With so many seminars and trade press articles on the business of HME, the needs of powerchair users can get lost in the shuffle.

In all the discussions about competitive bidding, new fee schedules, and falling reimbursement on the powerchair market, there is one group that has been left out of the picture—the consumers. “We are focusing so much on saving our business, we might be shooting ourselves in the foot or maybe we are shooting our patients in the foot,” says Larry Rice, president of In Home Products Inc, Dallas. “There are still real human beings that we have to serve.”

And, he says, trade magazines are not helping matters by relentlessly focusing on the abstract business side of the equation. Rice, however, does not blame only the trade media for losing sight of the customer. Instead, he zeroes in on both the manufacturers and the DME dealers.

For instance, trade show presentations by manufacturers tend to focus on one thing—the bottom line. “There are maybe two powerchair manufacturers committed to the customer and customer service,” Rice says. “The rest are just sales organizations that dump their product on the market; customer service is the DME dealer’s problem.”

And the problem is compounded by the fact that many of the companies are introducing admittedly high-quality products that may be impossible for patients to receive funding for. Rice points to Independence Technology’s Ibot powerchair. “The minute the Ibot was introduced, I received about 20 calls,” he says. Every call was met with Rice’s skepticism about whether private or government insurance would reimburse for the chair.

About five patients who called about the Ibot—and who could not receive funding for it—accused Rice of not caring about them or their needs. This accusation, and the fact that Rice and other DME dealers have to dash the hopes of their patients, stings the Texan deeply. “I really like my customers. I like what I do. I don’t want to add any more disappointment to their lives. I want to make their lives better,” he says.

And it is not just manufacturers that unrealistically raise patients’ expectations that cause his ire; Rice also levels a critical finger at those DME dealers who have abandoned customer service to make a fast buck. “Some companies’ customer service has devolved. They are selling the cheapest [quality] products at the highest price,” he says.

To add insult to injury, many of these dealers have discontinued even offering to repair the equipment they provide. “Let’s face it—for the most part, the only thing that makes companies different is their service,” he says.

On Your Mark
From the manufacturer’s perspective, some of this criticism may seem a bit harsh. Invacare, Elyria, Ohio, for instance, has just launched its Mark VI powerchair, which is aimed at vastly improving the life of the patient. As Mark Sullivan, vice president of Invacare’s Rehab Category, explains it, the Mark VI serves the needs of the clinician, rehabilitation technology supplier (RTS), and patient. The powerchair is easier to use than the company’s previous Mark V and is more aesthetically appealing.

The chair has a computer, and programs are contained on cards similar to those in digital cameras—with bigger graphic displays. It also features an automatic positioning feature. But the most important feature is one that cannot be seen—the chair is at the same price point as its older sibling.

Sullivan describes the Mark VI as part of the company’s largest launch of technology, but is quick to add that it was done with the consumer patient in mind. “You can never really stop focusing on the consumer,” he says.

With that in mind, Sullivan says that for dealers and clinicians to maximize reimbursement, they must find cheaper ways to deliver and set up the chair while still serving the patient.

Sullivan says that the company’s biggest concern is the Medicare fee schedule, which seems to sink lower every year. There are some improvements in this area, but they may, in the end, be illusory.

Power 64
CMS has introduced a new batch of 64 power mobility codes that have replaced the more general, temporary K codes. Sullivan welcomes them as a way to help differentiate powerchair technology, but sees the codes, in the short term,  causing some problems. Sullivan has one overriding concern, however, in regard to the new codes. “The tough part is that the new schedule won’t raise reimbursement rates,” he says.

Rice sees the codes helping to define the needs of the patients, and get them the chairs that best fit their situation. Sullivan says that one set of codes that do need to be changed are those that classify powerchairs as only for indoor use. “It’s draconian, archaic, and needs to be abandoned,” he says. “And it’s really contrary to the Americans with Disabilities Act.”

No matter if the codes improve things or not, there is one problem that both men agree on and that is the effect competitive bidding will have on the industry.

“Competitive” Bidding
Perhaps the only difference that Sullivan and Rice have in their reaction to the subject of competitive bidding is the set of adjectives they use to describe it. Sullivan calls it “Oxygen times 10” while Rice says, “It’s a gigantic train wreck.”

Sullivan sees competitive bidding as impacting high-end rehab chairs—such as Invacare’s Mark VI—by trying to simplify a service that is highly complex and built on long-term personal relationships. Rice sums up his position in a few words. “What is the price of mobility?” he asks, stating that it is virtually impossible to bid a custom powerchair to the lowest bidder.

Even with his skepticism plainly visible, Rice says that he will take part in the competitive bidding program even while noting that “it is a formula for disaster for dealers, patients, and the CMS.”

(Ac)Creditability
There is one government program, however, that meets with Rice’s approval—accreditation. Rice says that he likes the idea of accreditation, but cautions that “I don’t think accreditation will make you honest and ethical. With most [providers], what you see is what you get.”

Though he views the program as another way for CMS to extend its bureaucratic hold on the industry, what Rice especially likes about the requirement for accreditation is that it is a way for providers, like himself and his brother who runs the nearby Wheelchair Shop, to demonstrate their honesty.

Sullivan, for his part, agrees with this perspective, seeing the requirement as a means to increase credibility. However, Rice is concerned that the accreditation process is set up in such a way that an ethical and honest provider could not receive the CMS stamp of approval, while someone who is less ethical, but more adept at navigating the bureaucracy, could.

Innovative Perspective
While reimbursement and the issues attendant to it still form the backbone of the DME provider’s life, technological innovation continues to help drive the industry. For Sullivan, the most innovative product that the company has delivered is the Invacare TDX center wheel drive powerchair. “It has nice indoor mobility and is highly maneuverable,” he says, noting that this powerchair technology, introduced in 2003, has informed and led the market. Several companies have followed with similar systems.

Rice, as usual, sticks to the basics. For him, the biggest innovation over the last 5 years has been the abundance of mounting brackets that are available. The brackets allow additional equipment to be mounted on the chair, allowing for improved performance. He also notes that seat elevators, standing frames, improved cushions, and better electronics have led to greater quality of life for patients.

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