Doing more with less - Making appropriate seating and wheeled mobility clinical decisions in the face of funding cuts - part 1 - Manual Wheelchairs and seating

Panelists:
Foster Davis, Freedom Designs
Tom Whelan, Global Vice-President, Seating, Sunrise Medical
Tina Roesler, MSPT, ABDA, Director of Sales & Education, TiLite

Moderated by:
Joni McGhee, OTR, Clinical Coordinator, TIRR/Memorial Hermann

A discussion panel focused on how to provide the right equipment with fewer dollars and shrinking funding sources.

Tom Whelan started off explaining the need for education of our referral sources, payors, and our customers. We need to educate all parties on the need for the right equipment

Tina Roesler opened her remarks with a call for better collaboration. She noted that we need to go back to the model of the RTS/ATP working in collaboration with a therapist to come to a decision on the best outcomes for the customer. She stated that many RTS's are providing services to consumers for free that a therapist can bill for and may be more appropriate for a therapist to provide.

Foster Davis begins with advocating the development of a state organization of suppliers that can band together to work with each state legislature to develop the Medicaid program. The association in Texas has been able to work with the state in development of new programs to strengthen the Medicaid standards of care for the customers. This also allows the industry to impact the development of the laws rather than react to the laws.

The first question from the audience is in regards to the new Medicaid program cuts proposed in Georgia and how to build a relationship similar to Texas.
Time and relationship building are very important in building that relationship. It was also suggested from the audience that we should share our equipment costs as well as time and labor involved in providing the equipment for a consumer. Texas legislators have begun to understand the costs of doing business and are more sympathetic to the dealers now that they have a working relationship with the dealers in the state.

One of the keys to building that relationship is to show how you can save the state money. You may have to reduce spending or utilization on items like diapers (as was done in Texas) to a reasonable level in order to build trust and confidence when other items need to have the allowable raised.

NCART is building a repository for Medicaid information for all states across the country. There is a News, Toolbox, and Medicaid by State section of the website.

A call for uniformity in discount pricing. Since some payor contracts are based on discounts received by manufacturers, some providers have asked their manufacturers to reduce their primary discount and increase their secondary discount so that they can receive a higher reimbursement from the payor. If there is a standard discount for all rehab products (suggested 40%) and then negotiate secondard discounts based on purchase volume, credit terms, etc.

Doing more with less can not always mean going back to the manufacturers for discounts to get more money. We need to educate our therapists and payors on what our actual costs are to make the business argument to maintain or increase reimbursement. We need to show that rehab does not have the same cost structure as DME but is closer to the overhead cost structure of O&P.

Does providing products based on reimbursement, keeping the suppliers and manufacturers in business, and taking a stand on maintaining profit negatively impact the end user? At what point do we stop providing "appropriate" equipment and start providing "OK" equipment?

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