Manual mobility providers face critical decisions

Manual wheelchairs continue to be the standard bearer of the mobility industry despite the ongoing scrutiny and fee manipulation by Medicare. And even though questions persist about how the second round of competitive bidding will impact future reimbursement and supply channel stability in the future, mobility specialists expect product demand to remain strong.

"The category has been solid for us," said Tom Tucker, vice president of sales and marketing for Houston-based Attentus Medical Sales, which focuses exclusively on manual mobility. "Certain segments, such as bariatrics, have grown. We have also introduced a new width-adjustable chair that has generated a lot of interest."

Tucker concedes that the second round of Medicare competitive bidding will shake up the market and that mobility providers will have to make some difficult choices about how to submit a bid or if they should even bid at all in their market. Still, even those who opt not to bid could still find opportunity in the market, he said.

"There might be subcontracting opportunities for Medicare and outside the program," Tucker said. "The market is only 37% Medicare and the rest is non-Medicare business--HMOs, private pay and workers' compensation. So the prime opportunity is not to focus on the 37%, but on the other segments."

As reimbursement pressures have forced prices downward, the market has been flooded with "commodity type" wheelchairs made in overseas factories, says Marty Ball, vice president of sales for Tasco, Wash.-based TiLite.

"However, the more custom and 'made to measure' orthotic style ultralight chair cannot be mass produced as each chair must be constructed for an individual client," he said. "It is not always easy to determine who is most appropriate for the more advanced types of chairs and the funding of wheelchairs is dependent primarily upon diagnosis. If everything were equal and consistent, there would be greater use of the more functional 'custom' variety chair, as it affords users greater independence in their personal environment."

Mobility providers need to focus on higher acuity patients and more complex manual chairs to elevate the DME business beyond the commodity level, Ball said.

"What is needed is a more educated, professional community in specialized seating and mobility to recommend, fit and prescribe individualized wheelchairs," he said. "We also need a better-educated insurance industry on the benefits of the personalized wheelchair--not only to the user but to the payer as well."

Jay Brislin, director of product and clinical development for Exeter, Pa.-based Quantum Rehab, agrees that the more sophisticated K0004 and K0005 wheelchairs have an important role in manual mobility and that the need is steady, if not growing. Even so, reimbursement can be a circuitous process requiring a lot of information--and patience, he said.

"From a funding perspective, we can see the industry wanting more detail from the documentation for the more complex chairs," he said. "It is about understanding the specifics, getting therapist assistance and evaluations for the documentation. When you look at manual chairs and how many are out there, from dependent to independent mobility, you have to look at each client's ability to propel that wheelchair independently and rule out other chairs for that client."

While regulatory challenges will continue to keep providers occupied, the manual wheelchair category still has potential for companies willing to think creatively and efficiently, said Kyle Mooney, associate business manager for standard manual wheelchairs at Elyria, Ohio-based Invacare. One prime opportunity, he said, is affinity marketing.

"In the current business environment, branding has become more important than ever to businesses and consumers," he said. "I encourage providers to take a deep look into their markets and identify businesses where a branded product makes sense. As an example, Invacare partnered with an HME provider to brand several hundred manual wheelchairs for the University of Michigan hospital system. We were able to produce chairs that truly represented the U of M brand by specially painting the chair and incorporating their logo on the upholstery. Reviews have been so positive from other departments that additional departments have begun to place orders as well. Opportunities such as this exist everywhere, with corporations, institutions, charitable foundations, universities and more."

It is also important to establish and work within good business practices, such as streamlining inventory, Mooney said.

"While purchasing products from a variety of manufacturers based on fluctuating price may produce a short-term cost savings, the immediate cost savings are lost by the additional complexity that has been added to the system," he said. "Purchasers have to spend twice as much time placing orders, technicians have to learn new products and additional parts need to be ordered to keep the chairs in service. Those activities end up adding cost on the back end that more than exceeds immediate savings. Providers that establish a practice of one-stop shopping truly understand the total cost savings achieved through simplifying and streamlining their manufacturing vendors."