Is it Important to be Certified?

It can be an unconscious decision to entrust someone who is an authority in the field we need assistance from. Whether it is building a house, having a major renovation, having your automobile repaired, having a medical procedure; there is value and peace of mind knowing that your choice is certified and reputable.

You may find it surprising that when it comes to Seating and Mobility equipment; many insurances including local Medicaid's do not require any certification or licensing that the person recommending, and providing the equipment has no certification.  At the time I am writing this, only Medicare and a few Private Insurance carriers require at a minimum an A.T.P. certification.  The ATP (Assistive Technology Provider) is a RESNA certification that requires an individual have some basic experience in DME (Durable Medical Equipment), and who sits for a test.  This certification was established to set a minimum standard to ensure that the person who was involved with the equipment has some experience, and who is requires continuing education. 

As you can imagine, some individuals take this test to gain the minimum standards required by Medicare and never increase their skills as it is not a requirement. Is that enough? There are several people who have been in this industry for decades that have great experience; however when you are looking for an expert, how do you separate a veteran ATP versus one who passed the test last week?

If you are needing basic Seating and Mobility equipment then maybe a newbie can help, but if you are facing challenges; wouldn't you want someone who you can trust? 

The NRRTS organization felt that the ATP was a good starting point, but felt that Seating and Mobility is a specialty and felt there needed to be a higher standard.  NRRTS established the RRTS (Registered Rehab Technology Supplier) which you become after meeting their standards and are listed on a Registry.  After two years of being registered, with no complaints against you, you become a CRTS (Certified Rehab Technology Supplier).  The CRTS has been the gold standard when it comes to finding an expert Seating and Mobility Specialist. 

In the past few years, there is a new SMS certification. This Seating and Mobility Specialist Certification is tested on experience, and was created by RESNA.  This test requires years of experience as there is no manual, or book to read to pass the exam. 

I find it puzzling how if you want compression stockings, only a certified fitter can help you; however with a custom wheelchair with many insurances anyone can fit you for this equipment.  I am happy to see that it is changing, but in my eyes not soon enough. Many lobby that the reason more insurance carriers do not mandate these certifications are that they may not be enough ATPs around.

There was a time where every community had an amazing physician, or an amazing therapist who were the expert in Seating and Mobility; and where the equipment supplier only had to know about their product(s).  Today, with budget cuts, and increased productivity demands; the Physician and Therapist do not have the time or incentive to be the expert. They have higher demands and expectations on the Equipment Supplier for measurement, assessment and recommendation of equipment.

The Equipment Supplier is now suffering from the same budget cuts, and now have a reduced menu of services which depend on the funding source. These insurance pressures are forcing providers to provide what is minimally necessary to maintain a level of profit for the company to ensure their doors can stay open. 

At the end of the day you have to decide who will help you, who will recommend equipment equipment that will affect your life.  The equipment supplier has to make a profit for survival; however your equipment supplier must have your best interests in mind.   The certification(s) are a layer of protection for the consumer, not only for the knowledge and ongoing education.

Not unlike another Medical Professional there is a board that they are accountable for and where their licenses or certifications can be taken away and where it will affect their ability to work. 

This Article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center. He can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com. Find us on Facebook.

Tilt in Space has almost replaced Recline on Manual Wheelchairs.

Before tilt-in-space wheelchairs, reclining wheelchairs were dominant when a person was a high risk for pressure sores and needed to change their position in the chair during the course of the day. The drawback of reclining wheelchairs is that when reclining the backrest, it causes a sliding effect on the user. The back shears against the users pelvis and against their back. This can cause sores on the back and pelvis if the user's skin is susceptible. Additionally recliners can cause a client to slide down and out of the wheelchair creating positioning and functional issues.

Since the introduction of the Tilt-in-Space wheelchair; recliners have taken the back seat. The only time recliners are prescribed over tilts is when a client needs to recline for feeding, issues with blood pressure, hip limitation, daily activity or severe deformity.

Tilt-in-Space takes a person sitting upright and tilts the whole seat frame back. This allows for the pressures on the buttocks to be redistributed to the back of the user. The tilt-in-space also allows for correct posture throughout the entire range of tilt in space. The tilt with the assistance of gravity helps force a users back, and hips to the rear of the wheelchair helping maintained midline posture. With tilt there is no shear effect since the user's body never changes position against the support surfaces of the wheelchair.

There are chairs now that offer both tilt and recline that can offering maximum benefits.

This article was written by Carey J. Britton, ATP/SMS, CRTS for Active Mobility Center.  Any questions or comments, call (954) 946-5793 or email cbritton@wheelchariguys.com .

We Still Need your Help to Make a Change in CRT- HR 942

I am sitting here on the first day of June, thinking of how far we have come in our quest to change Complex Rehab Technology.  CRT is a relatively new term, which covers custom configured equipment including ultra light weight wheelchairs, powered mobility and seating and positioning equipment. 

It is mostly understood that, CRT is not a order and drop equipment, and requires skilled staff to help with the evaluation and assessment, the gathering and submission of paperwork to insurance funding, the ordering, assembly, delivery and fitting of this specialty equipment. 

Unfortunately our industry has not done enough to police itself and has a black eye, as it is lumped in with DME.  Every month you can see in the news DME suppliers investigated for fraud and abuse.  It is unfortunate that instead of CMS doing a better job screening their suppliers, they have placed higher and higher requirements which are negatively affecting the beneficiaries. What CMS/Medicare does, is adopted by all other insurance carriers.

I am excited to tell you at this moment we have 130 House Co-signers and 15 Senators who have Co-Signed on to this Legislation. This is a great start but we need more to make this legislation to be important enough for Congress to move on this.

None of us know if/when we may need these products and services; and there is a real concern that if things do not change, then this industry will certainly change; and possibly disappear.

A friend of mine reminded me that, Orthotics and Prosthetics went through this Journey several years ago, and it took them over a decade to be recognized and have their products/services separated from basic DME and are understood that it takes a special group of people to take care of those with special needs.

Take a moment to sign on to the petition to separate CRT. If you want to be move involved please contact me and I can put you in touch with several groups who are leading the charge to change CRT.

This Article was written by Carey Britton, ATP/SMS, CRTS for Active Mobility Center. He can be reached for comment at (954) 946-5793 or at cbritton@wheelchairguys.com.

Is Medical Equipment too Expensive?

I have seen many posts lately on Face Book and in Blogs about the high prices for DME and Medical Equipment. I have seen comparisons to Sport Aid and other online pricing compared to the brick and mortar companies. 

As a tax payer, and after taking an Ethic course and discussing the outside perception of the costs of Medical Equipment; I understand the concerns.  It is hard to fathom that a powered wheelchair may cost as much as a car, that an ultra light weight wheelchair may cost $3000. 

That being said, have you seen how much a refrigerator, furniture or a racing bicycle may cost?  I have a friend that has a bicycle that costs $5K.  I understand that the racing bicycle may be considered a luxury and where a wheelchair is not; but there are a lot more bicycles sold yearly than the same custom wheelchairs. Bicycles do not have the same requirements and liabilities as do wheelchairs.

As a Complex Rehab,  DME supplier and Board Member of NRRTS, I see the other side of the equation.  Generally Medical Equipment is funded through Insurance and all insurance companies follow Medicare guidelines. Unlike the Sport Aid type companies, we are forced to comply with all Federal, State, Local, Accreditation, and Insurance guidelines.  Unlike Sport Aid, we have to follow the clinical model and have to provide a report that builds a case for medical necessity, we have to chase all the paperwork, submit the request to funding, help with any appeals, order, assemble, deliver, fit and then submit the claim for billing; which can take up to one year to be reimbursed. 

Retail companies, advertise their products, take a deposit or the entire amount up front, and ship the equipment to the customer.  There is little cost and risk in this process. Catalog and On-line companies can be anywhere, allowing them to reduce costs, they do not have to have the insurance coverage, they do not need to be accredited, inspected, or follow the same standards as Insurance providers.

There are costs associated with playing the game. In retail, it is all about price and value. When providing equipment through insurance, you have to have a location that is certified, inspected, accredited, bonded and insured. The costs above the rent, staff, trucks, equipment, parts; etc. is the Professional and Liability Insurance ($10-$20K / year), Accreditation ($3-$5,000/year), Medicare and Medicaid Licensing ($1K/year), Bonding ($1K/year). There are regular audits by the insurance carriers, which cost much time, and expense in fulfilling the requirements and ensuring payment for services.

DME companies offer and provide knowledge, education, and their experience to improve the quality and successful outcomes. I am the first to agree that there are not enough safe guards in the DME world, which is why NRRTS is aggressively promoting trying to carve out Complex Rehab Equipment from DME.

There are studies that have been conducted, showing that in Complex Rehab that the net profit for most DME's are under 7% which is very low in comparing to other industries. This offers very little room for growth, pay increases to staff, or any additional benefits to workers. 

Competitive Bidding was introduced, reducing payments for many DME products. After the first year 33% of the winning providers went out of business as they could not afford to stay in business.
It is important to remember, that DME companies purchase the equipment they are providing, and help with all the insurance paperwork and do not receive any compensation until the equipment is delivered.  All of the labor costs from the intake, evaluation, quoting, requesting medical documentation, submission for approval, ordering, assembly, and ensuring there is a service staff to help with concerns is all funded through the sale of the product.  It is a semi-flawed system, however if insurance companies paid a lower rates, and considered labor hours for the entire process; the price of the equipment would be higher than it is now.

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

Active Mobility Center at the Muscle Walk in Palm Beach

The Muscle Walk !

Last week, Active Mobility Center participated in the MDA Muscle Walk at Roger Dean Stadium in Jupiter Florida.  The Muscle Walk supports the efforts of the MDA helping to research treatments and an eventual cure for this terrible condition.

This year Active Mobility Center will be more visible in the community, listening and learning on how we can be a more valuable resource to South Florida. Please help us by making any suggestions on how we can be more valuable.

This article was written by Carey Britton with Active Mobility Center in Pompano Beach. Any questions or commetns can be directed to Carey at cbritton@wheelchairguys.com or (954) 946-5793.

Running Out of the Gate

2014 is here, and things are not slowing down.  Active is looking at the industry as the glass is half full, and where there is great opportunity.  We are seeing many national companies buying up local companies and intimidating the local providers like Walmart.  Insurance is changing, and we are now learning the affects of Obama Care.  There is constant pressure to change, and the staff at Active are embracing this not to ensure survival but to become better.

Over the next few months, our customers and partners will see some major changes. Our office is having some renovations to increase it's display space, increase the retail and accessories available to our customers.  We are improving our inventory management system. A face lift on our website will be completed by February to offer a more friendly site to navigate and access the information.  An event calendar will be added and will show local and regional activies, and events to allow the community more involvement.  You will see a higher level of community visability and involvement. More interaction between our customers and business partners to help us become more valuable to the community and remove any inefficiences. Last but not Least, we will be adding more FUN.  We understand that the Medical Equipment business can be sterile and we want to improve the experience not only for our customers but also for our staff.

We realize change is occuring with or without us, and understand that we need to be ahead of the curve to ensure that we are here for our customers, partners and health care professionals.  We also know that what we do is very personal and that our customer wants a company who listens, who cares, who is local, and who will be there to support and educate them.

Thank you for your continued support. We understand that there is a choice for Medical Equipment and know we have to continue to earn your business and referrals.  Please continue to send in comments or suggestions on how we can continue to improve to be your number 1 choice.

This article was written by Carey J. Britton, ATP/SMS, CRTS from Active Mobility Center. Active Mobility Center, located in Pompano Beach, Florida provides and supports; seating, mobility and specialty rehab equipment.  Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

The TEAMS behind your Medical Equipment

Any time you want something done right, you need a team behind you.  Whether it is a medical procedure, a legal matter, or acquiring new equipment- you need a team to ensure that the job is done right.

Seating and Mobility Equipment can be intimidating, and the process painful and confusing.  A team with the knowledge and experience in this area is essential.  There are two teams, the one that helps you select and provide you with your equipment and the one that keeps it working for the equipment's useful life.

The initial team would consist of  you, your physician, a physical, occupational and possibly a speech therapist, your family, caregivers and the equipment supplier. Each of these individuals are crucial in providing information to ensure that the equipment fulfils your needs, and your goals.  You are responsible for helping the team what your goals/desires are for your future, what you need your equipment to do to keep up with your life demands.  Your physician will need to provide a history, and any goals/concerns that they have. The Physical and Occupational Therapist(s) bring information on body posture, functional capability, and expected prognosis.  These clinicians perform a functional assessment and are very involved with the equipment prescription. Your family and caregivers need to voice their concerns about function, equipment and accessibility issues. The supplier brings equipment knowledge and works directly with all involved to help recommend the most appropriate equipment based on all the information that is gathered.

This team works really hard to trial and document the equipment, which is sent to the insurance for consideration.  This team works with the insurance provider to provide any additional documentation that is needed to receive an approval. On delivery, the Equipment supplier works with the user, the clinicians, and the caregivers to adjust and optimally fit the equipment.

Once the equipment is used on a daily basis, the technical service department because the support team to help maintain, adjust and repair the equipment; until such time the equipment is worn out and needs to be replaced. 

In the event that the equipment no longer fits, or there is a change of condition, the user is referred back to the physician and clinical team to review the equipment and make any recommendations on changes needed.

This article was written by Carey J. Britton, ATP/SMS, CRTS at Active Mobility Center. Active Mobility Center is a Seating and Mobility Specialty company located in Pompano Beach, Florida. Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

Happy 4th ! from Active Mobility Center

Every year at this time, I reflect on how Active Mobility Center and our Country's Independence Day have much in common.  For many people with walking impairments, it is a time to celebrate; as not to long in our history, people with mobility impairments were left inside their homes and were not felt as EQUAL.  Their impairment left them "Disabled" or "Invalids" and were looked down upon. 

With the passing of the ADA, Americans with Disabilities Act,  in 1990;  the world has literally opened up doors, improved access, and increased independence for all. 

Active Mobility Center, in 1992, opened its doors to ALL people with Mobility Impairments, with the goal to maximize their abilities, and to Make Every Day Independence Day ! It may sound like a corny expression, but each and every day, our experienced staff listen to our customers, gain knowledge and understanding of what their obstacles are and offer solutions with equipment, or with recommendations to other professionals within our community. 

Through Equipment; wheelchairs, scooters, powered wheelchairs, gait trainers, walkers, bicycles, and handcycles; we are allowing people to stand and be equal.  We believe it is our duty, to ensure that all have access to mobility allowing everyone to be MOBILE, INDEPENDENT and FREE.


From all of us at Active Mobility Center, Happy 4th, !
Carey

Carey Britton is the resident Seating and Mobility Specialist wth Active Mobility Center, he can be reached at cbritton@wheelchairguys.com, or at (800) 326-4463.