Almost every provider of pediatric mobility and rehab equipment says pediatrics is the most rewarding segment of the home medical equipment industry. Daily, these providers witness small and large miracles as children inch closer to personal independence. But, providers are quick to add that pediatric mobility and rehab also is one of the most taxing segments of HME, because the financial and quality-of-life costs of improperly fitting a child are enormous.

GETTING EVERYONE INVOLVED

Typically, the first challenge for providers in the pediatric mobility market is fostering efficient and effective communication between rehabilitation technology specialists, parents, physical or occupational therapists, prescribing physicians and payer sources. Often, school- and clinic-based therapists have input as well.

“You end up with multiple referral sources — each one knowing the child in a completely different situation and not necessarily seeing all the other aspects of the child's life,” says Simon Margolis, CO, ATP, ATS, and vice president of clinical and professional development for National Seating & Mobility in Franklin, Tenn.

The goal of the RTS is to educate each party involved on the needs of the child in the different settings, so the best outcomes are possible. “[The RTS's job involves] helping people establish their priorities and making people understand the reality of the compromises needed to come up with a mobility system that meets the physiological and functional needs of the child,” Margolis says.

However, equally essential is the involvement of each of the other team members, says Mel Elliott, CRTS, and owner of Carolina Mobility & Seating, a pediatric mobility and seating provider in Apex, N.C. “Choices have to be made, because there are competing goals,” he says. “It's best to determine what the trade-offs are going to be on the front end, so the satisfaction on the back end has a much better chance of being acceptable to all the users.”

One way to achieve success in this process is to make sure all parties are aware of their choices. It is essential that payer representatives, such as case managers, understand the products, says James Hartman, president and chief executive officer of Gulf Coast Rehab. The Mobile, Ala.-based company provides adult and pediatric rehabilitation equipment to clients in Mississippi, Louisiana, Alabama and Florida.

Hartman says it is up to providers to educate payer sources about the products and about the benefits of using certified providers. “Whether [the payer representative] is a nurse, a therapist or a physician, [he or she] doesn't get any type of formal education on the equipment,” he says. “The best thing payer sources can do to ensure they are getting good information is to use certified providers.”

MAKING THE BEST CHOICE

Fortunately, providers say, manufacturers of pediatric mobility and rehab products are doing a great job meeting children's needs.

The options are out there, says Corey Vander Wulp, OT, a pediatric rehab seating specialist with Bay Home Medical & Rehab in Traverse City, Mich., which specializes in customized rehabilitation equipment. Vander Wulp says existing products can meet children's physical needs if providers consider the different functional aspects of the products.

Margolis agrees and points out that sometimes a combination of products can provide the appropriate solutions for the needs of a developing child. “When you are looking at the developmental stages of a small child, it's still difficult [to find a product that will grow with the child],” he says. “But, if you put together products from three or four manufacturers, then you end up with [a system] that is going to be appropriate.”

The challenge for providers is understanding the latest equipment technology and how the applications can be beneficial for their pediatric clients. “We have so many more choices today than we have ever had in the past, and we are finding that the manufacturers are very receptive to our needs,” Elliott says. The burden now is on providers to learn how to use those choices and configure a chair that is in the child's best interest, he says.

CROSSING YOUR T'S

A proper fitting goes a long way in promoting clients' and referral sources' satisfaction, and maintaining profitability. “It's not any more expensive or any less profitable to take a direct approach [to fitting a client],” Margolis says. “Making solid clinical decisions and being willing to use an intuitive approach is how to do pediatric seating and mobility correctly for the customer.”

Providers have to make their own choices to determine the best way to remain in business, Elliott agrees. “It is imperative that we are in business tomorrow to serve the next potential client,” he says. “We need to have the cleanest, best evaluations,” with no mistakes. “Mistakes are very expensive when you have to [rectify] them on your own.”

Mistakes also are detrimental to the children. “It's not simply a matter of providing a product — it's obviously much more involved than that,” Margolis says. “A good wheelchair and seating system may not enhance a person's life, but a bad one certainly will detract from its [quality].”

CREATING SATISFACTION

Many providers are in the pediatric mobility and rehab business because of the tangible benefits of contributing to another person's independence. “We got into this industry because we wanted to make a difference,” Hartman says. “There is no better satisfaction than to put a child into a motorized wheelchair and see the excitement that comes with [that] independence.”

And, Margolis has clear-cut advice on how to make sure you are able to make that difference in the long run. “The key to success is getting the needs of the individual down pat, having set goals, and measuring whether or not you achieved those goals,” he says.

IT'S ALL IN WHO YOU KNOW

WHEN REHABILITATION technology specialists work with referral sources to determine the types of equipment that best meet the needs of their clients, it's best for them to know with whom they're dealing.

It's not unusual for these referral sources to differ in opinion from each other and clients' families. And successful providers of pediatric mobility equipment say direct communication between parties can make the most positive impact in these deliberations.

But, how is the best way to communicate with referral sources? Often, the first step is understanding their goals and backgrounds. Many national professional and trade organizations provide Web sites where rehab providers can go to find out the latest clinical recommendations, practice protocols and industry guidelines under which their referral sources are working.

Some helpful Web sites include:

Case Managers

The Case Management Society of America is an international, not-for-profit membership society of case managers, nurses and allied health care professionals. Its members represent all practice settings, including managed care, acute care and private practice.
www.cmsa.org

Occupational Therapists

The American Occupational Therapy Association is the nationally recognized professional association for more than 50,000 occupational therapists and occupational therapy assistants. These individuals work with people experiencing health problems such as stroke, spinal cord injuries, cancer, congenital conditions, developmental problems and mental illness, in a wide range of practice settings including hospitals, nursing facilities, home health agencies, outpatient rehabilitation clinics, psychiatric facilities and schools.
www.aota.org

Pediatric Physicians

The American Academy of Pediatrics has approximately 55,000 members in the United States, Canada and Latin America. Members include pediatricians, pediatric medical subspecialists and pediatric surgical specialists. The AAP's section on Children with Disabilities was founded in 1990 and enables members who have a special interest in children with disabilities to meet for the purpose of developing ideas and generating programs and projects that will improve the care of infants, children and adolescents with disabilities.
www.aap.org

Physiatrists

The American Academy of Physical Medicine and Rehabilitation is the national medical society representing more than 6,400 physicians who are specialists in the field of physical medicine and rehabilitation.
www.aapmr.org

Physical Therapists

The American Physical Therapy Association is a national professional organization representing more than 64,000 members. Its goal is to foster advancements in physical therapy practice, research and education.
www.apta.org

Rehab Nurses

Rehabilitation nurses work with individuals and their families after a disabling injury or chronic illness strikes, and they continue to provide support after these individuals go home or return to work or school. A registered nurse with at least two years of practice in rehabilitation nursing can earn distinction as a certified rehabilitation registered nurse (CRRN) by successfully completing an examination that validates expertise.
www.rehabnurse.org
— D.H.M.