It is a well-known fact: Wheelchair seating-and-positioning systems usually turn out better when the mobility equipment provider has a strong, working relationship with referring physical therapists and occupational therapists.

The closer the connection, the more respect the therapists have for the provider’s contributions and the easier it is to get the job done correctly within the funding constraints imposed by payors.

Erik Strader, PE, ATP, owner of Integrated Rehabilitation Systems, Irving, Tex, believes the first step in developing relationships on that high level is to abandon the mentality of being a mere seller of seating-and-positioning products. Instead, you should think of yourself as “a source of extensive knowledge, an expert in measuring and fitting, and a provider of invaluable product-selection advice,” he says.

To encourage referring therapists to see Integrated Rehabilitation Systems in just such a light, Strader periodically hosts 1- and 2-hour seminars on generalized seating-and-positioning issues for up to a dozen therapists at a time.

“We try to do these seminars at the end of a Friday or over the weekend, and usually at the therapists’ office rather than at ours,” he says. “We also try to offer continuing education credits as an incentive for participation. We try to make these events as worthwhile as possible. Our feeling is that, if we can increase a referring therapist’s level of education and they are helped in their job by that, they are going to remember us.”

Once the relationship with therapists is cemented, it is essential to then maximize your communications concerning individual cases you are working on as a team.

“We stay in touch with the referring therapists via phone, fax, and email,” Strader says. “The goal is to keep them up to date whenever it comes to our attention that there has been a change in the client’s physical condition or funding status that in some way could or will impact upon the seating-and-positioning solutions we are attempting to produce.”

Paul D. Rice, CRTS, ATP, president of The Wheelchair Shop, Houston, carries a portable computer with him in his vehicle so he can pick up emails while driving around town. Immediately after participating in a client evaluation session, he types up his thoughts about client needs and then emails the document to all of the therapists who are involved with the client. This, he says, helps keep everyone on the same page.

10 TIPS FOR BETTER RESULTS
However, having a strong relationship with therapists is only part of what is necessary in order to create the best possible seating-and-positioning system within the cost limits set by the funding source. Here are 10 suggestions to complete the picture:

1. Acquire a thorough understanding of the patient’s diagnosis. “There are so many causes of disability out there that, in order to properly plan for a piece of equipment to be useful for as long as possible, it is necessary to do research about the long-term effects of a given disability, especially one caused by a progressive disease in which the client’s physical condition will be expected to deteriorate over a period of months or years,” Rice says. “If you are aware of the trajectory of that deterioration, you will be in better shape to devise a seating-and-positioning system that will be useful to the client longer than might otherwise be the case.”

2. Understand how the client intends to use the wheelchair, transport it, and transfer in and out of it. These issues have bearing on the design of the seating-and-positioning system that will work best, experts remind. But the time to gain this understanding is before you begin developing the seating-and-positioning solution.

“You don’t want to discover any of this after you have started creating the system, because then you will have to go back and make modifications—a waste of time and money,” Rice says.

3. Know the equipment. The more familiar you are with a piece of equipment, the greater your ability to successfully utilize it—and to recognize when it is not the most appropriate item that could be used. “Experience with the products is always your best guide,” Rice says.

4. Resist the temptation to force acceptance of a particular seating -and- positioning solution or component. Forcing acceptance is a sure-fire formula for encouraging patients to be displeased with the final product, Rice says.

“When they are unhappy about the system, they will not use it,” he says. “And because they’re not using it, they’re not going to be as functional as hoped.”

5. Craft a mock-up of your proposed seating-and-positioning solution. According to Strader, a mock-up lets you determine if the solution you’ve got in mind will actually work for the client.

“Many times you think the solution in your head will be perfect, but then when you buy all the components and put them together, you find out there’s some detail you overlooked,” he says. “Yes, it takes extra time to do a mock-up, but in the end you’ll avoid some headaches and extra costs and customer frustration.”

6. Ascertain beforehand whether and to what extent insurance will pay for a seating-and-positioning system. Some insurance companies have no out-of-network benefits, so if a case is referred to you and you are not on the payor’s panel of approved providers, chances are you will not be paid your due, Rice warns.

“Don’t even put in an order for any components of the seating-and-positioning system until the financial aspects have been fully fleshed out and all parties are aware of them,” he says. “Then, once you know the financial realities, you need to review all of that with the client and the therapists. You’ll look like a bad guy if you have to go back later after the fact and tell them that the money will not be there to pay for something that was expected or that the client will have to make up the difference out of pocket.”

7. Avoid repeatedly choosing the most expensive equipment when dealing with the same funding source. Rice believes dealers and providers can become habituated to recommending just one piece of equipment. Typically, that one piece is highly adaptable to a gamut of client needs, which is why it becomes so often recommended. But woe to you if that item is also top-of-the-line and pricey.

“Insurance companies that didn’t used to pay much attention are now scrutinizing the individual components that go into your seating-and-positioning systems,” Rice says. “As a result, they’re noticing if you are consistently selling them the most expensive products. Keep that up after they’ve detected the pattern and eventually they’ll start second-guessing everything you want to do in designing systems. Or you may all of a sudden find the payor passing you over in favor of someone who is more reasonable on pricing.”

8. Don’t venture beyond payor constraints. It is a mistake to come up with a great seating-and-positioning solution that pays no heed to the payor-imposed funding limitations, Strader says. The provider who ignores the constraints may be motivated by ego (a belief that he or she knows what is best and the patient deserves the best no matter what the financial realities might be) or by an overwhelming desire to please the referral sources. Either way, you set yourself up to eat the costs that overrun the payor’s limit, he says.

9. Don’t bury the patient in a blizzard of legal forms and disclosure statements. Rice recommends you take the time to verbally explain to patients their responsibilities, because patients seldom read every word of every page they are handed, even though they might initial or sign at the bottom indicating they have indeed read it all.

10. Offer payment options in situations where the patient must self-fund. For example, you can accept credit cards or carry the amount owed (on approval of credit).

Also offer clients a list of potential alternative funding sources, such as charities, to which they can turn. While it might be a good customer-relations move on your part to approach charitable funding sources on behalf of the client, it is usually more productive to have the client seek that financial support on his or her own.

“The chances of success are perhaps tripled if [the client] makes the appeal because the client is the one who is the more sympathetic figure,” Strader says. “It is appropriate, though, for you to accompany the client to the meeting with the charity’s decision-makers and offer moral support and encouragement. At the very least, you should provide the client with as much useful documentation as possible to help convince the decision-makers to provide funding.”

Rich Smith is a contributing writer for Dealer/Provider.