Pressure mounts on providers

The recent roll out of CMS's ATS requirement was supposed to be uneventful. After all, most providers who supply complex power wheelchairs already have ATSs on staff, industry sources say. But thanks to shifting market dynamics and a last-minute decision by CMS to change the rules of the game, providers have had more problems with the requirement than they expected, sources say. Shifting dynamics Starting April 1, providers had to use ATSs to supply certain complex power wheelchairs, those categorized as Group 2 or above. Around the time the requirement took effect, several providers reported losing ATSs to other providers, some offering big salaries. They describe these providers as procrastinators, small-time players or new entrants to the market. In some cases, the latter won bids to provide complex rehab for the first time as part of national competitive bidding. “What's happening is we have a somewhat limited supply of ATSs, because they're mostly already employed by companies,” said Don Clayback, vice president of government relations for The MED Group. “So when you have providers who didn't get on the bandwagon right away or providers who want to get into complex rehab, they recruit ATSs. I think that's why some providers are feeling some pressure.” One provider in the Midwest reported losing two ATSs after he paid their way to study for and take the exam--twice. “How do you train and keep your ATSs when they're offered $100,000 salaries elsewhere?” the provider said. “I can't afford that.” Provider Jody Wright lost two of his six ATSs to other providers when he asked them to sign non-compete agreements. “ATSs have become a premium,” said Wright, president of Rocky Mountain Medical Equipment in Englewood, Colo. With few unemployed ATSs out there, providers have decided to become ATSs themselves or make do with fewer ATSs. Changing rules Other providers are concerned with CMS's recent decision to allow providers to contract with ATSs to supply complex power wheelchairs. They thought ATSs had to be on-staff employees. Provider John Letizia said CMS's concession “takes the teeth out” of the ATS requirement. “It costs us a lot of money to get and maintain an ATS, yet one of my competitors can go out and sign a contract with an ATS for $100 per evaluation?” he said. “When you employ an ATS, it says something about your business, and when you don't, that says something, too.” Industry sources worry that allowing providers to contract with ATSs will result in reduced service. “It may be harder, if not impossible, to have contact with the ATS again if there's a problem,” said Weesie Walker, who manages the National Seating & Mobility branch in Atlanta. “A beneficiary's relationship with an ATS only begins with delivery.” Providers can take some comfort in knowing that the contract arrangement between providers and ATSs may not last long. CMS's revised quality standards propose that ATSs be W2 employees. “Providers are getting a little more time, but they should still be working to train employees to become ATSs, because it's probably temporary,” said Jerry Keiderling, vice president of U.S. Rehab. On the bright side The ATS requirement has caused some providers who only do a small amount of complex rehab to drop out of the market, opening the door for providers with ATSs to pick up additional business, industry sources say. “We're seeing some potential for attrition in the complex rehab market and because of that some potential for opportunity,” said Cody Verrett, an ATS and national sales director for Quantum Rehab, a division of Pride Mobility Products.