As the owner of a rehabilitation technology company (RTC), one of the most annoying problems I encounter is when a client comes to me after purchasing an inappropriate mobility device from an inexperienced and unknowledgeable provider. If the equipment cannot be modified, the client is pretty much out of luck.

Invariably, the offending provider will not take the equipment back and refund the payor source. Instead, they simply say they provided the equipment as prescribed by the physician. The payor will not pay for a new mobility base, and, all too often, the client can’t afford to pay for the replacement equipment out of pocket.

HME vs Rehab
The fundamental difference between an HME company and an RTC is the process employed in providing equipment. DME/HME equipment tends to be generic in nature and required for persons with acute needs that can become chronic. The referral includes basic funding information, the patient’s diagnosis, and the required equipment. The equipment is usually procured from inventory in stock and delivered almost immediately.

A referral to an RTC initiates an appointment for an assistive technology evaluation. The purpose of this individualized evaluation is to determine the person’s functional abilities, limitations, goals, pertinent medical interventions, and any environmental, social, or other issues that would impact the appropriate assistive technology. Only after the evaluation is the actual technology determined and the process of seeking authorization and technology provision begun.

This process usually takes several weeks or months. An RTC provides equipment for persons with chronic needs or disabilities. Neither the HME nor the RTC is superior. The equipment and processes are merely different and fill different needs and purposes.

Right Person for the Job
Few would argue the need for a respiratory therapist when providing respiratory equipment or the need for an enterostomal therapy nurse when providing wound care or support surfaces. So why is it that so many do not understand the need for qualified personnel when providing powered mobility?

I remember reading an article in one of the trade journals that interviewed an officer from a large company that specialized in powered mobility. He said that fitting a senior for a power wheelchair “wasn’t that hard” and that they probably got it right “80% of the time.” Would you like to deal with a cardiologist that got it right “80% of the time?” Even though it won’t kill you, I’m sure you would not want to deal with an auto mechanic who only got it right “80% of the time.”

Mass Marketing
In much the same way that pharmaceutical firms have increased the demand for their products, a few power mobility companies have found that direct-to-consumer advertising is a great way to increase sales. It increases awareness and promotes the concept of maintaining functional independence within the consumer’s home. But unlike the traditional DME/HME or rehab referral from a health care provider, clients can also be misled in the absence of proper professional guidance.

Many of these companies screen clients to determine insurance coverage. But these screenings should not be confused with a detailed evaluation. When clients receive a screening for funding eligibility without the detailed evaluation, they are much more likely to be shortchanged.

And what happens to the client whose degenerative condition could have been reasonably anticipated to require seating components that could not be mounted to a standard captain’s seat? If the client received no evaluation and their chair will not accommodate a rehab-type seat frame, who is responsible when the client winds up with a 200-pound wheeled paperweight? If the most positive thing clients can say about their power mobility technology is that their insurance paid for it, is that enough?

Raising the Bar: Accreditation vs Credentialing
Accreditation involves evaluating a health care organization or company’s performance in areas that most affect patient health and safety. The organization or company is accredited, not the individual. Credentialing recognizes the competence of individuals for their ability to provide assistive technology services and equipment.

Currently, there are several organizations that accredit health care companies, but the emphasis has been more focused on traditional DME/ HME rather than rehabilitation. Many rehabilitation professionals feel that credentialing is a better means of identifying qualified rehab professionals.

The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) offers three credentials for providers of assistive technology: the assistive technology practitioner (ATP) for service providers who analyze a consumer’s needs and training in the use of a particular device. The assistive technology supplier (ATS) for service providers involved with the sale and service of rehabilitation equipment, assistive technology, and commercially available products or devices; the rehabilitation engineering technologist (RET) is for service providers who apply engineering principles to the design, modification, customization, and/or fabrication of assistive technology for persons with disabilities. The credentials are internationally recognized and are earned after successfully passing an exam. Exam criteria may be found at: www.resna.or (see credentialing program).

In 1992, the National Registry of Rehabilitation Technology Suppliers (NRRTS) was founded to provide a mechanism for consumers, clinicians, and third-party payors to identify qualified suppliers and ensure high-quality rehabilitation technology and related services for people with physical disabilities. This was the first organization anywhere to establish voluntary standards for individual rehabilitation technology suppliers. NRRTS is an organization of individuals who have met specific experiential criteria for registration. Rehab technology suppliers who have been NRRTS registrants for 2 years or more and have also successfully passed the RESNA ATS credentialing examination are deemed certified rehab technology suppliers (CRTS). Criteria for registration may be found at: www.nrrts.org under “registration.”

Both RESNA and NRRTS require their members to abide by a code of ethics and standards of practice. Both organizations require continuing education for professional development. At this time, it appears unlikely that the federal government will require credentialed individuals to be involved in the provision of powered mobility. A number of states already require that the provider employ a RESNA-credentialed employee and/or a NRRTS registrant to provide custom manual and any type of powered mobility to Medicaid beneficiaries. And even more are in the process of doing so.

Determining Needs
So how do you determine your client’s needs? Just like a physician, a physical or occupational therapist would not think of recommending a treatment plan without a thorough assessment—and neither should a mobility specialist. How do you become a mobility and seating specialist—also known as a rehab technology supplier (RTS)? That is a bit harder and requires a commitment on both the part of the RTC and the individual.

Most major manufacturers sponsor mobility seminars, and I strongly recommend you attend because the manufacturers tend to focus on their products and their application. Not all manufacturers produce all products for every need, and not every manufacturer produces the best product for every need.

A good RTS needs to select the products with the necessary features from an array of manufacturers to get the best outcome. It is much like a mechanic who needs a complete set of tools and must always select the most appropriate tool for the job. And you can’t get that knowledge by attending one seminar. You need to understand the products and their application along with the disabilities and their pathology (progression of disease). You need to understand how to measure and fit seating systems of all types. You owe it to your clients—and if you truly aspire to be a professional, you owe it to yourself.

Beyond Wheeler Dealer
In the last 18 months we’ve seen “Operation Wheeler Dealer,” policy clarifications, the retraction of policy clarifications, and most recently, the Federal District Court for the Eastern District of California ruled that the CMN is the Medicare document of record. CMS is reviewing its policies and disability rights organizations are vowing to fight for “functional ambulation” and fight against the “in the home” restriction.

If you think the days of “ask three questions, obtain a one-page form and drop ship the product halfway across the country” will return, think again. Those days have gone the way of seat lift chairs, TENS units, and lymphedema pumps. As they should.

Sydney Gubin, ATP/S, CRTS, is president of Home Health Supply Inc doing business as The Seating Center, Palm Springs, Calif. He has been a registrant of NRRTS since 1995 and has served two terms on its board of directors as well as 7 years on its ethics committee. He is a member of the RESNA professional standards board and the Medicare Region D DAC Rehab A Team. Gubin can be reached via email: sgubin@dc.rr.com.