Many are the HME dealers that have attempted to break into the niche of pediatric dependent mobility devices, only to make one costly error upon another.

“These dealerships, they are hard-charging and get into the arena thinking they will do well, but after 6 to 9 months of mistakes, of not getting paid fully for product, they are gone—they will have written off so much business that they can’t afford to be in the field any longer,” says Lee Bowman, an accredited technology supplier (ATS), a certified rehabilitation technology supplier (CRTS), and rehabilitation director for Superior Mobility in Torrance, Calif.

Pediatric dependent mobility devices primarily mean manual and power wheelchairs, but also strollers and even standers. “The child who uses equipment of this type is unable to operate it by himself or herself,” says William Crosslin, director of sales for rehabilitation products at Pointe Medical Equipment in Grosse Pointe Woods, Mich. “This inability is usually due to the child’s medical condition or physical size. Sometimes it is due to the specifications of the equipment itself.”

Bowman says one reason so many newcomers to the field stumble is that referral sources prefer to work only with product providers who are highly knowledgeable about pediatrics in general and about dependent mobility devices for children in particular.

“The referral sources—doctors and therapists and the facilities they work for—have in many cases developed long-term relationships with the established players, and are very comfortable working with them,” he notes. “To have a chance at winning them over, a company just getting started in this arena has to really be on top of things.”

That is a difficult task, says Toby Bergantino, ATS, CRTS, rehabilitation technology consultant with Connecticut Rehab and Medical Products in Newington, Conn. “Among other things, [pediatrics] is time-consuming since you are usually seeing a very wide array of disabilities,” he says. “It is not straightforward, like when you are dealing with geriatric patients. With the elderly, you see the same handful of [disorders] all the time. But with pediatrics, you see a lot of different diseases and each one comes with what seems like a different prognosis for each patient.”

Still, HME companies can and do successfully enter this niche. Here are eight suggestions from the experts on how to thrive:

1. Forget about showroom displays. Pediatric dependent mobility equipment is a demand-type product. In other words, if the consumer doesn’t need it, he or she is never going to think about it, let alone know what it is, Bowman says.

Superior Mobility, Bowman’s company, has a showroom, but it does not display pediatric mobility products in it. “We tried that once before, and limited it to displaying only the most generic wares, like strollers,” Bowman says. “We found that no one paid attention to them. People just don’t come into your showroom and exclaim, ‘Oh! There’s an $800 stroller! I need that today; it was just what I was looking for!’ These are not impulse items. When people come to the dealer to discuss a pediatric dependent mobility device, it’s because they’ve been referred by the doctor or therapist.”

Instead keep just a few pieces of demonstration equipment in a fitting room or available for trips to fittings in the field—namely, at the facilities where children undergo treatment and therapy, or at the children’s homes.

2. Avoid stocking an inventory of these products. “The products change too rapidly as a result of constant innovation,” Bergantino says. “If we were to buy a full set of inventory this year, by next year it would be obsolete and we would be stuck with product that we would have little or no hope of moving, ever.”

In addition, because of the wide range of disabilities seen in pediatrics, most products must be customized. “It’s impossible to properly fill the needs of patients with off-the-shelf equipment,” Bowman says. “Besides, it would be cost-prohibitive for us to carry in stock everything that we potentially would want to offer.”

At the same time, though, the range of conditions and prognoses is so broad that a dealer must have ready access to a gamut of equipment and equipment options. The way to resolve this conundrum is to convince equipment manufacturers to lend demonstrator equipment on your behalf to the facilities from whence referrals come, experts counsel.

“That’s a win-win arrangement for everyone,” Bergantino says. “It benefits the manufacturers because they gain high-traffic locations to showcase their products with you as their active, on-site sales force. It benefits you because you don’t have to maintain an inventory or lug product from place to place. It benefits the facilities because it gives them direct access to great equipment that they don’t have to pay for. And it benefits the parents because their children are able to test the various makes and models, which gives the parents a good idea of what they’d like to own.”

Giving caregivers and patients the opportunity to try equipment out can be invaluable in making sales. “At bottom, this is a touch-and-feel type of business,” Bergantino says. “If the product is there where it can be seen, used, and shown to work, it will be recommended by the therapists and desired by the parents.”

3. Use a formal set of questions when evaluating the child. This is crucial in order to determine the most appropriate equipment to meet the patient’s needs, Bergantino says.

Design the questions to give you an understanding of the child’s home, school, and play environments; how the equipment will be transported; what are the specifics of the disability; and what the parent hopes to accomplish by giving the child a particular piece of equipment.

4. Remember that children grow. The equipment chosen for each patient must accommodate the child’s expanding frame and/or increasing weight.

“If you don’t allow for growth and there are any major neuromuscular or orthopedic changes in the child, the entire system you have ordered may be wrong or too small,” Crosslin says. “You can evaluate a child today, determine his or her needs, and, by the time you get funding approval for the system, he or she can present differently. In addition, that child can change again between the time you get approval and the time the equipment comes in.”

5. Provide the most durable equipment possible. Because the equipment will be in the hands of children, it is more likely to take a pounding and need more repairs than a similar piece of equipment used by an elderly adult. Frequent servicing will drive up your costs and eat into your already razor-thin margin, experts caution.

“Maintain open communication with your service department, so that if products are failing, you will know about them and will be able to avoid them in the future,” Bergantino says.

6. Adopt a team approach. According to Crosslin, the biggest advantage a dealer can have comes from assembling a team of professionals with experience in pediatric dependent mobility equipment. “If all these people communicate well and in a timely fashion, success will usually follow,” he says. “The team evaluates a child and discusses their findings, then offers their thoughts on what would be the best piece of equipment for this particular patient’s need. What’s good about this is that each person draws on his or her expertise and knowledge of the equipment market. A consensus emerges, and that will lead you to the best product.”

Experts recommend assembling a team composed of doctors, therapists, and representatives from the HME dealership. At least one of those dealer representatives should be a CRTS or an ATS.

“ATSs and CRTSs know what works and what doesn’t in the way of equipment,” Bowman says. “And, if they’ve been in the pediatric arena for at least a few years, they will know the funding sources and how to get things paid for.”

7. Know the facts about reimbursement. There are some urban legends floating around with regard to reimbursement for pediatric dependent mobility equipment. One of them is that equipment can be purchased only once every 3 years.

“That’s sort of an unwritten rule, the 3-year period, but, basically, it’s a fallacy,” Bergantino says. “If, say, 6 months after the child receives his equipment he outgrows it, you can always put in a claim for new equipment on the grounds that the child has experienced a medical change. Payors rarely deny reimbursement for new equipment needed as a result of a medical change. But because there’s no clear definition of what constitutes medical change, you must document the child’s growth, weight gain, or weight loss and be able to demonstrate how that has impaired the child’s ability to use the equipment.”

8. Communicate with payors. Despite impressions and experiences to the contrary, payors can be reasoned with, Crosslin says. “You might submit a claim to Medicaid, for example, which will be accepted but reduced to an amount that is less than what you paid for the equipment,” he says. “If that happens, write back to Medicaid and include a copy of the invoice showing your cost for the product. In your cover letter, emphasize that you cannot possibly provide the product for the amount offered, and ask for a reconsideration. Many times they will reconsider, especially if you include a letter from the doctor and therapist attesting that there is no other piece of equipment that will meet the patient’s need.”

Rich Smith is a contributing writer for Dealer/Provider.