Something has to change. That's the word from manufacturers of seating and positioning products, who say declining reimbursement could decide the future of the market.

"The outlook for this market is as good as available funding will allow it to be," says Tom Borcherding, vice president of sales at Crown Therapeutics, adding that if reimbursement continues to decline, it ultimately will lead to an accessibility problem for patients. "We're pretty close to that linein the sand right now," he says, "and we're going to see some negative impact to consumers if the price erosion continues. That's a scary thought for those of us who are trying to look forward as to how this market will move over the next three to five years."

Payer Policies Manufacturers question the policies that various payer sources, including Medicare, have implemented. For example, current Medicare policy states that patients qualify for a therapeutic or positioning cushion if they are at risk for developing pressure sores. But Medicare does not provide clear definitions for "at risk" or for a "therapeutic or positioning cushion," manufacturers say.

Moreover, the application and pricing of those products can be problematic because of the vast array of seating and positioning products that are available. With no definitions for how patients qualify clinically and which equipment they may use, some patients could run the risk of being prescribed a lower-cost, lower-quality product that may not be as effective in treating them, manufacturers say.

The policy also fails to keep up with emerging technologies that breed new and innovative devices, says Mark Dittmer, account representative at Danmar Products. "I see payer sources as being five to 10 years behind the times sometimes," he says. "New products come on the market all the time, and there's no procedure code to use them. For example, a headrest system comes out on the market that might cost $400 to $500, but there's no procedure code for that other than what's been used in the past, which is only $150. We then have to recode that under an NOC 'not otherwise classified' code and wait to see what'll be paid for it. We're left hanging out on a limb because we don't know."

Codes To Come Times may be changing, however. With the industry's assistance, the Statistical Analysis Durable Medical Equipment Regional Carriers are revising the coding for seating and positioning. Manufacturers hope that the new policy will address long-term seating and positioning needs -and that the SADMERCs will finalize it within the next two years.

"What the industry would like to see is a policy that gives much better definitions for what is a therapeutic seating product and what is a positioning seating product, and defines a lot more specifically the qualifying criteria for the need of certain levels of seating and positioning devices," says Borcherding. "By having better definitions and establishing more codes to represent the world of seating and positioning technology available, the consumers will get more appropriate equipment, and the suppliers will be able to get paid for providing the level of equipment that's necessary for the consumer."

While they eagerly await these new codes, manufacturers continue to grapple with the current policy's limitations, one of which has to do with custom-made products for patients with specialized needs. Insurance companies often balk at paying for such products because they are more costly, manufacturers say.

Mix and Match To help overcome this limitation, manufacturers are devising modular equipment with interchangeable parts. Such products serve a wider range of patient needs and reduce setup time and inventory for providers.

For example, says Lauren Boulware, director of product management for seating and positioning at Invacare Corp., products can now be angle-adjusted to meet the individual needs of those with posture problems. "Some providers have told me they have been able to use these products where, in some cases before, they may have gone to a more custom product," she says.

"The modular systems are becoming more customizable so that something that's off the shelf can be fit to a wider range of needs than perhaps could have been done in the past," says Boulware. "It's a technological advance that we're looking at, where companies are developing products that are more advanced." HC

Manufacturers have made a number of advances in seating and positioning products in recent years. Case in point are the more dynamic seat cushions and back support systems that adjust as the patient moves. Some manufacturers even go so far as to "break in" their products before putting them on the market so they adjust more quickly to the patient.

Driven by reimbursement concerns, companies are also focusing on extending the lives of their products. "Manufacturers realize that the product has to exceed the life expectancy [of] 10 years ago-that when someone buys their seating system, it has to last more than three years," says Frederick Nelson, U.S. sales manager at Action Products.

"Because there's a very good chance they may not get reimbursement the next time around," he says, "it is in the best interest of the manufacturer to produce something that's going to last far beyond that three-year cycle into the five- to 10-year cycle instead." -R.P.

Part of the frustration of getting reimbursement for their products, say seating and positioning manufacturers, stems from a general lack of knowledge among payer sources. Adding a physical or occupational therapist-or at least someone with knowledge of seating and positioning-would help payers to make more informed and better decisions, they suggest.

"Some insurance companies, if they knew a little bit more about the wheelchairs and the seating, would be better able to say yea or nay-that this system is right or this system's wrong," says Mark Dittmer, account representative for Danmar Products.

He cites wheelchair trays as an example, noting that for some clients, they go beyond a simple convenience. "It gives them upper shoulder and arm support when they're on it, versus slinking down in their chair," he says. "But a lot of the trays aren't approved because payer sources think they're a luxury item."

Someone with a background in seating and positioning would be able to advise otherwise, he says, adding, "Now obviously we don't need a tray for every person, but for some of the clients, it's definitely warranted." -R.P.

Tom Borcherding, vice president of sales, Crown Therapeutics, Belleville, III.; Lauren Boulware, director of product management for seating and positioning, Invacare Corp., Elyria, Ohio; Joe Cericola, vice president of sales and marketing, BIO.FX, Glendora, Calif.; Robert Clarke, product manager for wheeled mobility and seating and positioning products, Otto Bock, Minneapolis; Mark Dittmer, account representative, Danmar Products, Ann Arbor, Mich.; Dalena Ganakes, director of national sales, Convaid Products, Palos Verdes, Calif.; Mary Jane Jacobs, national accounts manager, Huntleigh Healthcare, Manalapan, N.J.; Frederick Nelson, U.S. sales manager, Action Products, Hagerstown, Md.; and Arnold Silverman, president, Skil-Care Corp., Yonkers, N.Y.