Internet Sellers and National Marketers:
the Ethical Decision for a Rehabilitation Technology Companies
by Simon A. Margolis, CO, ATS/P
(This article was originally written for "Health Care Products" and is reprinted with permission of author.)
You're a rehabilitiation technology supplier attending a seating clinic you've attended for years. You get a referral for a powered mobility base with a power reclining back for Beatrice Jones. You tell Mrs. Jones and her caregiver, Jason, approximately how much Medicare will pay and approximately what Mrs. Jones' will have to pay. You get the prescription from the physician and begin the process of filing a claim for Mrs. Jones.
Two days later you get a call from Jason saying that they've had a stroke of good luck--they've found a supplier, ACME Internet Sales, who will provide a power chair for free. Mrs. Jones won't have to pay any money at all for the power wheelchair.
Coincidentally, Cynthia, your customer service manager, tells you she received a call from Bruce at ACME Internet Sales asking your company to deliver, for a $250 fee, a power wheelchair that ACME has sold to a consumer in your area. Cynthia felt that this seemed like a pretty good deal --$250 for two hours work--so she said yes.
The next afternoon Bruce faxes you the information. The name on the paperwork is--Beatrice Jones. The chair that ACME is drop shipping to you, to deliver to Mrs. Jones, is a mobility base with standard seating--not the chair with power recline that the physician prescribed.
You're confused and more then a little upset. You look at the paperwork more closely. The delivery ticket that Bruce asked you to have Mrs. Jones sign reads:
- "I, the undersigned, have received the equipment listed above in good working condition and accept delivery of this equipment. I understand that my attending physician has ordered the use of this equipment and that in accepting the delivery of this equipment from ACME Internet Sales, my insurance will be billed. I also am aware that any additional expenses related to the delivery or pick-up incurred, I am responsible for. I also understand that any unsatisfied co-payment due to lack of secondary insurance coverage will be billed to me by the provider ACME Internet Sales. I accept full responsibility for payment of listed equipment".
This is, unfortunately, a true story-- only the names have been changed to protect the innocent--or maybe in this case shield the guilty. Not only was the equipment not "free" to the consumer--the wrong equipment was being provided. This scenario is replayed all too often across the United States.
How should professional and ethical Re/habilitation Technology Companies (RTCs) respond to the proliferation of unscrupulous, abusive and sometimes fraudulent Internet sellers and other national marketing schemes? How can RTCs help to protect the integrity of the Re/hab Technology process and the consumers they serve?
There are two opportunities for RTCs to address these issues. The first is when a consumer calls and says they are having problems, or need service on a product provided by an Internet or national marketing company.
The people that work for good RTCs care about consumers and want to meet their needs. Their first reaction is to do everything they can to help the consumer. This attitude is admirable, but doesn't address the problems caused by Internet-based and other national marketing companies selling products without appropriate service and support. Sometimes saying "No", even if it inconveniences the consumer, may be the right thing to do.
It would seem that the behavior of many of these Internet and national marketing companies violate the Medicare Provider Guidelines. The fact is, that in most cases, these companies do business in a way that is just barely within the limits of the law.
The only group involved in the equipment provision process that can curb the behavior of the Internet sellers and national marketers is the manufacturers. The RTC needs to provide the manufacturers with the ammunition they need to shut down the unscrupulous and abusive providers. At the very least the customer service people working for RTCs need to gather the following information from the consumer when they call for service on equipment supplied by Internet or other national marketing companies:
- Customer name, address, phone, etc.
- Name, address, phone number of original supplier
- Manufacturer, serial number and description of the equipment
- How did they learn about the original supplier? (mail, Internet, advertising, etc.)
- Was an in-person evaluation conducted and measurements taken?
- What arrangements were made for after-sale service?
- How and by whom was the equipment delivered to the consumer?
- How and from whom did the consumer get the name and number of the RTC?
This information will begin to demonstrate to the manufacturers, and eventually to payers, the gross disservice that this product delivery model pays to consumers who need both Re/habilitation Technology products and services.
The second opportunity is when an Internet or national marketing company calls an RTC to evaluate for, or deliver product for them. Here are some factors to consider:
Should an RTC be promoting the brand of another supplier? If the Internet company or national marketer is reaching into the RTC's service area for referrals, is there a benefit to the RTC by providing assistance in the process? Once the RTC staff becomes involved as the local point people, they become, at least in the minds of the consumer and referral source, the de facto responsible party for the process. Most RTCs are barely able to keep up with the service work on the products and systems they provide. Doing additional service and repair work for an Internet-based or national competitor may not make sense.
How much revenue can an experienced rehabilitation technology supplier generate in an hour of clinical contact with consumers and referral sources? A power chair with seating system might yield $15,000 in revenue. A fee of $250 from an Internet or national competitor to do an evaluation might pale by comparison.
Should an RTC deliver Re/hab Technology products that are being supplied without appropriate evaluation or measurement? The RTC needs to help protect the interests of the consumer. The RTC also needs to protect the integrity of the Re/hab Technology provision process and assure that local RTCs flourish. This set of needs seems to indicate that alliances with Internet-based sellers and national marketers of Re/habilitation Technology products may not be in the best interest of any of the stakeholders.
Are all Internet sellers and national marketers of Re/habilitation Technology products unscrupulous and out to abuse and defraud the system? Not at all -- just as in any other field, there will be good people and bad people. Are there ways for RTCs to work effectively with the good people? There may be if the integrity of the process is maintained; the consumer informed and protected; and the overall value of the process, to the RTC, clearly demonstrated.
Is it a fact that these kinds of suppliers, both the good and the bad, are here to stay? Probably, but the professional and ethical RTC should carefully consider whether to facilitate the success of these companies by participating in what is generally a significantly flawed process.
Simon Margolis, CO, ATS/P is an ABC Certified Orthotist and a RESNA certified Assistive Technology Supplier/Assistive Technology Practitioner. He is Vice-President for Clinical and Professional Development for National Seating and Mobility, Inc a Chattanooga, Tennessee-based Re/habilitation Technology Company with 50 branches throughout the United States. He is a past president of NRRTS and currently serves as president-elect of RESNA. He lives in Plymouth, MN with his wife Marcia, a physical therapist and RESNA certified Assistive Technology Practitioner, and his daughter, Erica.
Last Updated: 3-2-2006