Teaming with Rehabilitation Technology Suppliers
The following article first appeared in the October 23, 2000 edition of OT Practice and was reprinted with permission of the American Occupational Therapy Association. If you wish to cite the article use the following as your reference: Lipka, D.D. (2000). Teaming with Rehabilitation Technology Suppliers. OT Practice, 5(21), 17-19.
Rehabilitation technology has expanded dramatically over the past 5 to 10 years. Two very popular technologies, mobility and seating, have seen some of the most dramatic changes in terms of availability, reimbursement, and service provision. However, occupational therapists may sometimes be disappointed if they have unrealistic expectations of what rehabilitation technology can accomplish, or if they do not understand the importance of including a rehabilitation technology supplier on the team.
Rehabilitation technologies such as mobility and seating are more than just products. Simple durable medical equipment (DME) and home medical equipment (HME) products that can be ordered over the phone and dropped off at the user's home are not rehabilitation technologies. Rehabilitation technologies require evaluating the user's individual needs, trial fitting or use, mixing and adapting components from different manufacturers, providing choices to the end user, and making individualized adjustments at the time of delivery to obtain maximal user function. Providing clients with optimal mobility and seating systems is a very specialized area and requires considerably more knowledge, adaptive skills, and support services than providing clients with common, everyday wheelchairs or simple seat cushions. Qualified rehabilitation technology suppliers have long emphasized the differences between a sophisticated power wheelchair and an off-the-shelf rental wheelchair.
With its focus on containing costs, managed care has changed the way some suppliers conduct business. There are some companies that secure contracts by being the lowest bidder. To remain profitable, these low-priced vendors often cut corners by limiting product choices, minimizing service, or delivering equipment without adjusting it for the client or providing appropriate instructions. Sales volume becomes the most important goal for these vendors, while addressing client needs is a distant consideration. This model may have a minimal effect on therapists recommending common DME and HME equipment, but it is unacceptable for therapists who are recommending rehabilitation technology. There is generally no comparison between a vendor that simply provides low-cost equipment and a competent and skilled rehabilitation technology supplier.
With so many technology suppliers and more entering the marketplace every day, how do you select someone who will offer a fair price, product expertise, and good customer service? Accreditation and credentialing are minimum requirements to look for. Accreditation, such as through the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) is becoming fairly commonplace. Accreditation is a "seal of approval" bestowed on the rehabilitation technology vendor that indicates appropriate policies and procedures, such as record keeping and equipment management. Beware of companies that do not have some form of nationally recognized accreditation.
Credentialing is another important way to separate the unscrupulous vendor from the ethical and competent rehabilitation technology supplier. Credentialing is awarded to individuals within a rehabilitation technology company who choose to commit to a minimum standard of knowledge and behavior. The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) has developed credentialing programs to establish a baseline knowledge requirement for suppliers and practitioners. The Assistive Technology Supplier (ATS) credential is similar to the Assistive Technology Practitioner (ATP) credential and is intended to establish a baseline measure of assistive technology competence. The ATS exam focuses on many areas, including typical and atypical development, seating and positioning, augmentative/alternative communication, pathological conditions, ethical responsibilities, and federal legislation. Persons with an ATS credential have demonstrated a basic knowledge and are required to maintain their competence through continuing education activities.
The National Registry of Rehabilitation Technology Suppliers (NRRTS) has developed a companion credential called Certified Rehabilitation Technology Supplier (CRTS) that adds a practice-based component to the RESNA exam. Both of these credentials include a requirement to practice in an ethical manner. Although credentialing does not necessarily guarantee ethical behavior, it does allow for oversight and disciplinary action in the event of unethical practices. Therapists involved with higher-end rehabilitation technologies are wise to seek out credentialed rehabilitation technology suppliers.
A team approach, where the rehabilitation technology supplier is an active and contributing member, is an important characteristic of quality service delivery. Mutual trust is the underlying foundation or any working team approach. The occupational therapist needs to involve the rehabilitation technology supplier in the process from the beginning. This involvement may include assisting in the client evaluation, identifying medical conditions that may affect the best type and use of technology for the client, seeking input on developing client goals or outcomes, and securing essential funding information. Some inexperienced therapists have expressed a discomfort with rehabilitation technology suppliers who want to be involved with the evaluation, fearing that this involvement dilutes their professionalism or responsibility. Nothing could be further from the truth. In fact, the truly professional, responsible therapist will draw on the expertise of as many team members as possible to ensure that the client receives the technology that will best enhance his or her function.
Some rehabilitation technology suppliers have expressed frustration with therapists who tend to dominate the discussions on appropriate rehabilitation technology and act as decision-makers for the clients without recognizing the rehabilitation technology supplier's expertise. The rehabilitation technology supplier and the therapist both have a responsibility to the end user to discuss options and to identify the benefits and limitations of those options. The rehabilitation technology supplier can provide detailed information about different product features and benefits and how those can help achieve the desired outcomes. It is equally important for the rehabilitation technology supplier to identify the limitations of each potential product so the end user's expectations do not exceed what the equipment can accomplish. Ultimately, the final decision lies with the end user, but with the combined input of the clinician and the rehabilitation technology supplier, the consumer can make an informed decision that will prevent later disappointments.
Some occupational therapists have found themselves in situations where they believed that the rehabilitation technology supplier was recommending a more expensive seating and mobility system than was necessary just to make a bigger profit. This situation is most likely to occur with companies or salespeople whose primary motivation is profit. Although overselling does sometimes occur, the predominant environment of cost containment and limited reimbursement more often results in the rehabilitation technology supplier recommending lower-cost systems to better match reimbursement limits. In reality, having money as the primary basis for either buying or selling a technology system is problematic and needs to be addressed.
If the therapist believes that the rehabilitation technology supplier is going overboard in the recommendations, it is appropriate to ask to have these recommendations justified in terms of the user's needs and come to a mutual agreement. This is an important and reasonable request because many funding sources expect the therapist and the physician to provide a medical justification for the recommended system. The therapist needs to be aware of each client's reimbursement limits and not expect the rehabilitation technology supplier to provide a system that may allow the highest level of function but will not be adequately paid for. By the same token, the therapist should not allow the rehabilitation technology supplier to provide a system that will not adequately meet the user's needs just because of reimbursement concerns. Knowledge of funding sources' policies and good communication can usually prevent over or under-prescription of a mobility or seating system.
Therapists need to become familiar with all of the rehabilitation technologies that are available so they can provide their clients with all the options. They also need to be aware of which products a particular rehabilitation technology supplier represents. It is important for them to try products out themselves to fully understand how they work and what they can and cannot do. Although it is not unusual for therapists to recommend an advanced power wheelchair with specialized driving controls without trying it out themselves, this practice is not appropriate, given the high cost of rehabilitation technology and ask to the user if the system is not optimal.
Manufacturers' in-services are one way of getting product information, but therapists need to be aware that these presentations tend to be biased toward the positive aspects of each product. A healthy dose of skepticism is important to separate sales hype from fact. Therapists need to try different products for themselves. They should feel comfortable asking several manufacturers' qualified rehabilitation technology suppliers to identify their experiences with product reliability and outcomes and use this information to select the appropriate supplier for the client.
Most RTSs with experience and credentials are honest business people who try their best to assist the clients they serve. Profit is important, but it is not necessarily the driving force. They are not immune from making mistakes, but when mistakes occur they will do their best to rectify them. By developing strong relationships with RTSs who provide good services, therapists can provide the most comprehensive intervention for their clients.
FOR MORE INFORMATION
Applications of Technology for Persons with Disabilities
Assistive Products: An Illustrated Guide to Terminology
Assistive Technology and Occupational Therapy: A Link to Function (Self-Paced Clinical Course)
Assistive Technology for Persons with Disabilities: The Role of Occupational Therapy (2nd ea.)
Assistive Technology: Principles and Practice
Ergonomic Change. .. Blueprints for Occupational Therapy Today and Beyond
National Registry of Rehabilitation Technology Suppliers (NRRTS)
Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
Daniel D. Lipka, MEd, OTR/L, ATS, CRTS, is an occupational therapist and certified rehabilitation technology supplier. He has worked for Miller's Assistive Technologies in Akron, Ohio, in the areas of seating/ mobility and computer technologies for the last 14 years. He is past vice president of the National Registry of Rehabilitation Technology and is a current member of the RESNA Board of Directors. He can be reached at firstname.lastname@example.org or (330) 753-9600.
Last Updated: 3-2-2006
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Please note: This information is provided a archival information from the Rehabilitation Engineering Research Center on Wheeled Mobility from 1993 to 2002.