NSM ‘cuts through the noise’ to set rehab apart

Monday, February 28, 2005

Mike Ballard

National Seating and Mobility started 2005 by taking steps to distance itself from the crooks and unethical providers that have given the HME industry a bad name. In January, the national provider of custom rehab products launched the quarterly newsletter Access, which was sent to 9,000 medical practitioners and clinicians nationwide. The company also redesigned its Web site, creating a more interactive format for consumers and caregivers, as well as practitioners. The site now allows doctors, among other things, to track their patients’ orders and read case studies of other NSM clients. Mike Ballard, president and CEO of NSM, says he hopes the new additions will “cut through the noise” and help differentiate NSM from the "wheeler dealers" who have dominated the business - and headlines - in recent years. Ballard spoke with HME News in February about this challenge and others facing rehab providers in 2005.

HME: Is the newsletter and Web site redesign an effort to further separate NSM and rehab providers from HME providers? Is this still an important goal for NSM and why?

Mike Ballard: We have never been a company that engages in the traditional sales and marketing activities. We are 100% referral based and our services are almost always requested by a therapist or physician to assist in developing a mobility solution for a patient in their care. However, because of some trends in the marketplace, it is now more important for us to differentiate ourselves and our medical model from the consumer direct marketing model. That’s what we are trying to do.

This always has been a goal for NSM. I think the industry made a lot of progress over the last 15 years through the efforts of NRRTS and RESNA, but we took two or three steps forward but then knocked 10 steps backward because of the K0011 Wheeler Dealer scandal. It created a ‘guilt by association’ for anyone remotely associated with wheelchairs, so we have to beat the drum a little louder and say, ‘Hey, it’s not us.’ It’s had an adverse effect on our credibility, so NSM and the other stakeholders are going to do whatever we can to separate the perceptions.

HME: Do you feel NSM, NCART and the rehab providers in general have made progress in trying to rehabilitate their image with lawmakers, politicians and the general public?

Ballard: I don’t think it has been that effective at this point, although NCART has been effective in what they have been able to bite off. This whole coding thing with CMS has drained a lot of resources, so we haven’t been as effective in the states as I’d like to see us be, and that’s a function of resources. There have been miniscule resources directed towards state issues. On the other hand, there has been a Herculean effort to protect the very profitable consumer power market. The good thing is that in the last 12 months a lot of wheelchair manufacturers have realized how important it is to take the message to the state level. I expect it to get better over time.

HME: NSM stresses its dedication to adhering to the highest clinical standards and not driving sales through advertising. What about rehab providers who market more aggressively through advertising and say they also adhere to high clinical standards? Are consumer advertising and high clinical standards mutually exclusive?

Ballard: No, they are not mutually exclusive. There are companies out there, like Hoveround, that are sincerely trying their best to adhere to high clinical standards and documentation. They even make conscientious efforts to refer the more involved patients to core rehab providers. But there are still too many out there just doing what the law says they have to, or their interpretation of the law.

In NSM’s end of the business, advertising would do nothing to increase utilization – so why would we do it? The healthcare professionals caring for a new spinal injury know a mobility system is required so they refer to us the way a family practice physician may refer to a surgeon. Philosophically I just don’t agree with consumer adverting to drive utilization. I believe in the referral kind of business, and I’m not just talking wheelchairs. It drives me crazy as an employer who fights healthcare costs that all these pharmaceutical companies are advertising. However, I understand and respect a company’s right to do it in the consumer model. I just don’t like it.

HME: What’s your outlook on Medicaid’s dire budget situation? How will this impact NSM and rehab providers in general?

Ballard: Healthcare costs are a serious issue in this country, and we need to get a handle on it or it’s going to bankrupt us. Having said that, high-end rehab is not an area where there are utilization problems, and it’s not an area of increasing costs. The average price of a custom manual system is only 5% more than it was five years ago. The problem comes when broad-based changes are made to the programs. States that have utilization problems in the geriatric area may decide to make 20% across-the-board cuts. Well, there’s still a profitable business at the consumer levels, but it destroys the viability of doing true rehab.

HME: What’s your take on Medicare’s new coverage criteria that emphasizes a more clinical approach to functional ambulation and does away with the current bed-or-chair confined criteria?

Ballard: NSM has been a supporter of clarification, and we supported raising the bar to have a more clinical approach. Too much of the ‘clinical side’ of a lot of Medicare chairs was just something companies did in order to have the right documentation to get paid. Anything Medicare does to move it down to higher clinical standards in terms of ‘here’s a patient with a need now let’s determine what a proper system is for them,’ we are all in favor of and have supported.

HME: Medicare has proposed replacing the current five power chair codes with 49 new codes. What are the pros and cons of this? Is it better than what’s in place now?

Ballard: I think it’s a step in the right direction. It’s an awful lot of codes, but I think it’s going to stop the abuses that are going on in the industry. These codes are going to stop people from getting junk chairs that don’t perform the way they are supposed to, and hopefully the established allowables will be consistent with the effort and the work that have to go into the provision of the different chairs.