Commit to, don't dabble in, complex rehab

Friday, March 20, 2015

As HME providers continually search for business segments outside the scope of Medicare competitive bidding, complex rehabilitation is an option that is being looked at with more interest than ever before. It seems like a natural fit for companies already engaged in mobility equipment and also has relevance for clinical categories like respiratory therapy because of patient comorbidities.

But unlike adding a retail or other sales-related component, complex rehab is a specialty unto itself and authorities in the field say the decision to enter the business requires extensive deliberation.

“There are significant considerations for a company contemplating a venture into complex rehab technology and it is not a decision to be taken lightly,” says Cody Verett, president of Carson, Calif.-based ROVI Mobility Products. “You cannot dabble in this business segment and expect it to succeed. As with any business, high-caliber, compassionate and dedicated personnel throughout the organization is paramount.”

In complex rehab, the assistive technology professional is the face of the company, Verett says, and while the position is crucial to the company’s success, the support team, including customer service and technical support, are also essential in providing the client relationship that drives the business.

Greg Sims, president of Matrix Seating USA in Gainesville, Fla., agrees.

“Complex rehab requires more interaction with patients, referral sources and caregivers than any other DME product,” he said. “Through that interaction, relationships are formed. These relationships are key to further business. If you have a strong relationship with a patient or referral source, they are more apt to refer business to you.”

Payer profile

By working in complex rehab, providers are essentially trading Medicare for Medicaid and various private insurance plans. It is a trade that enables providers to participate in other programs, though it brings with it other challenges, such as an extensive Medicaid qualifying process and sharp negotiation skills needed for managed care contracts, rehab specialists say.

“It is imperative to acquire the locally relevant payer contracts for specific rehab products and services and to negotiate appropriately for the time-intensive nature of the process,” Verett said.

Yet because complex rehab is diagnosis-driven, it requires less scrutiny by payer sources to determine whether a piece of equipment is medically necessary, Sims added.

“Payer sources see more value in equipment for complex rehab patients than with less complex mobility equipment,” he said. “They are becoming increasingly more aware of the financial benefits of equipment that is versatile enough to accommodate a client’s medical progression.”

For example, Sims contends that payers would red flag a mobility provider who requested authorization for a K0823 power chair with a standard captain seat for a client with ALS. Within complex rehab, they “are increasingly more educated on seating systems that would accommodate the progressive needs of a client with a neuromuscular disease,” he said.

Earning a reputation

A complex rehab segment cannot be built without gaining a reputation for excellence in the category. And it is a gradual process, starting with acquiring the necessary expertise, says Nick Everington, national training director for Matrix Seating USA.

“Complex rehab providers need to have integral knowledge of multiple types of equipment from multiple manufacturers,” he said. “One manufacturer does not typically offer all of the solutions or equipment requirements to meet the seating and positioning needs of a complex rehab patient, so you might have to use three to six different manufacturers. As a result, manufacturers offer training to ensure seating evaluators and specialists have a solid clinical understanding of their products.”

Once personnel are thoroughly trained in equipment and techniques, the complex rehab provider needs to seek out referrals and continually earn them by demonstrating excellent customer service along with equipment and therapeutic knowledge, Sims said.

“The No. 1 concern for referral sources and patients is customer service,” he said. “Providers should be able to address adjustments and repairs in a timely manner. Complex rehab seats are made up of many bits and pieces to accommodate the postural challenges related to the condition. Because of the number of accessories, that is a lot to manage.”

The consolidation factor

Because complex rehab is one of the few HME areas where allowables aren’t being drastically cut, it has triggered a wave of consolidation among providers seeking to gain larger market share. Penetrating the market dominated by growing chains is admittedly a challenge, but Sims says independent companies can compete.

“In order to offset the larger companies’ ability to market broader and with increased frequency, smaller companies must focus on building and maintaining relationships with referral sources,” he said.

Verett says that small companies have two essential factors in their favor: demand and need for complex rehab going forward.

“The demand from consumers requiring these services and the need for competent and compassionate providers with talented ATPs aren’t going away anytime soon,” he said.