Medicare's ATP requirement goes too far

Saturday, March 31, 2007

In 2008, CMS will begin requiring that certain PMD candidates undergo evaluation by an ATP (assistive technology practitioner) independent of the DME supplying the equipment. In case you didn't feel it, CMS just slapped the rehab provider again. While the disrespect and lack of trust our industry has incurred has in some respects been earned, we should not concede every time someone insults us. This non-reaction allows us to become a scapegoat instead of positioning ourselves as the value-added service providers we are.
Although I feel most of the new requirements for rehab suppliers, which include ATS assistive technology supplier certification and national accreditation, are excellent, the anticipated 2008 requirement of ATP evaluation for certain PMDs goes entirely too far in discrediting our industry expertise. Quality rehab providers have been making appropriate decisions for their clients since chairs were placed on wheels. It is in our and our client's best interest to continue to do so.
Currently, the shortage of independent ATPs is well documented and the belief that there will suddenly be plenty by 2008 is overzealous and overly optimistic. The president of our company, who is now ATS certified, recently completed the RESNA certification process. She found the material and test to be extremely challenging--this from a person with 10 years of experience practicing as a physical therapist, five years of experience in seating and positioning with our company, and a master's of science in physical therapy. In conversations with others undergoing certification, she found that many were on their second and third attempts to pass. At $500 per testing attempt, plus travel and overnight expenses, and the amount of time committed to learning the material, certification is expensive and time consuming. To justify seeking ATP certification, one would have to know that there is a large enough market to warrant the time and expense. Economically speaking, a market would have to be under served to motivate the additional investment for ATP certification. Of course, waiting for a territory to gain sufficient ATPs does not serve the needs of our mobility clients.
Besides the ramifications of the inevitable ATP shortages, the underlying message being sent with this requirement is that rehab providers are incapable of making sound seating and positioning decisions, even with ATS certification. I believe there is nothing further from the truth.
ATP certification, in and of itself, guarantees nothing. As Glenn Hedman, president of RESNA states, "The ATP and ATS provide a baseline of knowledge and skill level." Anyone can study the material, take and pass the exam without any experience at all. And this person will tell a seasoned rehab provider what is in the best interest for his client? We also need to ask ourselves, "Who will ultimately bear the brunt of responsibility if the evaluation is flawed and the equipment is inappropriate for the client?" The equipment supplier will--not the ATP.
Additionally, we know from experience that there are many ways to approach seating and positioning issues. Those who have worked with pediatric clients know how difficult it can be to bring various and unrelated therapy teams, physicians and family members to agree on certain client needs. Am I now expected to bring an independent ATP, who has no history with the client, into a skilled facility to bandy about with a staff therapist, the physician and us about what is best for the client? Dare I suggest this will result in "too many spoons in the pot?"
But what should really have every DME provider's attention is that this is the latest step in re-establishing the DME industry as a commodity industry. We can fight oxygen and wheelchair cuts as long as we can produce evidence that we provide an important clinical service. As long as we are part of the continuum of care, we are professionals. When we outsource our professional knowledge and ability, then we simply start providing chairs with wheels and our reimbursements get cut even further.
So, what can we do? We must organize ourselves and recreate our image. We have far too many good stories to tell, and we need to begin sharing them. We must be direct with CMS and tell them we are not going to allow another unnecessary layer that will have bearing on what equipment we provide. We will gladly embrace the ATS certification, and we will enthusiastically police our industry to root out nefarious suppliers. But if ATPs are going to slow us down and interfere with our recommendations for equipment, let them pay for it and then jump through the ever-tightening hoops for Medicare reimbursement.
Gerald Sloan is the owner of Progressive Medical Equipment in Lenexa, Kan.