Is this product medically necessary? Does the client want it or need it? Does this product meet functional goals? Can we get paid for it? Can we make a profit providing it?

WHICH IS MOST IMPORTANT?

Rehabilitation technology suppliers face these questions every day, but 10 RTSs would offer at least 10 different responses. Ultimately, the questions boil down to ethical conduct, which is a personal and individualized set of behavior standards, and to professional responsibility, which is dictated by rehab's professional associations and credentialing body.

Ethics can seem like a double-edged sword. On one hand, we have a responsibility to our clients and referral sources to provide the appropriate products to meet clients' needs. Occasionally, this may entail providing a product that exceeds what the funding source pays. On the other hand, we have an ethical responsibility to our employers to follow company policies and to maximize the company's profitability.

How do we reconcile these apparently conflicting imperatives? First, we need to establish a paradigm in this area for our industry and profession. Managed care organizations use the acronym LEPET — which stands for “Least Expensive Professional and Ethical Treatment” — to describe the benchmark they use in determining coverage levels for their subscribers. I am convinced that adopting the LEPET principle in the rehab and mobility industry would help us with our ethical questions and professional responsibilities. However, I would modify the LEPET principle to MCEPET: Most Cost-Effective Professional and Ethical Treatment. As we all know, the least expensive solution seldom is the best solution.

How exactly does MCEPET help mobility providers? It becomes the filter through which we pass all our decisions about equipment provision. If a referral source requests a product that is not cost-effective, then it is our responsibility to try and change the therapist's mind — by suggesting and explaining more cost-effective alternatives. If clients or their families are requesting equipment that is beyond the realm of physiological and functional necessity, then it is our responsibility to suggest alternatives and to explore private-pay options with them.

Let's put the MCEPET principle into practice.

PRODUCT PREFERENCE

If your employer presses you to supply a particular manufacturer's product when the product does not pass the MCEPET test, what should you do?

First, you can cite the standards of practice and codes of ethics of our trade and professional associations. But you also should point out that the rehab market is getting more competitive, which means that providing less-than-appropriate equipment compromises your company's reputation. A competitive market also means there are more opportunities for qualified RTSs to move to other companies that may be more professional and ethical.

THE BLIND BID

If you are asked to blind bid on orders without seeing the client, what should you do?

This is a relatively simple problem. Everyone in the process loses when a product is supplied without a personal, onsite evaluation. The client receives equipment and service that are far less than optimal because the nuances and details of an evaluation cannot be completely communicated on paper. The payer also loses because the chance that a provider could offer inappropriate equipment increases dramatically. Finally, you and your company lose because of the increased potential for mistakes and “redos.” My advice is don't blind bid.

LEAST EXPENSIVE OR JUST CHEAP?

If a payer says it will pay only for the least expensive product or technology, what should you do?

This situation is more complicated than that of the blind bid. It requires resolve and a long-term perspective. I believe that a large part of the answer is to just say no!

It is not good business to decrease your profit margins to the point that you simply exchange cash with the payer and the manufacturer. It also is not good professional and ethical behavior to provide products at significantly reduced profits.

RTSs should be on a career track. We should be looking at the bigger picture — even as we wade through today's problems. Inappropriate profit levels inevitably put companies out of business — although not quite as quickly as do cash flow problems. If you want to be around to serve your clients in the long run, you must keep profitability on your service provision checklist.

Simon Margolis is president-elect of the Rehabilitation Engineering and Assistive Technology Society of North America. He also is vice president of clinical and professional development for Chattanooga-based National Seating and Mobility, where he manages the company's clinical initiatives and promotes NSM's leadership position in the rehabilitation community. Margolis is a founding director and past president of the National Registry of Rehabilitation Technology Suppliers. He is a certified orthotist and a RESNA-certified assistive technology supplier and practitioner.