understands that providing cheaper batteries may get you a sale, it has an increased failure rate and costs more in customer and technical service in dealing with these inferior batteries. 

MK Battery, is the industry standard; it is what most trusted brands of powered wheelchairs and scooters are shipped with. It is what has been tested, and matches the specifications that is on the manufacturer specification sheets.

Another common misunderstanding is how and when to charge the equipment. In the past Scooters and Powered Wheelchairs did not have battery gauges, they had LED's. Now with all of these products have a display that shows the battery condition it is much easier.  MK, the leader in battery technology for medical equipment states that charging batteries when they are depleted to half full, they should be re-charged allowing increased life on the battery(s).

Every time we charge a battery, we are taking away one of the life cycles of the battery. Additionally, unlike your car battery that helps power/start the car, the batteries in your medical equipment are the only power source.  These gel batteries when new and fully charged have the longest range possible.  With each re-charge, the range on how far the equipment can go becomes reduced.

Most insurance providers understand that wheelchair users charge their equipment each night, and with that information and that most people using powered equipment only travel 5 miles per day, that batteries should last 12-18 months.  If you charge your batteries more efficiently, when the batteries are half full; the batteries will last longer.

When charging your batteries, it is important to use your provided equipment's charger. Charging Gel batteries with a automotive charger can damage the gel in the batteries.

I hope this information was helpful, and helps keep you mobile and independent.  Our Service Department is able to answer any of your Equipment and Service issues, you can email them at service@wheelchairguys.com .  Remeber at Active Mobility Center, we are your wheelchairguys, and we Make Every Day Independence Day !!

Why Care what Medicare Does?

Living in the United States, unless you are over 65 you probably do not care about what Medicare does. What may surprise you is that decisions that are made at CMS/Medicare affect what private insurer's and Medicaid does.  Private insurance uses what Medicare does on the Federal level as a guideline of what minimum services they need to offer.

CMS uses SADMERC, a group that determines coverage, and coding of all DME (Durable Medical Equipment). These codes are universally used by all insurance/funding groups.  Medicare establishes a fee schedule and longevity of each product code which is published.  Once a fee schedule is published it is accessible by all other insurance providers.

Generally private insurance PPO's use a formulary that offers higher fee's paid to service providers (Doctors, Clinicians, and Equipment Suppliers).  Private Insurance HMO's use a fee schedule closer to what Medicare offers. Medicare HMO's use a fee schedule lower than the Medicare fee schedule as they generally package other benefits into their program and uses the lower fee schedule to offset the additional benefits.

Presently in the DME industry, there are three (3) important battles shaping up......

Competitive Bidding

The First major issue is competitive bidding, which was introduced in 2010, and was trialed in 10 metropolitan areas. Although it hasn't been a total failure, it has caused a huge reduction in access. In the first year of 2010, almost 1/3 of the winning providers went out of business unable to perform under the agreed contract.  In 2012, the Scooter Store was closed down by the Government, and had contacts in all contact areas.  In 2012, the 2nd round of competitive bidding starts in July, if not stopped, will affect the entire United States.

What is Included in Competitive Bidding?
Most DME equipment including; wheelchairs, scooters, group 1 and group 2 powered wheelchairs, beds, mattresses, patient lifts, canes, walkers, oxygen and respiratory products and many other supplies.  Not one company won all the bids, so it is possible if you need multiple products, you may have different suppliers for each one.

Less providers equal less access. You know when you have a problem with FPL or ATT, that you are stuck. You cannot switch your business to another provider.  Once these companies are struggling and do not have adequate funding to survive, will they care about unsatisfied customers?  If they have limited reimbursements, less options, and less quality products and services will be offered. Since DME has a life expectancy of five (5) years, if the equipment is not as durable, will beneficiaries become stranded if the equipment is of less quality?

Further we have seen from what occurred with the Scooter Store, that beneficiaries of equipment have become stranded. It is not recommended to provide service to a customer whom you did not provide their equipment and do not have the supporting documentation in your files. As you will read shortly, in an audit from the initial company, if CMS/Medicare finds that the equipment was provided inappropriately, not only will the money for the equipment purchase be recouped, but also will any services provided for that equipment. When additional suppliers of DME disappear, their customers are severely disadvantaged and will most likely have to personally pay for services, or go back through the process gather medical documentation to support the need for their equipment.

Several economists have shown that this system will fail. A system where you force an industry to bid low or no longer be able to stay in business does not foster competition, it creates fear, and survival instinct. Many companies bid low, not because it was a sound business decision, but a way to keep their business alive. There are many in Congress that have been trying to stop Medicare/CMS from moving forward with the competitive bidding program; however Medicare/CMS continues to boast huge savings; overlooking the destruction of businesses, the loss of customer choice, and reduced access to equipment and service.

The Second major battle are the audits. If it were not bad enough that CMS/Medicare created competitive bidding, they also hired companies, bounty hunters, to audit DME companies to ensure that they were billing properly and to avoid fraud and abuse.  This is where it gets interesting....Most recognize fraud and/or abuse by the providing of equipment to people who do not need it or billing equipment that was not provided.  Medicare determined that if they reviewed a file, even if there was medical need, if a date was not proper, or a signature not clear, that the claim could be deemed improper and money can be recouped from the provider.  I say again, it is not because the patient did not need the equipment, they are looking for a technicality to reclaim money from the equipment supplier. They do not go after the Physician, or Clinician, but the supplier.  This has cause these bounty hunter companies to become aggressive- they get a percentage of money recouped, so it is to their benefit to find things wrong.  If they find claims wrong they can extrapolate back several years based on a percentage of claims found not be correct and demand money back.  It is up to the supplier then to hire an accountant and attorney to dispute this, in most cases the company declares bankruptcy. As you can imagine, more and more companies are leaving the Medicare program to avoid these unfair audits.


Many private insurance companies are now looking a these types of audits.  The underlying question is whether these audits are for supplier integrity, or whether it is to recoup funding back to the insurance provider.  

The Third battle is over Complex Rehab Technology (CRT).  Complex Rehab Technology is described as equipment that is specialized and customized for an individual with mobility challenges. This level of equipment requires a greater knowledge, higher skill set and certification.  Currently these are the specialized companies who are the experts in your community.

The only current certificate required is an ATP- Assistive Technology Provider, which was set to be a
minimum qualification and is for general assistive technology.  There are other certifications currently offered (not yet required), Seating and Mobility Specialist  (SMS) and Certified Rehab Technology Supplier (CRTS).  With all the pressure from competitive bidding, many companies who did not receive a contract (winning bid) are trying to keep their businesses and are trying to migrate to providing complex rehab equipment.

An ATP certification requires only passing a test, it doesn't say you are qualified or good at providing CRT. An ATP who passes the exam on Monday is now on an equal playing field as an ATP who has been providing this level of equipment for 10 years. Would you want a Surgeon who just passed their board exam to perform your surgery or the Surgeon who has experience?

There is legislation in Congress and in the Senate attempting to separate CRT from DME.  This legislation has been years in the making, and spearheaded by NRRTS, NCART and United Spinal. These group are very concerned that the industry, filled with knowledge and experience, may soon disappear if not protected.  You can sign a petition for HR-942 and support CRT.

Tying this back together, what occurs with Medicare will carry over to Private Insurance and Medicaid. If/when you need equipment, unless you know how to fit yourself, and  know what is important, pro's and con's of different equipment and are handy to fix your own equipment; you need this industry to survive.  Many insurance companies are watching closely to these Medicare programs, and many have already adopted parts of the program.

Many manufacturers of Assistive and Rehab Technology Equipment have already frozen research and development- No further Innovation or Advancement.

It is short sighted not to care just because you do not need this equipment now. We are all aging and living longer, and it is inevitable that we will need some piece of adaptive equipment to continue with the quality of life we desire.  Baby Boomers are coming of age and this huge population will depend on Assistive and Rehab Technology to continue to live independently in their homes.  Without a unified effort, we may lose this industry, and lose the local service provider who will assist you when you have a need.

If you are motivated, you can contact your legislator and let them know how you feel. You can find you local representation by clicking here.

Carey Britton, ATP, SMS, CRTS, works for Active Mobility Center, and has been committed to lobby congress, and participate in the Advocacy of people requiring CRT.  Carey can be reached at (954) 946-5793 or emailed at cbritton@wheelchairguys.com

Active's Product of the Week: Gait Trainers

A Gait Trainer is just that a device that helps stablize posture allowing a person to concentrate on their gait (walking).  Most insurance funding will cover Gait Trainers for individuals who cannot walk indepenently and who demonsrate teh ability and desire to walk. 

Gait trainers are similar to postrior positioning walkers, however gait trainers have more support and positioning options whereas the positioning walkers like Kaye, Wenzellite, and Nimbo.

Over the years gait trainers have been used as a combined device of standing and gait training for kids and adults requiring more support and assitance.  There is no replacing a good stander for the benefits of standing, however when an individual shows the capability of taking steps and a desire for movement; a gait trainer is a valuable tool. 

For Children it has been found that movment is critical for development. Those children who do not move indendently need equipment to support and allow for this type of mobility.  For Adults who are sitting in a wheelchair all day, standing and moving independently or assisted has a host of benefits from standing, stretching, and movement.

Benefits
* Concentration on Gait Function
* Improve Muscle Stength
* Reduce Spasticity
* Length/Stretch Tendons/Muscles
* Improve Bone Density
* Improve Bowel / Bladder Function
* Improve Spacial Concepts
* Allow Mobility/Development

There are many types of gait trainers, we will go into more detail in the future.  Although there are many out there, the most commonly used, based on access, manufacturer support, durablity and dependability are;

Leckey: Nurmi Neo
Prime Enginnering: Kid Walk
Rifton: Pacer
Snug Seat: Gator, Pony, Mustang

Each gait trainer has some unique benefits and options that may make one device better than another for an individual.  This equipment is usually trialed, and evaluted for by a Seating and Mobility Specialst, and Physical or Occupational Therapist.

Important Considerations;
* Size and Ability to Grow
* Individual's Needs for Support / Positioning
* Ability to Collapse and Transport

Active Mobility Center, has a committed staff that can offer consultation, assessments, and assistance submitting this equipment for funding.  Give the Rehab staff at Active Mobility a call or email if you have any questions on Gait Trainner Equipment at (954) 946-5793 or (800) 326-4463.

Life is a Journey of Personal Growth

You may find it interesting to know that many of the most successful people in this world did not stop at Highschool or College for their education.  It is said to stay Green and Growing, as when you become Ripe; you are eaten or become rotten.

For me, I found myself nearly a year ago becoming frustrated in my career. After 20 years of building Active Mobility Center, spending countless hours learning about wheelchairs, scooters, powered wheelchairs, seating and positioning; learning on webinars, symposiums and conventions about the newest technologies, and approaches to fitting this equipment- I realized that although I was becoming the expert in my field; I had lost some of the passion of growing my vision and direction of the company.

Let me be clear, I enjoy what I do, and I am one of the most passionate people in my industry. Knowing that I was missing something and not having a mentor to guide me, I looked for a business coach.  At the same time in my life I found another  business I am interested in; not shockingly it is also in the health care field, has proven science, and is helping people live a more independent and fulfilling life. 

Both of these changes in my life have made me a much better person. They say that you are a combination of the five most influential people around you. If you want to be better, surround yourself with better people.

What I have learned about the saying above, is that even if we are working in a field we enjoy, making the world better,  have great friends and family; we still may feel something missing in our lives.  Life is changing and we need to change  if we want to stay relevant and valuable. If we become complacent we can lose our importance and disappear.

For many of the people I serve at Active Mobility Center, their lives have become dramatically influenced where life stands still. No longer being able to ambulate, or perform an activity can take over all of their energy and thoughts. If they are finished growing, they may feel like giving up; but if they are still growing, and open minded they realize that they can still do anything they set forth to do.

Personal Growth is painful, spending time learning, planning and taking the journey to improve your life.  I can tell you from experience, when you choose to grow, and find gratitude your life will be much more rewarding and enjoyable. You will spend less time complaining and blaming and more time living.

Please feel free to send me an email to comment on my article.

24 Hour Positioning

We live in the greatest country in the world, yet our Health Care system fails compared to the world. Our current system reacts to sickness, and tries to cure the problem or the symptoms; hopefully soon we will take more steps towards prevention.

In Europe, they realize that long term wheelchair users are at high risk for deformity, and health complications from the body sitting for long hours.  They believe in 24 Hour Positioning. Anyone requiring the use of a wheelchair long term, are issued alternative positioning devices; as they know the need for standing, and positioning to counter the affects of gravity, spasticity and tone. 

Here in the US most insurance provides standers and/or gait trainers for children as they know that growing children have high risk for deformity and contacture. There is clear evidence that not providing alternative positioning equipment results in higher medical costs. 

For children who attend school, there is protocol for alternative positioning. The research shows that not only does sitting all day affect posture, but it also affects the ability to learn.

Why then do we not address sleeping and positioning as when a wheelchair user is not in their chair they are usually in their bed.  If sleeping consitutes 8-10 hours per day, why are we not using this time to improve posture, and/or reduce the destructive affects for nearly half of every day?

For over 20 years, I have been involved in the assessment and recommendation of equipment for people with special needs. I have seen children become adults, and have seen that with consistent therapy and caregiver involvement children have much better flexibility, posture and function. Most of these individuals had gait trainers, standers or other alternative positioning equipment. When these individuals had progressive therapists, that put in place alternative positioning programs in addition to stretching and range of motion; these individuals had greater outcomes.

It is important to first look at the primary equipment the individual is using. Their posture is dramtically affected from it.  I am sure you have seen an older man/woman in the mall or grocery store, and they are sitting in a basic wheelchair, and their body had formed to the shape of the upholstery.  The wheelchair and seating needs to be monitored in children every 1-3 months, and every 6 months to a year in adults. If an individual has a change in condition, the equipment should be reviewed.

Once the wheelchair or primary equipment is addressed, alternative positioning equipment can be added. It is my belief, that every wheelchair user should be using a stander- as long as a physician has cleared them for safe standing. Standers are avaiable in prone, supine, manual and power options. They come in table style or sit to standers.  If there is the ability to take steps, then a gait trainer may be more approriate.

If standing and gait trainer is not an option, there are other positioning chairs including hi/lo variety. 
There are side lyers that can be used where the user lies on their side, which can counter the affects of gravity, tone and spasticity.  Wedges, and moldable bags can be used for positioning and support.

Many wheelchair users, have issues with swallowing and breathing where their bed needs to be adjustable. Hosptial beds are used to raise the head and/or foot area.  There are low pressure mattresses to reduce pressure or help with skin breakdown. A newer product to the US is the Dreama bed. I believe there will be more of these types of systems soon, as it makes sense that when sleeping 8-10 hours per day, we have a good amount of time to impact change on body position, posture, tone and spasticity. 

I would suggest to parents, to read, ask questions and learn from others on how to help counter destructive postures.  Please feel free to contact me with any questions or comments about 24 hour positioning.

Active Mobility Center is Changing to Better Serve our Clients

Back in November we hire a Business Coach to come in and look at our business and it's practices. Sure we could have hired an industry consultant, but that would have only compared us to other similar companies. We wanted to improve our efficiency, our customer service, our efficiency, and our service delivery.  We have the best management software, so we wanted to concentrate on creating systems and procedures to help our consistancy and delivery. We hope our customers are seeing improvements, and understand it will take several more months to achieve the level of consistance we are reaching for.

We are spending more time each week to work on the business and it's practices instead of working in the business. This is a constant challenge as we are busy, and making time continues to be very difficult.

This Saturday, our staff came together at Active Mobility Center, to spend time working together, when customers are not on the phone or in the office; giving us a chance to communicate, and learn more about one another. We spent from 9am-3pm socializing, eating, brainstorming things we want to work on and improve, and time to clean and re-organize the office and warehouse. 

A sincere Thank  you to our staff for taking the time away from their family and weekend, I believe the time spent was invaluable to our company, the way it
functions and to our customers.

To our customers, as you can see we do listen, and strive for constant improvement. If you have constructive critisim on how we can do better, please send me an email, and feel confident that we will review and discuss it.

Best Regards,

Active Mobility Staff

Head Positioning Options

We know that seating starts with the pelvis. Stablize the pelvis and posture/positioning is improved. We also know that the vision and head position can dramatically affect posture, positioning and function. Until recently we had options for posterior and laterally collapsing head postures, but had few options for anteriorlly collapsing head positioning. Forward collapsing head positions pull down shoulders and cause curving of the back which can lead to kyphosis.

Whitmeyr Biomechanix has a line of products that incorporates head straps to help reduce forward collapsing head postures.  These head supports have had success however with any spasticity or tone, they tend to fail.  Stealth Products makes a support called an I2I with combination chin prompt which can be affected. Metal Craft makes a Hawc support with articulating side supports that can prompt head upright. 

Symmetric Designs makes a product called a Savant, which is a moldable head support with ear cut outs with optional head strap that seems to have very good results; however it offers little movement, so with people who do not tollerate being straped it can be an issue.

The HeadPod is a newer product in the US, and it uses straps configured like what you would find in a  hard hat, that supports the head with an overhead support and line attached. This helps keep the patient's head upright and allows for dynamic movement. 

If you or a love one has an issue with head positioning, consult with your doctor,  therapist and
seating specialist to see what product may be right for you.

Carey Britton, Seating Specialist at Active Mobility Center can be reached at 954-946-5793 or by email cbritton@wheelchairguys.com.

Important Factors in Choosing the right Provider for your Medical Equipment

There are some important factors in choosing the right provider for your medical equipment. There has been some sweeping changes in the insurance industry that has caused some chaos and has caused several companies to go out of business.

So how do you interview and become confident who you choose will be looking out for your best interests?  By nature we trust people and feel that anyone in the medical profession is certified, professional and is in the business of helping others.  After doing a little research you will find that these practices are businesses, and with the changes in funding/insurance; each business has to decide where they will cut costs to ensure survival.  Not unlike your Surgeon, they bill you or your insurance for a completed service using codes created by the insurance industry. The Doctor/Business has to determine when they replace your knee, do they replace it with the best quality product, or do they use a lesser product to allow for a profit with the reduction in what insurance companies are reimbursing for services?  

You must interview your provider, ask them what brands of equipment do they offer, what services do they provide, do they offer a showroom where you can see, touch and feel the products? If I were paying privately is there different options available? Can I upgrade to something better if my Insurance only offers a certain product?  Do they come to your home? Will they consult with your physician and medical professionals taking the team approach to determine what is the equipment/services based on your specific needs?

Since 1992, Active Mobility Center has adopted the approach that we are providing equipment and services to ensure increased function and independence. This part of our mission and vision to ensure that our business continues to ensure that the customer is taken care of. Much of our advertizing budget goes into continuing to provide the highest quality products and services to our customers.  If you have questions or comments, you can contact Carey Britton.