Suppliers/Ordering

Take Action & Be Heard!

As promised, I am sharing part of the latest legislative update from NCART:

The November 4 election marks a change in the executive branch of government and its effect on the HME industry and complex rehab is unknown. President-elect Obama has not addressed the issue of HME and his selection of Department of Health and Human Services Secretary and CMS administrator will be key. Health care reform is a top priority for President-elect Obama and Democrats in Congress have said they are committed to making a comprehensive effort to reform our health care system. Work is currently underway to lay for foundation for legislation next year.

Under President-elect Obama’s proposal, most individuals would continue to receive coverage through their employer. Individuals who are uninsured would have access to a new public plan – modeled on the current federal plan for federal workers, or to private coverage through a “National Health Insurance Exchange.” This Exchange would also reform the private insurance market, incorporating a ban on excluding coverage due to health status. The plan includes a “pay or play” mandate for employers to provide insurance or contribute a percentage of payroll toward the cost of the national plan. Small businesses would be exempt from this mandate and would receive tax benefits to help purchase coverage.

President-elect Obama’s proposal includes an array of health system changes to improve quality, reduce waste and drive down health care costs. Proposed system changes include the use of comparative effectiveness research, disease management and care coordination, preventing Medicare waste and fraud, and increasing competition in the insurance and drug industry. Many elements of these reforms have support from Democrats and some Republicans.

Medicare is likely to be a big part of the debate. Many Democrats believe coverage through a public program is part of the solution for the uninsured and many leading Democrats have sponsored legislation that would allow individuals to “buy-in” to Medicare. Congress could also turn to Medicare savings as a way to finance health reform. President-elect Obama and many Democrats have called for reductions in payments for Medicare Advantage and for Medicare prescription drugs, among others. Any of the proposals for Medicare savings debated by Congress in 2007 and 2008 could be on the table, including the elimination of the first month purchase option for power wheelchairs.

Sen. Baucus (D-MT), chair of the Senate Finance Committee, expects to release this week his options for health care reform, and Sen. Kennedy (D-MA), chair of the Senate’s Health, Education, Labor and Pension Committee has been working on a proposal also. NCART will monitor these efforts at comprehensive health reform and advocate for more reasonable reimbursement of complex rehab and to avoid policies and programs that could potentially harm people with disabilities who need complex rehab technology.

Other health care legislation to be considered in 2009 includes the reauthorization of the SCHIP program which expires in March, and legislation to “fix” the current physician reimbursement reduction scheduled to go into effect in September. These two pieces of legislation, in addition to health reform legislation, are possible vehicles for attaching a proposal to eliminate the 9.5 percent reduction for complex power wheelchairs.

2009 is quickly approaching, now is not the time to sit back and wait to see what direction the new administration and Congress will take Complex Rehab and the HME industry. Now is the time to be vocal and let your Legislators know what you (either as providers of Complex Rehab, or consumers of these devices) need!

What actions are you taking to be proactive? How are you making your voice heard?

Are you going to the Medtrade show October 28-30 in Atlanta? Historically, Medtrade has been the show of the year for DME Suppliers and Rehab manufacturers to gather. Seeing new products, attending educational seminars, and networking is on everyone’s agenda. Despite the decreasing attendance at Medtrade over the years, Altimate Medical is excited to be going to Atlanta once again:

1. The greatly anticipated EasyStand Bantam makes it first appearance at Medtrade! After a thorough design & evaluation period, we are excited to show suppliers and therapists the new stander that their schools and families were waiting for!
2. Our standers are Evolv-ing! A prototype of the EasyStand Evolv with an optional Swing Away Front will be in our booth. This allows the front table and kneepad to swing to the side, providing maximum transfer room.
3. The Evolv E3 was designed to make standing more attainable to the customer- come talk to us about it to see if it’s the right fit for you!
4. We can see old friends! For us, Medtrade is a great place to talk to our friends and customers in person; with the product right in front of us to play with!

Are you going to Medtrade this year? Why or why not? If you are attending, be sure to visit our crew in booth #1637A! We want to show you what the new Bantam and Evolv are all about! If you are not attending the show, let us know, and we will send you the new Bantam literature and price list when it’s available.

Therapists and parents around the globe have been waiting for the release of the EasyStand Bantam - the new EasyStand stander for kids! For the past few months, we have had some prototypes in select areas of the U.S. and have been gathering clinical and consumer feedback from the experts. Soon, we will be ready to make a formal introduction!

So here is a just a glimpse of the Bantam, some photos from our our recent photo shoots with Ryan Kane and Isabel Koegel. Aren’t they adorable? And yes, the stander is pretty cool, too!

• The Bantam will be at the Medtrade Show in Atlanta, GA on October 28-30th, 2008.
• It will be available in two sizes, extra small for kids 28″-40″ tall and up to 50 lbs., and small for kids 36″-54″ tall and up to 100 lbs.
• It will be available with standard planar seating, optional comfy-style seating, or a combination of both.
• The Bantam can be ordered with optional Supine Positioning, making it the only stander that combines sit to stand with supine!
• An optional Shadow Tray can be added to the Bantam for more support and a desk surface from sitting to standing.
• The standard unit will be very different from the EasyStand Magician, more on this later.

Watch for more information (literature, pricing, specifications, availability) to be on www.easystand.com around Medtrade! Pre-order Bantam literature and pricing and we will mail it to you when it is available. We will begin taking orders for the EasyStand Bantam in November 2008. In the meantime, leave us comments to tell us what you think!

One of my responsibilities at Altimate Medical, Inc. is to inform our staff about legislative issues that will either directly effect, or have a trickle down effect on our suppliers, clinicians, and ultimately the consumer. My main source for clear, concise legislative information and updates is from NCART (National Coalition for Assistive and Rehab Technology).

NCART’s Mission:
NCART’s mission is to promote the interests of the Rehab and Assistive Technology industry, ensuring adequate consumer access to appropriate technology and services while creating a stable business environment for providers and manufacturers of rehab and assistive technology.

NCART’s Vision:
NCART’s vision is to have rehab and assistive technology recognized and accepted as a unique and separate health care delivery model from DME. Then, to use this differentiation to effect changes in coding, coverage and payment.

In upcoming blogs I will share appropriate legislative updates from NCART to provide access to this important information to our customers. I welcome any questions or comments!

After talking with newly injured clients and caregivers last Friday at the Abilities Expo in Minneapolis, I found a common theme arise. How do I get this item (stander, wheelchair, cushion, etc.) purchased for me? I was amazed at how many people recently (and not so recently) out of rehab had not been explained the procurement of Durable Medical Equipment (DME). I’m not sure if it’s because they had more important life issues on their minds when in rehab, and were inundated with information? Of if we, the DME team (manufacturers, suppliers, and clinicians) are trying to make the process invisible so as not to overburden the consumer during a difficult time of adjustment?

I’m guessing it’s a bit of both. Regardless, somewhere before leaving rehab there should be someone or some document that explains what DME is and the normal process for acquiring these life-necessary technologies.

There are many different payers who have different needs for funding DME, but generally speaking the ideal process is as follows:

1. Discuss with your physician the specific need you want to address with the item of DME. Ask for a referral to a clinician or OT/PT that can help with the evaluation process.
2. Pull together your DME Team (therapist, local DME supplier, caregivers, & self).
3. Set up time for evaluation /trial of the equipment or technology you think will work best for you.
4. The therapist will document the outcomes from this trial and write a Letter of Medical Justification or Necessity (LMN).
5. Once the LMN is signed by the medical team, therapist, and physician, it is sent to the DME Supplier for prior authorization with your funding source.
6. When approved by your funding source, the DME will be ordered, received, assembled, delivered and fit by the supplier.
7. If your funding source denies or pends your DME prior authorization, review your right to appeal in your benefits book from your funding source. Then decide your next step. Remember there are many on your team who are willing to help with this process, but you, the consumer hold the most weight in an appeal.

This is just a brief outline of the process. Many more funding tips as well as legal resources for appeals are available on our website.

Why do you think consumers are not more educated on how to get the DME equipment that they need?  Have you had any experiences getting DME that you would like to share with others?  Am I missing any important steps of the DME equipment purchasing process?

Altimate Medical would like to invite clinicians and suppliers to attend this NRRTS teleseminar on standing. Earn CEU’s and learn about standing without leaving your home or office! Register today for next weeks seminar!

Standing: Advanced Principles, Practices and Clinical Applications

This exciting course moves expert rehab providers to the next level. Bone density, bowel, bladder, spasticity and range of motion benefits of passive and dynamic standing (including vibration) programs will be highlighted. This session will conclude with a rousing session on funding that will leave you shouting “show me the money.”

Ginny Paleg is a pediatric PT from Silver Spring, MD. She works in a 0-3 (Early Intervention) program for Montgomery County Public Schools. She serves children in their homes and daycare centers. She is the Reimbursement Chair and listserve monitor for the pediatric section of the APTA. She is on the editorial board of Rehab Management and PT Products Magazines, and is on the consumer advisory board of VTech toys.

When: Thursday, September 18, 2008

Time: 5:00pm to 7:00pm EST

Registration: Register on-line at www.nrrts.org or by phone at (800) 976-7787.

Cost: NRRTS registrant $20, Friends of NRRTS $25, and anyone else is $35.

CEU’s: .2 CEU’s have been applied for.

Are you planning on attending Ginny’s NRRTS seminar?  If you attended, what did you think?  Did Ginny’s presentation provide information on standing therapy or standing equipment that you were not aware of?