Open Communication Building a Better Community

In a time were Social Media seems to be taking over, I was fortunate to have spent several hours face to face with the Broward CIL leadership group led by Danny Murphy.  The BCIL leadership program, spends time visiting community partners to learn about what they do, and at the same time bring a different view on how businesses and organizations are perceived.

I was excited, as I had received a preliminary email last week on some questions that were raised from the group.  I had answered these questions, and provided some background information of the history, mission, vision and challenges faced both locally as well as an industry to help build a foundation, to allow us to get deeper in conversation about what the community is looking for.

After a tour, we met in the conference room where we discussed the history, vision and purpose of the company.  We discussed what we feel separates us from our competition; and why we continue to do what we do.  I believe the group has a much better understanding on how the system works, and what increased pressures and requirements we face over a more traditional business.  I believe we were able to share some valuable resources that can benefit the group and the community.

Unlike Social Media, there were no boundaries or hiding behind a computer; we were looking for feedback, suggestions, what their ideal CRT Company (Complex Rehab Technology) looks like, what challenges / obstacles they face, and how we can be a more valuable part of the community.

The group was able to ask questions, and offer their perception, and what they are looking for in an equipment company.  The exchange provided us with several ideas, and much to discuss with Active's staff on setting up a schedule in which to implement some of these suggestions.

We Thank Danny Murphy, and the members of the Leadership Group for taking the time to learn about what we do, and helping our company improve.

Any questions can be directed to Carey Britton, Seating Specialist for Active Mobility Center. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com .

What is Complex Rehab Technology ?

CRT (Complex Rehab Technology) is the newest term, developed over the last few years to describe specialty equipment that which is more involved than basic  DME (Durable Medical Equipment). As you may know DME encompasses everything from disposables  to custom wheelchairs and Orthotics/Prosthetics. You may wonder why a new term was created if it is part of DME? 

Invacare Rear Drive Powerchair

For years, DME vendors have been given a bad name, with a few bad companies taken advantage of the system and many times committing fraud.  CRT was born, when Medicare created the Competitive bidding process and they didn't understand the level of involvement with Specialty Seating and Equipment. After much work from the Rehab industry, some specialty equipment was exempt from the competitive program; including ultra light weight wheelchairs, tilt in space wheelchairs, and group 3 powered wheelchairs.  Medicare, who sets precedent for Medical Equipment to all funding sources, accepted that the skill level and expertise in providing this level equipment was above the typical DME provider.

Since that time, NRRTS ( National Registry of Rehab Technology Suppliers ) and NCART ( National Coalition of Assistive and Rehab Technology ), has been lobbying Congress to further separate Complex Rehab equipment from DME.  It is understood that there is a value for this equipment provided and that there needs to be increased safeguards, and education from individuals providing this level of equipment. If  this industry is not protected, and the value shown, it will disappear in the upcoming years.  The average age of Rehab Technicians are late 30's, with most over 40, and few new people learning this trade.

Carey Britton

 With the baby boomers aging, we will need more specialists  involved; helping match proper equipment for seating and mobility needs.  A further issue causing challenge, is that there are fewer physician and therapists specializing in this field; leaving more pressure and expectations on the Seating and Mobility Specialists.   Although the Seating and Mobility Specialist is a critical component in the team that provides and supports these services; the clinician is  the gatekeeper, and we need more clinicians  to step up become community leaders. 

In order to ensure  good outcomes, we continue to progress in this industry with increased credentials, increased education, and increased safeguards to protect patients.  Our industry needs to continue to educate the allied services to become more involved in the team that is required to improve seating, function and overall satisfaction.

This article was written by Carey Britton, Seating and Mobility Specialist at Active Mobility Center. He can be reached for comment at 954-946-5793 or at cbritton@wheelchairguys.com  .

 

Nova South Eastern University OTs come to Active Mobility Center

On Monday, we welcomed nearly 40 second year Occupational Therapy Students for a morning Seating and Mobility training.  Each year, we host this training to provide a glimpse into the world of complex rehab and assistive technology equipment.  We divided the group in to four groups and created stations including; Insurance Coverage and the process of getting equipment, manual wheelchairs and scooters, seating and positioning, and powered wheelchairs.

With smaller groups, the OTs were able to ask questions and interact with each presentation. At the Insurance coverage session, the groups heard how complicated the process is. There are many changes in health care that make the intake, insurance verification and needed documentation a specialized process. The groups were disappointed in learning that the complex rehab process can take 2-4 months for patients to receive their permanent equipment.

At the manual wheelchair and scooter group, they learned about standard through ultra light wheelchairs, about tilt in space and recliners, and the differences in scooters. The groups were fascinated on how the process to determine the equipment was more involved that thought. They had not learned about competitive bidding and how it is negatively affecting individuals needing this type of equipment.

The groups learned about how many different types of foam cushions, contoured cushions, and molded seating types there were. Some were overwhelmed not sure how they could ever grasp how much information, and options were available.

In the powered wheelchair group, the students were shown the different types of powered wheelchairs, different ways to control them, powered seating systems and were able to trial driving these chairs; including a stand and drive permobil. 

Concluding the program we discussed how important the team (physician, therapy staff, equipment provider, individual and caregivers) is in equipment provision.  We discussed how the physician initiates and drives the process; however the PT and OT are just as important, and in some cases more important.  We discussed the importance of a good dialogue on the history of the patient, their past equipment experience, patient environment, patient dimensions, patient goals, and caregiver needs.  It is critically important to gather this information, and openly discuss the options to ensure that the patient is satisfied and that their life is improved. What is selected and provided affects that patient for a minimum of five years. 

It was impressed on these students, that if they find themselves helping someone with complex rehab, that they seek assistance if they are unsure of what best resolves the needs.  We explained that ego's should be checked at the door as the process is not for us, but the individual needing this equipment.  We suggested that once they find a position that they find a peer mentor to help them. Additionally they should find a RESNA and/or NRRTS registered provider to be part of their seating and mobility team/program.

Although many of these OTs may never be involved with Complex Rehab Equipment, they now have some basic knowledge, were give some valuable tools and have  a better respect for Complex Rehab Equipment.

This article was provided by Carey Britton, Seating and Mobility Specialist for Active Mobility Center located in Pompano Beach, Florida. Carey can be reached at 954-946-5793 or at cbritton@wheelchairguys.com .

New Quantum Edge with TB3 Seating



During a weekly training meetings we had our local Quantum Rep, Tim, who brought in the new Quantum Edge, mid drive powered wheelchair with a Tru-Balance 3rd Generation Powered Seating System. 

There are similarities to the Permobil seating systems, and some items that have been improved on.  There is an industry trend to make powered wheelchairs less medical and more economical.

The new seating allows for several adjustments to be made while the user is sitting in the chair. The seating can be configured with powered tilt, powered recline, powered legs and powered seat elevator.

The seat elevator is a big improvement with a scissor lift that raises the user 10". The scissor lift over a post elevator is much more durable and more sturdy when being transported in a vehicle. The new seat frame has extensive adjustability for growth/change. The arms appear to be very durable, and adjustable.  The new options including hand grips, hydration unit, cell phone holder, and back pack clips all will help users with increase independence.

The new Joystick is very streamlined, with trim that makes it look very classy. The display is color, and the horn can be programmed to be louder than in the past.

With all new systems, users can choose two standard accessories (cup holders, phone holder, accessory clip or reflectors) that will come complimentary with their new chair.

This article was provided by Carey J. Britton, Seating and Mobility Specialist with Active Mobility Center. Carey can be reached at (954) 946-5793 or cbritton@wheelchairguys.com .

It's Time to Advocate for the Future Access of Complex Rehab Equipment

Demand your Rights, Get out and Live !

For years, the DME (Durable Medical Equipment) and HME industries have given away too much in the attempt to best service our customers.  Our industry is comprised of caring individuals who want to make a difference in the lives of patient's we serve. What drives us is that we know at the end of each day, we made an impact, and improved the lives of the people we touched.

The DME and HME industries were created to help reduce the costs of Health Care. Research shows that getting a patient home from the hospital they heal and recover faster. Having a system where equipment and services are provided to the home reduces costly Hospital and Nursing Home Care. The DME industry is 1% of the Healthcare Budget, and saves a lot of money.

In the past few years, the pressures of insurance reductions, fraud and abuse, and increasing equipment costs have affective the way we conduct our service delivery.  What started out as a noble profession of helping, has become a business of becoming efficient.

Caring for our customers, we created networks and groups to lobby the state and federal governments trying to avoid further reduction in access to wheelchairs, scooters, powered wheelchairs, standers, gait trainers and seating and mobility equipment.

What happens at CMS/Medicare is adopted by all other insurance carriers; so those who don't care what happens with Medicare are fooling themselves. Many of our customers cannot speak, many fear that if they complain and lobby that they could lose more than they already have, and others don't know how. Many providers have continued to give away services and equipment and now are no longer able to.  We have failed to educate our customers, and now we are caught in an insurance system who isn't paying and customer's who are angry that they can't get what they used to.

Suppliers and Manufacturer's have commited time and resources to this battle; however since these groups profit from the provision of this equipment their voices are not heard as loudly as when it comes from the customers and beneficiaries of these insurances. Beneficaries will need to Advocate or Accept reduced access to quality equipment and services.

In the past few years, Medicare has instituted competitive bidding, where they forced providers to issue their lowest bid in order to stay in business. The first round of bidding caused hundreds of companies to go under, and 33% of the winning bidders closed within the first year.  This program is being launched nationwide this year, and will certainly cause havock on beneficaries.  As you may have seen the Scooter Store was raided and closed (for now), and all of their customers are stranded. Since they were investigated for fraud, providers are concerned. If a provider repairs and submits a claim for one of these customers, and that customer's paperwork is investigated and found that the Scooter Store did not complete their paperwork properly, that the funds for the chair and all services can be recooped by Medicare.

CMS/Medicare in the past two years had created a system where private companies are auditing providers in hopes to find missing or incomplete documentation so they can recoop money back to Medicare. These companies (bounty hunters) receive money based on this recoopment.  Generally these recoopments are not because the customer/beneficiary didn't need the equimpent, not because they didn't get the equipment; but because their was a T-not crossed or an I not dotted.

Major insurance companies are following Medicare's programs, and it is affecting everyone needing durable medical equipment (DME).  Many DME companies have stopped accepting Medicare as a payment sources as the risk of audits are too great.

There is still time to improve access to this life enhancing equipment.  There are several groups looking for your and your voice to send a message that will affect the future of Medical Equipiment. I encourage you to research these groups and commit to sending emails and making calls to help reduce the future pressure. We cannot afford to lose more companies with the baby boomer population retiring and who will need access to these services. With the pressures from Insurance, the risks are too great for any new companies to invest in the infrastructure of a company to provide these services.

Important Pending Legislation

HR-942- House Bill to Separate Complex Rehab Technlogy Equipmentt from DME, an important step in ensuring Access
S-948- Senate companion bill to separate Compex Rehab from DME

HR-1717- Bill to Stop Competitive Bidding


Get involved:
NRRTS- National Registry of Rehab Technlogy Suppliers
NCART- National Coalition for Assistive and Rehab Technlogy
USREHAB- a Division of VGM
Users First- Voice of Consumers using Equipment

Any questions or comments can be directed to Carey Britton with Active Mobility Center, located in Pompano Beach, Florida.

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