Providing seating-and-positioning services for children to whom you supply wheelchairs can be a profitable endeavor, despite the miserly reimbursement practices of payors. The key is ensuring that the job of seating-and-positioning is performed correctly on the first attempt, since funding sources, such as Medicaid, and virtually all private insurance companies will not reimburse for second or third sittings to correct mistakes.

Unfortunately, getting it right the first time is a difficult task. “It is a worthy goal, but a goal is all it can be,” says Lonnie Schultz, CRTS, ATS, who works as the pediatric specialist for Mobile Med Care in Lenexa, Kan. “There are too many variables you have to contend with. Time is one—you may not have all the time necessary to get the job done in one sitting. Equipment availability is another—sometimes an item you need is not in stock and you have to special order it. If you are getting the job done right the first time in 60% of the cases, you should probably pat yourself on the back.”

If you would like to improve the pediatric-positioning success rate of your company, take a look at your procedures and see if you are following all six of these suggestions.

1. Collect as much information beforehand as possible. Find out, up front, everything you can about the client. This includes the disease state; the home environment, the school environment, and where else the chair will be used; how the child will use the chair and whether there are any therapy goals attached to that use; and what functionality or skills the child possesses for using the chair.

“That information will allow you to readily select the most appropriate type, style, and size of wheelchair, and then put together the best possible seating-and-positioning system with seat depth and height of the back dialed in and ready to go,” says Darren Hulbert, CRTS, of ATG Designing Mobility in Cerritos, Calif. “For this, I use an evaluation form that I developed myself from years of experience with clients. It helps me get all the information up front, so that when the equipment is delivered to the client there are no surprises.”

Hulbert is often astonished at the number of dealers who refuse to ask even basic questions that would enable them to correctly satisfy client needs. “For instance,” he says, “they don’t ask questions like in what kind of car the child will be transported. Are there stairs or steps at home and, if so, how many of each and located where? Are there any proposed surgeries? What was the last growth spurt?”

He says some companies refuse to ask because they are more concerned about selling a particular piece of equipment. “They’re not concerned about whether it is the most appropriate piece of equipment for that child,” Hulbert says. “Instead, they are looking at it as just equipment that needs to be pushed out the door. That’s very shortsighted.”

2. Simulate with demonstrator equipment. “Demonstrator equipment is readily available from manufacturers, so take advantage of it to create a simulation of the seating-and-positioning system you’ll want to end up with,” Hulbert says. “This is especially useful when the patient is getting his or her first seating-and-positioning system, or when you are changing to a different support surface.”

3. Acquire technical knowledge. It is easier to get the job done right the first time when you possess sufficient education concerning the various disabilities and disease processes that affect children. The same is true of instruction with regard to pediatric physiology in general and mobility equipment in particular.

“To gain necessary knowledge, I would start by attending industry expositions,” Hulbert says. “It is an invaluable way to learn about the various products on the market and those that are soon to be introduced. But that alone is not enough. I would also go to continuing-education classes and attend lectures, presentations, and symposia on mobility technology and seating-and-positioning techniques.”

4. Call in the cavalry. Never be afraid to ask for the help of therapists or colleagues with more experience when a pediatric seating-and-positioning challenge seems daunting. “Some people,” Hulbert says, “just want to make the sale and move on. They’re willing to let the product go out the door with a seating-and-positioning job that’s not quite right. That’s not the way to do it. If you are not sure how to make a system work for a particular client, it is better to get the help and do the job right the first time than to have an unsatisfied client or caregiver come back later to have it remedied.”

Most rehabilitation technology specialists do a fantastic job providing assistive therapy services, Hulbert says. “The areas where I see equipment that is either inappropriate or fit incorrectly is when insurance contracts—especially capitated ones—exist that force the end user to go to a specific supplier regardless of experience or expertise.”

5. Partner with other players. Teaming up with clinical rehabilitation professionals to jointly tackle pediatric seating-and-positioning can be a shrewd move. Schultz’s company, Mobile Med Care, performs most of its pediatric seating-and-positioning in clinic settings at nearby Children’s Mercy Hospital and the University of Kansas Medical Center. This gives the company access to academic talent and tools useful for coming up with fast, creative solutions to seating-and-positioning problems. Moreover, it extends to Mobile Med Care a certain cachet in the eyes of referral sources and parents of clients who want to deal only with a company on the cutting edge of the profession.

“There is no question that we are better able to serve our clients by working alongside pediatric physiatrists and rehabilitation therapists,” Schultz says. “And there is no question that our relationship with Children’s Mercy Hospital and the University of Kansas Medical Center affords us some real advantages in the market.”

6. Find ways to manage tone. Tone is one of those physiologic conditions in an infirm child that can fluctuate from day to day—and that can adversely impact whatever seating-and-positioning system you devise. “Properly managed tone makes it easier to achieve correct seating and positioning,” Schultz says. “One technique I have observed for managing tone is to have the child outfitted with an orthotic on the ankle. This helps the child get good plantar/dorsiflexion, which allows all the other parts of the body’s tone to diminish. Medications may also be useful for bringing down tone when the child has too much of it. You need to find a balance for it because tone is used to perform certain functions, such as maintaining head position.”

7. Wait to order equipment until after funding is secured. To ensure a successful seating-and-positioning job, Schultz remeasures his clients after their funding source has given permission to buy the wheelchair. Since anywhere from 2 to 4 months can lapse between the initial evaluation and the receipt of funding authorization, remeasuring is a good way to ensure that the child’s growth or physiologic change has not invalidated the original set of measurements.

“I learned that the hard way,” Schultz says. “I had one client, a little girl who weighed 17 pounds when I weighed her at the time of the initial evaluation and measurement-taking. Two months later, when I showed up at her home with the equipment, she weighed over 30 pounds. I was not aware that, after the initial evaluation, she had received a gastrointestinal feeding tube, which, obviously, worked very well for her. Consequently, she was too big for the seating-and-positioning system I had developed for her.”

Creating the most perfect seating-and-positioning system possible for a child does take extra effort, but it saves losing money on nonreimbursable sittings to correct mistakes, and wins the esteem of clients and referral sources alike.

Rich Smith is a contributing writer for Dealer/Provider.