The Right Fit

Within the rehab industry, the importance of appropriate and effective seating and positioning is well known. Through the use of new technologies and materials, efforts to reduce the occurrence of pressure ulcers and enhance function for those with disabilities have been effective. But the challenge of ensuring that users obtain the most appropriate products continues to be a struggle.

"The biggest challenge facing suppliers in this market is being able to provide clinically appropriate products and remain financially viable in the current reimbursement environment," says provider Gary Gilberti, CEO of Chesapeake Rehab Equipment.

Gilberti, who is also president of the National Coalition for Assistive and Rehab Technology, says the HCPCS code sets and fee schedules do not effectively recognize the variety of products or technologies that can be employed in providing seating and positioning.

"This situation severely restricts suppliers and clinicians and forces them to use items that might not necessarily provide the best functional benefit or outcome for the patient," he says.

Tom Borcherding, president of The Roho Group, adds that the current funding environment and proposals working through federal and state government programs that will "further reduce funding to catastrophic levels" are also a strong threat to the industry.

"The monster of such programs is the poorly constructed competitive bidding program, which, if implemented, will result in widespread funding cuts and restrictions to access to all but the most low-cost equipment," he says.

Borcherding's concerns about the impact competitive bidding will have on those who rely on such products range from access to detrimental health outcomes.

"CMS seems to accept that users who rely upon seating and positioning and advanced mobility solutions will be able to maintain independence under a health care benefit that essentially accepts the lowest common denominator when it comes to equipment selection," he explains. "Should this ill-fated bidding program become reality, CMS is in for a rude awakening when the true impact of its actions — diminished access to necessary equipment, increased hospitalization and treatment costs, and loss of productivity — becomes established."

Restrictive reimbursement fees will likewise require providers to change their operational practices.

"Suppliers no longer can absorb the cost of a variety of seating into the cost of the mobility base because the margins have gotten so tight across the board," says Gilberti. "Every line item has to be accounted for on the system now."