New changes are on the horizon for providers of seating and positioning products. On the upside, technology innovations mean manufacturers are offering an array of product options. At the same time, Medicare recently assigned new codes, but new fee schedules have not yet been issued. Predictably, this has made it difficult for providers to do business efficiently. Even so, providers such as Jeff Lock, owner and president of LTC Providers Inc, and Christine Dace, office manager at LTC, feel that Medicare is on the right track and the future looks bright for seating and positioning. After more than a decade in business, the Sullivan, Mo-based providers have seen their share of change. Why the optimism now?

Dealer/Provider: New codes for seating and positioning/wheelchair cushions came out recently, but various related fee schedules have not yet been issued. How are you dealing with this confusion?

Jeff Lock

Lock: Medicare is differentiating between general-use cushions, skin protection cushions, and positioning cushions. Essentially, they are trying to define the codes to make it clearer for manufacturers, providers, and end users. All of this is good, but the problem has to do with timing.

Medicare came out with new codes on July 1, 2004, but manufacturers do not yet know which products meet which criteria. Therefore, no one knows the new allowables yet. As providers, we are operating under the old codes until September 30, and we are expected to convert to the new ones by October 1. But we are running out of time.

First, there is an administrative challenge. We need the new information to update our HIPAA-compliant billing system for correct and accurate billing. Equally important, there is a huge education component attached to a change in the codes. Our salespeople, customer service, service techs, and billing people need to know which products will be available to Medicare patients. We can’t begin to retrain our people until the allowables are made public. My guess is that the grace period will be extended, and we will be given more time to make an effective transition.

Dace: The confusion has forced us to delay certain business activities and decisions. For example, we have put a hold on all training until the new codes are announced. We have put a hold on purchasing decisions because we can’t decide on what we will stock until we know what the new fee schedules will be. There may be certain seating and cushion products that we carry now that we won’t be able to afford to carry in the future.

Dealer/Provider: How does this situation affect what you can offer clients?

Lock: Right now we are still grandfathered by the old codes. So presently it does not affect what we can offer clients. As of October 1, we simply won’t know what products we will be able to carry and which ones we will have to eliminate. But historically, when Medicare comes out with new codes, manufacturers adapt. They develop new products that are feasible to provide and that is a positive. Still, it is unfortunate that the system has to work this way—that manufacturers have to adapt a product to fit a fee schedule. Ideally, they should be able to use the newest and best technology.

Dealer/Provider: How do you hope this situation gets resolved?

Lock: The manufacturers are working closely with Medicare to get their products in the pipeline to get coded. At the same time, I think Medicare is on the right track by keeping inferior wheelchair cushions off the market. Essentially, the industry is working together to resolve the situation and get the new codes established and the allowables clarified. It is positive for the long-term picture, but I do not think the situation will be resolved by October 1.

Dace: Once the codes and the fee schedule have been “officially” provided, the hardest step will begin. Retraining will be required—not only for our staff but also for home agencies, physical therapists, occupational therapists, treating physicians, and any professional individual involved in the seating and positioning needs of a patient.

Dealer/Provider: How are you preparing for nationwide competitive bidding?

Lock: If nationwide competitive bidding goes into effect, it will most likely create a merger mania between HME companies. The independently owned and operated business would become nonexistent. In the future, it would be the patient who would suffer. More advanced products would not be as available since the main goal will be cost-efficiency, not patient care.

Dealer/Provider: How do you decide which wheelchair cushion to use (regular or positioning)?

Dace: Basically, Medicare gives you the guidelines. The diagnosis and the doctor’s prescription help determine the type of cushion that is allowable by Medicare. A general-use cushion is covered for a patient who has a wheelchair that meets Medicare coverage criteria. However, skin-protection seat cushions or positioning seat cushions depend on specific diagnoses.

Lock: Unfortunately, there was some abuse in the past by providers who wanted to issue only higher-end positioning cushions—because they wanted higher margins. Medicare is trying to eliminate the gray areas by saying the patient must have specific diagnoses to get a higher-end cushion. In the past, the criterion was pressure ulcers—and that is pretty broad. Now, to qualify for a positioning cushion, you have to document the positioning needs and tie it to a diagnosis.

Dealer/Provider: Do you consult with PTs regarding cushions, seating, and positioning?

Lock: Yes, quite often we work hand-in-hand with the therapist, client, and caregiver. We also employ an RN. We try to take all the opinions into account. PTs can be a big asset with positioning needs. Basically, they tell us what they are trying to achieve and we make recommendations. For example, a therapist may tell us that a patient needs head support or lateral support. Or it might be a functional issue like the patient needs to be positioned so he or she can propel the wheelchair more effectively.

Dealer/Provider: What would you say to providers who want to expand into the seating and positioning/cushion business?

Lock: The seating and positioning market is a tough business to manage, and it is hard to forecast needs when Medicare codes change and new technology and products keep changing. It is important to stay abreast of the industry and the innovations. That being said, there are good reasons to get into the business. The long-term outlook for rehabilitation is promising.

The situation with seating and positioning is a little bit like what happened with the bariatric niche. Medicare has established many more codes for bariatric products and now they are doing the same with our business. There are more coalitions and lobbying groups working toward establishing more codes for seating and positioning. In the end, this will be positive for providers.

Dealer/Provider: If you had 2 minutes of time with the administrator of CMS, what would you tell him?

Lock: I would say that I think he is on the right track, but I hope that he will keep an open mind for new products that can help the end user. It is good that inferior cushions will not be on the market, and tightening up on which cushion fits which code makes sense for the industry. Still, it is important to recognize product innovations that genuinely help the patient. I would also tell CMS that providers need more time to implement the new codes. I would suggest a longer grace period so that we can properly educate our sales, customer service, and billing people. But also, we need time to evaluate manufacturers’ products and to determine how clinically effective and cost-effective they are.

Dealer/Provider: What is the biggest misconception regarding the seating/positioning business?

Lock: I think Medicare may not see the difference between a general HME and a rehabilitation provider. Rehabilitation providers are offering a higher level of service and skills. We are experts on seating and positioning. Medicare needs to recognize that we have PTs, certified technicians, and RNs on staff. Our expertise should be valued and respected.

Dealer/Provider: What do you envision for the future of seating and positioning?

Lock: It is a growing market. Manufacturers are moving fast and developing so many great products. It is amazing what is available today vs 10 years ago. One area I am most hopeful about is back supports. Medicare is now establishing codes for back supports instead of the miscellaneous category and that is promising for providers. There is much more awareness today, too. Again, it is like the bariatric niche. In the past, bariatric patients had few accommodations, but now they have plenty to choose from. It is the same with positioning products. A greater awareness of the need has led to new technologies and many options in cushions, chairs, and more. The outlook for the future is bright.

Dealer/Provider: What gives you the most satisfaction in your job?

Lock: My role is primarily management, but I love getting positive feedback from patients, caregivers, or clinicians. For example, when we provide a customized cushion or wheelchair and someone takes the time to make a phone call or write a letter saying how much they appreciate our efforts, that is satisfying. Recently, we provided a chair to a working woman who gives speeches as part of her job. She needed a chair where she could stand up and make her presentations. We jumped through hoops to find the solution and get it funded. Well, she loved the product and really let us know how grateful she was.

Dealer/Provider: What is the most frustrating aspect of your job?

Lock: Not being paid for your services is quite frustrating. The service end of this business is very demanding. We have to go out regularly to adjust chairs and work on seating and positioning challenges. There is a good deal of time and expense in driving to a client’s home and providing the expertise. But we are not paid for the service end.

Dealer/Provider: Is the industry still feeling the effect of the wheeler-dealer scandal, or has that faded?

Lock: Yes, but my hope is that Medicare will recognize the need for patient mobility and won’t prevent access for power wheelchairs and scooters due to the actions of a few unscrupulous, so-called providers.

Marianne Matthews is a contributing writer for Dealer/Provider.