Power mobility equipment providers have one chance to make a good impression on a client. If a power wheelchair is the wrong fit, chances are the client will not come back.

For Simon Margolis, CO, ATS/P, vice president of clinical and professional development for National Seating and Mobility (NSM) in Plymouth, Minn, success means balancing a strong service ethic with an efficient business plan. It starts with qualified staff members who are passionate about helping clients find the right mobility solution. “The biggest challenge is not providing the appropriate technology,” he says. “When you hire the right people ... the challenge is to set up the infrastructure to support them.”

At Chattanooga, Tenn-based NSM, which has approximately 50 locations in the United States, employees are certified members of the National Registry of Rehabilitation Technology Suppliers (NRRTS), which involves passing an exam administered by the Rehabilitation Engineering and Assistive Technology Society of North America. In addition to 12 to 13 years of experience and a good understanding of the industry, Margolis says that employees must enjoy their work through the 14- to 16-hour days. “The CEO [Mike Ballard] wants people to have a song in their heart about the business,” he says.

Continuing education is essential to rehabilitation technology suppliers (RTSs), and NSM holds frequent 4- to 5-day symposiums to keep employees up to speed with the industry. By investing time in the employees, NSM ensures proper client evaluations. “When we are providing a power mobility base, it is never just a wheelchair. Typically, the people we work with have a specific set of needs,” Margolis says. For example, clients often require custom features such as additional arm or back support. “You must ask the right questions. The [profit] margins cannot support making a lot of mistakes,” he says.

GETTING IT RIGHT
NRRTS and the American Association for Homecare Re/hab Technology Council require that RTSs discuss power mobility needs with clients in person. NSM representatives meet with customers face-to-face at bimonthly or weekly seating and rehabilitation clinics, such as those sponsored by Easter Seals.

Evaluations last from 45 minutes to 2 hours. Often, providers will visit the client’s home, school, or work environment to take note of obstacles, sharp turns, and door, gate, or path measurements. Although the RTS usually has a general idea of the client’s size, shape, and skills before they meet, specific questions during the evaluation leave less room for error. (See “Power Quiz” below.)

Before presenting available products, providers must establish the client’s needs, limits, and funding. “Don’t show options that are not viable—establish needs and limits first,” Margolis says. “Success or failure of the product has little to do with the product. It has to do with the individual.”

If a client is already using a power wheelchair, the provider should ask what the client likes most and least about the chair. Then they can discuss what the client would like from the new power wheelchair that the current system does not offer.

This leads to specifics such as the length, height, and width of the chair, which depend on physical and environmental factors. For example, if a client needs to transport the chair, providers must know the specifications of the transportation vehicle. If it is a van, does it have a raised roof? Will the client need a tilt or recline option to sit comfortably in the vehicle?

Then providers take a closer look at the physiology and symptoms of the client. If a client has a degree of spasticity or scoliosis, seating and support systems may be required. By considering these factors, providers narrow the product options. For example, if a client needs a tilt or recline feature, only certain power bases are available. Once providers understand the client’s needs, they can present product options that fit.

Evaluations give providers and clients the chance to develop rapport. Explaining the process up front and directly addressing client questions about cost and timeliness go a long way toward building that relationship, Margolis says. “We have to establish our credit with the client,” he says. “We have to set the person’s expectations up. [Buying a power wheelchair] is a slow process.”

ENSURING PROFIT
Cost is a concern for both clients and providers. According to Margolis, a customized power wheelchair costs between $10,000 and $12,000—not including service. Selling to customers is one challenge, collecting reimbursements is another. “There is a tremendous outlay of money by rehabilitation technology companies,” Margolis says, adding that providers pay for products 3 to 6 months before they are reimbursed. “You can buy a house faster than get a wheelchair funded by Medicaid.”

Companies like NSM do not keep products in stock because each chair requires individual specifications. This means paying for power wheelchairs months before receiving payment. To ensure timely reimbursement, the paperwork must move smoothly through the process. “We go from a clinical mode to a very rigid business mode,” Margolis says.

Once a client places an order, NSM works to meet payor requirements as efficiently as possible. This means knowing the procedures for Medicare, Medicaid, and combinations with private payors. NSM works with approximately 15 different payors, according to Margolis. “We understand the rules,” he says. “You cannot fly in the face of the system.”

The sooner the paperwork is filed, the sooner providers receive preauthorization. Then they can concentrate on delivering the chair to the client. Sometimes the client’s therapist requests a rough fitting of the chair before it is completed. “Ninety-five percent of the time, it works fine,” Margolis says. “It is never as straightforward as we would like it.”

After the final tweaks, providers deliver the chair and make sure the client is satisfied. If it is done right, clients may return for additional products, such as standing frames.

Although profit margins are limited, there is still money to be made in the power mobility industry. The trick, according to Margolis, is being small enough to give individual attention to each order and large enough to handle several orders at once. “It can be done. But it takes a combination of the right clinical people and business model,” Margolis says. “Without the commitment, it is not a good way to make money.”

Ann Carlson is associate editor of Dealer/Provider.

HME Insider

In the past 20 years, power wheelchairs have been transformed from cumbersome vehicles to streamlined machines. But Medicare regulations often do not reflect that change, say industry analysts. Dealer/Provider talked to Invacare president and CEO Mal Mixon about keeping up with power mobility trends and home care regulations. Q What advances in power wheelchairs have you seen? A When I came to Invacare [in 1980], I remember the motorized chairs at the time—you could not control or steer them. They had institutional pulleys. Today, products are as complex as automobiles. In the past 5 years, we have made a technical breakthrough with our gearless/brushless drive systems. The 3G drive systems are quiet and efficient, and eliminate pulleys and gearboxes. Invacare was also the first company to introduce microprocessor controls. Q Invacare has been a leader in mobility research, introducing many new products over the past few years. How does Invacare develop these new products? A There are two groups. Research and development works on very enhanced concepts, experimentation, and perfection. The engineering department of the company incorporates the technology into a real design. There is a 1- to 2-year development cycle from concept to conclusion. We design products concurrently—meaning that we design the product, manufacturing, and performance requirements all at once. We use continuous focus groups to arrive at the best products. We employ 80 to 100 active people with disabilities as test pilots for prototypes. They give feedback on design. We also work with industrial designers to make the product aesthetically appealing. Q When you develop a new element of technology, how do you overcome reimbursement challenges? A It gets frustrating when you have a new technology and there is really no change in reimbursement to make that product available, although it does a lot more for the consumer, and the provider as well. You have to sell the features and benefits to both the consumer and the provider, and hopefully, if that does enough, they will find a way to get the product they want through private insurance or another means. It is never easy though. Q Do you expect the Bush administration to address that issue? A We are very fortunate that a man named Tom Scully has recently been made head of what is now the Centers for Medicare and Medicaid Services (CMS). I know Tom personally and have a very high regard for him. I think that we’re going to have a very open-minded leader, a very accessible leader, and one who is much better prepared to answer the needs of consumers. We have probably had more communication with the Health Care Financing Administration (HCFA, now CMS) in the 2 or 3 weeks he has been on the job than we have had in the last 10 years. I think the new administration is going to dramatically reduce the administrative complexity of HCFA. Today, if you talk to providers, the most frustrating problems they have—even more than the absolute reimbursement amount—are all these stupid forms they have to keep filling out. It is just a nightmare of bureaucracy that adds so much cost. Tom Scully and Department of Health and Human Services Secretary Tommy Thompson have stated that they hope to make a much more consumer-oriented agency and to do away with a lot of red tape. I think that will be hugely applauded by our industry, if they can pull it off, because our dealers spend so much time on worthless paperwork. The industry of which Invacare is a part continues to lobby for changes that will help eliminate a lot of this complexity. Q What supports does Invacare offer for HME providers? How do you solicit feedback? A Obviously, you can never do too much for your customers—there are always new things you can do to gain their loyalty. In addition to our claims consulting program and the new InvacarePro Web site, we have recently introduced our TV advertising program where we refer leads to our participating providers. Through our co-op advertising program, providers can create their own ads from the copy that we make available to them, plus we pay for our share of the ads. A few weeks ago our first direct mailing generated hundreds of leads that were turned over to participating providers. So there are always new things that we are experimenting with and sometimes we formalize those into long-term programs. We also offer LEEP—Learning Education Enrichment Program—for home care providers and for therapists. This program offers education credit, and involves a lengthy and tailor-made curriculum depending on the individual. We schedule the courses around the country, and we get some really good accolades on our school. These programs include our on-staff therapists who are experts in this area—not just fitting but the specialized seating. Probably, informal communication is the best vehicle to solicit feedback. We communicate daily with thousands of providers and frequently they voice their opinions to us about things we need to do better or change. We also have our in-house think tank where we try to anticipate trends and understand additional services that we can provide our customers. I do not think there is any magic to the process itself, but it is more a matter of what we can do next. www.invacare.com;   (800) 333-6900.