Despite a tough reimbursement climate, standers are good business.

Not many providers think of standers as an obvious option for their patients or a good line of business, but those that have are finding the equipment fills a need and is profitable. This is in spite of the fact that the Medicare and Medicaid reimbursement climate is less than sunny. Alternative Care Providers Inc, North Chelmsford, Mass, started carrying standers about a year ago after seeing a demo at Medtrade, and after one of their equipment representatives also recommended the company carry them. Shortly after these twin experiences, the company had a patient who was an ideal fit for a stander. “The positive response from this patient left an impression,” says Michael Schleipfer, vice president of operations. Consequently, standers became a regular part of Alternative Care Providers’ diverse menu of DME—which ranges from beds and respiratory equipment, to wheelchairs and scooters, to lifts and slings. The company has a second location in Nashua, NH.

The company relies on demonstrations to patients or clinicians—many of whom know little about the clinical benefits of standers—and says that these demos have a bit of a “wow” factor. Schleipfer likens the psychological effect on a patient to the novice scuba diver who takes his first breath underwater. “It is that sort of paradigm shift,” he says.

Though caregivers may not have the same emotional reaction as the patient, Schleipfer says, they can appreciate the fact that the patient is standing up. It is the rare caregiver who will resist the use of a stander.

The patient and, by extension, the caregiver can be convinced of the usefulness of standers directly. In Schleipfer’s experience, the clinician is sometimes a tougher sell.

Clinical Sales Job
According to Schleipfer, clinicians’ awareness of standers is nonexistent, but “they are receptive to learning,” he says. To that end, the company holds formal education sessions in its Nashua showroom. Included in these sessions is a show-and-tell featuring the demonstration of a stander. Depending on the circumstances, Schleipfer will have an actual client demonstrate the equipment. The participants can ask the client questions about his use of the stander and gauge its clinical effectiveness. This gives the presentation a level of credibility.

These presentations build awareness and strengthen relationships with potential referral sources. For instance, Schleipfer notes that a clinician who has a multiple sclerosis patient may be more apt to consider a prescription for a stander, after witnessing a demo and discussing it with a client/user. This relationship building is the key to Alternative Care Providers’ success with its standers.

Schooling the Competition
Efrain Guerrero has built a successful stander niche by developing consistent relationships with school districts. The owner of Border Mobility Inc, MacAllen, Tex, has been providing standers to the local schools for several years.

And all it took was a few phone calls. “I start by calling up the special education department and contacting the PT or OT for the district directly,” Guerrero explains. “The [district] purchasing department makes the authorization [to buy a stander], but it will usually take the recommendation from the PT or OT.”

Guerrero’s approach has an evangelical feel to it. He takes the beneficial message of standers to every venue he can. Marketing for Guerrero, like Schleipfer, is a question of demos. “You need to invest in demo equipment,” the Texan advises. “About 90% of the time I bring a demo stander with me on calls.”

And these demos are a powerful tool, particularly in dealing with children—which is Guerrero’s special focus. Many times he will place potential pediatric clients in standers to see if they are right for them. The results are immediate. “When you have a kid in a stander, it opens a new world to him,” he says. In one instance, the child fell asleep in the stander during the demo, which he considered a ringing endorsement for the equipment.

Guerrero attends as many medical expos, parents’ organization meetings, therapy clinics, and in-services as he can. In addition, he visits local schools regularly. In every case he arrives with either a piece of demo equipment or one of his brochures, or both, at the ready.

A big part of his message is that more children probably could be using standers, trading on all the benefits of being up and mobile. “If a kid can bear weight or possibly bear weight, then they can probably use a stander,” he says.

But it is not ignorance that is necessarily at the bottom of this dearth of patients using standers. It is bureaucracy.

Stander Funding
Though there have been cutbacks in Medicaid funding, Guerrero says that he has not been unduly impacted by it. He continues to bill standers under the E1399 code. The change has come more from the level of detail in his billing explanations. For instance, if he includes casters and ratchet handles on a stander, Medicaid typically requires a justification for these accessories. The big frustration is that “you never know what information Medicaid will request,” Guerrero says.

It has become a fact of life that a bill submitted for a stander will undoubtedly net a denial at some point. To combat that problem, Guerrero has developed a group of “canned answers” for the most common requests. “You will get denials, but you have to give a reason and then address the denial [on appeal],” he says.

On average Medicare and Medicaid reimbursement is about 18% below retail (or $400 to $530 less depending on the model). Guerrero has been able to offset this through manufacturer discounts, including an additional 2% price break if he can turn his billing around within 10 days.

Schleipfer, a native of the Federal Republic of Germany, finds the American approach to medical funding both frustrating and antiquated. “Medicare is…looking at the cost savings on the front end,” he says. “None of the insurers will pay for grab bars [for instance], but they will pay for a hip operation [after someone falls]. Standers are one of those things that bring tremendous benefits for lower costs.” He notes that Medicare is not necessarily the only solution for funding. “There are funding sources out there that parlay a whole host of problems [into solutions],” he says.

C.A. Wolski is a contributing writer for Dealer/Provider.