Over the last 5 years, choices of pediatric standers have increased, as has the quality of the models. Gone are the cold metal contraptions that were likely to frighten children. Today’s standers are much more kid-friendly, incorporating bright colors and advanced materials.

Getting patients into these improved standers, however, is another matter. Standers are typically priced in the thousand-dollar range, a big-ticket item particularly if parents have to pay for the device in its entirety. Many state-funded Medicaid agencies are still willing to pay for standers, but even that expectation is evolving as state budget managers look for ways to reel in expenses.

Ask Dan Weatherly, CRTS, ATS, owner of Weatherly Medical Consultants Inc, Savannah, Ga, about the current reimbursement climate for pediatric standers, and you are likely to get an answer as tricky as the nation’s health care system. Says Weatherly, “It seems that we are all involved in this nonstop tug-of-war with reimbursement involving some types of DME, including pediatric standers. I think we all share in the responsibility for this,” he continues. “The cost of manufacturing products is going up, the cost of maintaining day-to-day business operations is going up for the vendor, and the costs of providing payment for health care services are certainly going up.”

The good news is things are not quite that tough in all 50 states. In Ohio, for example, while admitting that the reimbursement climate has devolved over the last 3 years, Vicki Heidler, PTA, ATS, says, “We occasionally get denials, but for children, standers are getting funded.”

So what is the key difference between now and a few years ago? Paperwork. If your state Medicaid can afford it, you can get reimbursed. However, reimbursement comes only after a bevy of requisite forms and letters of medical necessity are completed.

And yet while the current reimbursement remains workable, things may get worse before they improve.

Consider Heidler’s case. A sales representative and evaluator for Miller’s Rental & Sales in Cleveland, Heidler knows things are tough when parents are forced to choose between wheelchairs or standers. “In Ohio, you can’t get a wheelchair and a stander. In the next 6 months it might get even more difficult.” In the Buckeye State, Medicaid is finding it difficult to maintain its budget while Medicare won’t even cover standers.

“I don’t want to spend any more money on Medicaid,” said Sen Lynn Wachtmann (as quoted in a May 14, 2004, Ohio Plain Dealer article), a northwest Ohio Republican who is spearheading the Senate’s efforts to curtail spending on Medicaid. In fact, in Ohio Medicaid is the fastest-growing part of the state budget. Adds Wachtmann, “I just want to spend what we have but spend it better.”

Despite these financial concessions, the value of pediatric standers has never been in less doubt. The importance of face-to-face communication, even in the era of instant messaging and cell phones, is not lost on the adolescents who struggle with disabilities that prevent the use of their lower extremities.

Weatherly sees it this way, “It is important to talk about obvious benefits. Our bodies are designed to function in a standing position. Circulatory, digestive, and respiratory functions, just to name a few, all seem to work better when we stand.” The trouble is that what is deemed necessary by parents and teachers is not always deemed “medically necessary” by agencies that control the state government’s purse strings.

One study at Georgia Tech University, Atlanta, confirmed, “Proper weight-bearing on long bones helps prevent osteoporosis, while improving circulation, muscle tone, and functioning of internal organs.”

“While I certainly understand the phrase ‘medically necessary,’ ” continues Weatherly, “sometimes for a parent to see her child standing at the chalkboard, or standing toe to toe with a classmate, is just plain ‘necessary.’ I have always found this a benefit that is easily understandable to a parent.” As a result, the challenges for providers become assisting parents through the maze of paperwork required to get reimbursed—if such an option even exists.

The Right Option?
Early in the diagnostic process—before the paper trail begins—health care providers must consult parents to help determine if a stander is the best option for the child. For Weatherly, this is a key step. “We always conduct patient evaluations with a team approach,” he explains. “We attempt to have the physical therapist, occupational therapist, parents, and any other caretaker or medical professional involved with the child’s care present. In doing so, the parents can receive input about the clinical benefits for their child from every angle. And since the evaluation is always open to parents’ questions and concerns, any anxiety is immediately alleviated.”

The next phase, after getting the state to help finance the purchase of a pediatric stander, is proper fitting. If state agencies are tough to please, consider the children who must deal with standers. Fortunately, many pediatric standers can be customized at a relatively low cost.

Miller’s Rental & Sales, explains Heidler, does not typically customize standers; however, “we have added chest harnesses, headrests, or seating surfaces. Standers have a lot of growth adjustment potential so you can make it work.”

Weatherly agrees. “Most manufacturers have certain guidelines that you must follow such as height and weight [limitations]. As long as you stay within these criteria, the additional accessories and ease of adjustments can usually be done by the caretaker after receiving an in-service provided by the vendor.”

The benefits of pediatric standers are well documented, particularly when considering how they impact a child’s social life, self-esteem, and biological/anatomical needs. And yet, caregivers are still encountering challenges with regard to getting parents reimbursements.

Bright Future?
So what does the future hold? Certainly, a more daunting financial environment for getting standers reimbursed looms. Beyond that, it is ever more essential for ATSs to explain to parents and policymakers the health benefits of upright posture and face-to-face socialization. Considering the financial challenges being faced by most states, decision-makers will need all the advice they can get.

G.F. Sheffer is a contributing writer for Dealer/Provider.