The seating and positioning market is … pick one: growing, slowing, both, neither. Perhaps more than any other market in the durable medical equipment industry, the prognosis for the health of the seating and positioning market most closely mirrors that for the entire industry.
On one hand, growth factors for DME and seating and positioning are in plain view. The population of potential end users is booming, manufacturers are introducing better and more cost-effective products and the federal government has authorized several long-awaited improvements, including new, more specific HCPCS codes for many seating and positioning products.
“The marketplace for all DME products is growing tremendously,” says Steve Schlegel, product manager for seating and positioning for Invacare. “Looking at the exceptionally large population of people getting older and coupling it with the fact that people are living longer, growth is inevitable. With that said, as people continue to need mobility bases, whether powered or manual, they will need the appropriate seating and positioning products.”
On the other hand, both the industry and the market have experienced a slowdown due to Medicare and Medicaid budget cuts, as well as intense scrutiny on everything DME-related resulting from a government crackdown on reimbursement fraud and abuse.
“The market is in a constant state of flux,” says Jennifer Saville, brand associate for Varilite, a division of Cascade Designs. “Factors contributing to growth include the introduction of new products and subsequent reimbursement codes, as well as the ever-growing size of industry trade shows, while factors contributing to the slowing of the market include reimbursement abuse and misuse, and growing restrictions associated with third-party-payer sources.”
“The recent [Centers for Medicare and Medicaid Services] scrutiny on the provision of power wheelchairs does have a trickle-down effect on all wheelchair-related categories, so this has been a factor that has somewhat limited the market growth rates for seating products,” says Tom Borcherding, senior vice president, global medical sales for The Roho Group.
“There was a very tiny group that, through fraudulent practices, created Operation Wheeler Dealer,” says Foster Davis, national sales manager for Freedom Designs, a manufacturer recently acquired by Invacare. “On a federal level, [officials] lump the whole rehab industry into that fraudulent group, where seating and positioning is so much more in depth. [Power wheelchair fraud and abuse] gave the whole rehab industry a bad name.”
Reimbursement — A Mixed Bag
Reimbursement changes have been a mixed blessing for the seating and positioning market. In January, CMS adopted new codes for power positioning products, including power tilt and power recline. Where before all power positioning products had been coded “miscellaneous,” now each type of product has been reclassified and given a separate code and a set allowable.
“Funding is moving in the right direction from a power positioning standpoint,” says Jay Brislin, clinical and professional development manager for Pride Mobility Products. “We still have a couple of questions regarding allowables, but we and other manufacturers and providers are working with CMS and the DMERCs to get what's best for the client — who is the most important person in the equation.”
“Coded reimbursements can be helpful to speed up the process by providing set guidelines as to which ICD-9 codes are accepted for specific HCPCS codes, and so require less documentation and allow the use of automated systems,” says Saville of Varilite.
“The reimbursement climate is also helpful in this market to control the unfortunate reimbursement abuse and misuse that occurs in the industry,” Saville continues. “There are changes currently happening to reimbursement for power wheelchairs, and there are changes on the very near horizon for wheelchair seat and back cushions.”
“Very near” is right. Effective July 1, CMS will adopt a new set of 20 “K” codes for seat backs and seat cushions, breaking up the E0192 code — which had encompassed very low-end to very high-end cushions — into separate codes based on skin integrity features, positioning features, product dimensions and other defining criteria. The new code set will also include codes for mounting hardware.
“The new national policy will have a major impact on the business of seating and positioning,” says The Roho Group's Borcherding. “[We hope] the changes represented in the new policy will be good for manufacturers, providers and product users. I am cautiously optimistic that this much more thorough policy will reflect a positive direction for providing the appropriate seating and positioning equipment to users needing these important products.”
Despite the positive changes, reimbursement for seating and positioning products still has some downsides. First, there are the “cons” to balance the new-code “pros.”
“Reimbursement is undergoing some of the most significant changes it has ever seen … which portends a time of adjustment,” says Tom Whelan, vice president, seating and positioning for Sunrise Medical. “It is important to remember that all new codes mean all new reimbursement levels.
“Additionally, the new Medicare policy incorporates significant requirements for testing, safety and product validation that have never existed before. While these requirements are a definite step in the right direction to ensure poorly designed and manufactured products don't compete in the marketplace to the detriment of end users, it is quite possible that a number of products currently in use could be challenged to remain on the market.”
Other manufacturers echo these sentiments.
“While these [coding] changes present some challenges, we do understand the necessity to more accurately define products and clarify the intended use,” says Invacare's Schlegel. “As long as all parties that are impacted by the changes continue to be proactively involved in the process, we are confident that the best possible solutions will be obtained.”
“[The new coding] creates a more complete system to understand what these products are supposed to look like,” Freedom Designs' Davis says. “It will equalize the standards for all manufacturers.”
The ultimate goal, Davis explains, should be a complete coding system that not only recognizes cost of the product itself but also the cost of application.
“Payers have failed to recognize the importance of the RTS' [rehab technology specialist's] role in evaluating what products are needed and the time, effort and knowledge of doing the evaluation,” Davis says. Seating and positioning should have a coding system similar to the system used for orthotics and prosthetics, where “each procedural set-up has a certain code. The material doesn't cost much, but the application does. [There are codes] for that part of the labor or expertise to understand how to make this piece of plastic for that bend.”
Positive Prognosis
To return to the initial question, where does this place the prognosis for the seating and positioning market? Closer to good than bad, and growing rather than slowing.
“While not up to historic growth rates, the domestic market for seating and positioning products continues to experience a moderate level of growth,” says The Roho Group's Borcherding. He explains a triumvirate of growth factors including “growth in the aging population, the continuing and steady incidence level of skin breakdown and the continuance of the current reimbursement climate that does pay for seat cushion products for prevention.”
And, prevention is the key to the future of the seating and positioning market, experts say.
“As the rehab industry continues to grow, one thing we're trying to do is deal more in a preventive nature than a reactive nature. We're now getting clients who we want to have the best functional capability they can have, as opposed to simply reacting to their particular positioning needs,” says Pride's Brislin. “The industry is looking at products that will help this person get the most out of his or her daily activities.
“We try to educate funding sources as much as possible and about paying for [prevention] as opposed to looking at the least costly alternative each time,” he continues. “For instance, [this preventive approach] may decrease doctor's visits and hospital stays. We also try to educate them to realize that every person is different, and that there is so much technology out there that can help every client.”
Experts Interviewed
Tom Borcherding, senior vice president, global medical sales, The Roho Group, Belleville, Ill.; Jay Brislin, PT, clinical and professional development manager, Pride Mobility Products, Exeter, Pa.; Foster Davis, national sales manager, Freedom Designs, Simi Valley, Calif.; Jennifer Saville, brand associate, Varilite/Cascade Designs, Seattle; Steve Schlegel, product manager, seating and positioning, Invacare, Elyria, Ohio; Barry Steelman, marketing manager, Permobil, Lebanon, Tenn.; Tom Whelan, vice president, seating and positioning, Sunrise Medical, Longmont, Colo.
Education Helps Providers Roll with the Changes
How can providers take advantage of the opportunities available in the seating and positioning market? Education, education, education, say the experts.
“Get educated and become client-driven,” says Jennifer Saville, brand associate for Varilite, a division of Cascade Designs. “Provide a seating system that achieves the client's optimal functional position and be the client's advocate in order to obtain the products the client requires.”
“Being well-educated in the seating and positioning market is a huge [part of being successful],” says Jay Brislin, PT, clinical and professional development manager for Pride Mobility Products. “There are many different courses that manufacturers, providers and other facilities offer. The more information providers have the better. There are so many products out there that being able to assess what clients are looking for and trying to find the products that best suit them is crucial. With more education about these products in the back of their minds, providers can take clients' needs and wants and ask, ‘Who can do this for me?’
“That's one of the big things: just being aware of what's out there. The nice thing about this industry is there's so much technology, but because it changes on a daily basis it can be hard to keep up with.”
Providers also need to be aware of recent — and any upcoming — changes to reimbursement.
“Know the details and implications of the upcoming CMS policy on seating products,” says Tom Borcherding, senior vice president, global medical sales for The Roho Group. “This will provide new opportunities for those providers who know the policy details and [who can] educate their referral sources on the coverage criteria and payment rules.”
“Well-informed dealers will be best-positioned to analyze and respond to changes in product choices that may need to be made in order to maintain viability from a business perspective — without sacrificing the end users,” says Tom Whelan, vice president, seating and positioning for Sunrise Medical.
Providers can also take advantage of innovations that save on labor costs. For instance, providers are now able to purchase seating and positioning products with mobility bases, as is the case with Invacare's On-Chair Seating program.
Form, Meet Function
Product innovations in the seating and positioning market are popping up left and right these days. From the aesthetics of the products — seating components that match the power base — to a new spin on tilt and recline — systems that rotate — to increased adjustability at a lower price, it's all happening in this market.
One new product from Lebanon, Tenn.-based Permobil introduces a unique marriage of mobility and office-furniture technology. The C2S Aeron chair pairs a Permobil C2S power base with an unlikely seat — a Herman Miller Aeron office chair.
“Herman Miller spent three years and millions of dollars on research and development to create the Aeron office chair, [which was] developed for office workers who spend an average of eight to 10 hours per day at their desks,” says Barry Steelman, marketing manager for Permobil. “Certain features developed for this use have rehab properties that can be used in the rehab power wheelchair industry: the Pellicle material offers increased airflow, which reduces heat and moisture buildup, and the Posture Fit, or PSSI, support system supports the base of the spine and helps to maintain proper curvature of the spine.”
Pleased with the Herman Miller chairs used in the Permobil office, company executives approached the furniture-maker with a proposal — and walked away with a product design that represented the first time Herman Miller had offered another company the use of its trademark.
“They believed in the quality of this product and [in] Permobil as a company and therefore allowed us the use of the trade names and trademarks,” Steelman says.
Cutting-edge qualities aside, Permobil is quick to point out that this power wheelchair is not designed for every user. “The target for this chair would be anyone with cerebral palsy, muscular dystrophy, multiple sclerosis, post-polio conditions, paraplegia — any condition in which some sensation or the ability to weight-shift still exists,” Steelman explains.
