Surgeon/ATP leads quality push at Hoveround

SARASOTA, Fla. - When Hoveround President Tom Kruse asked Medical Director Don Vliegenthart, MD, to pursue assistive technology practitioner certification from the Rehabilitation Engineering and Assistive Technology Society of North America, he could have predicted the response. “He rolled his eyes and gave me a ‘you've got to be kidding' look,” Kruse said. “I understand - he's already a physician, but I thought it was important for him to get an idea of the level of knowledge and expertise in the industry and what the expectations are.” What's more, if any physician would be up for the challenge, it was Vliegenthart, a former practicing orthopedic spinal surgeon. “I've known ‘Doc' for 15 years and as a physician, he was on a deeper level than most when it came to his patients,” he explained. “He was always asking why we did things with regard to patients. He's not only smart about medicine, but about the mechanical engineering side of the business.” So it's only fitting that Vliegenthart put aside his initial skepticism and graciously complied with Kruse's request. “Tom is constantly pushing the professionalism bar higher, so I told him I'd be happy to take the ATP exam,” he said. Even to someone of Vliegenthart's intellect (he finished high school at 16, graduated college at 19 and started his residency at age 22), the ATP exam was “not easy,” he said. To prepare, he attended a review course offered by RESNA last spring. After that, he knew that even a skilled physician would need to study hard in order to pass. “As a surgeon who has evaluated thousands of cases over the years, I can honestly say it was a well-designed, thorough survey of your anatomy knowledge,” he said. “It's not as in-depth at the clinical level, but that's not the idea behind it.” Vliegenthart has his own category as a physician-slash-ATP. Of RESNA's 1,125 ATPs and 668 Assistive Technology Suppliers, only eight indicate “physician” as their primary field and Vliegenthart is the only MD listed, the association reports. One of the most valuable aspects of earning ATP certification, Vliegenthart said, is learning the “practical” part of rehab. “You need to establish relationships with funding sources so you don't leave patients hanging,” he said. “If you are an ATP, you need to have decent knowledge of finding the right people to take care of their equipment and funding needs.” Vliegenthart had to retire from surgery prematurely eight years ago because he contracted Bell's Palsy, a condition that paralyzes facial muscles. As a result, he has trouble blinking, is susceptible to abnormal tearing and is sensitive to light. While most Bell's Palsy patients recover eventually, Vliegenthart's situation is permanent. After stepping away from surgery, Vliegenthart worked as an independent consultant. Since he was calling Vliegenthart nearly every day with seating questions, Kruse thought it would be a bold step forward to hire him as a medical director. By bringing Vliegenthart on staff, Kruse sensed that Hoveround's clinical credibility would get a big boost. “While most in the industry consider seating an art, Doc makes it a science because he's an expert in the anatomical and physiological aspects of pelvic alignment, spinal alignment and pressure reduction,” he said. As medical director, Vliegenthart places a premium on clinical experience for Hoveround's sales staff, many of whom are RNs, OT/PTs and certified athletic trainers. RESNA reports that 10 Hoveround employees, including Vliegenthart, hold the ATP credential. Clinical expertise is integral to the in-home mobility evaluation program Vliegenthart developed for Hoveround because its intent is to be “the physician's eyes and ears.” For no charge, an eight-page survey is conducted to determine whether the patient will benefit from rehab technology. “Physicians don't have the time to go to a patient's house, but they are the ones who decide whether the patient gets the technology,” he said. “I interact regularly with physicians to make sure our evaluation covers all the areas they are looking for.” To guard against the touchy issue of power chair over-utilization, field staff isn't allowed to generate prescriptions or certificates of medical necessity. Instead, that duty is handled internally by a designated prescription department. Together, Vliegenthart and Kruse have teamed up to work the political side of the industry, meeting with agency heads like CMS Director Tom Scully and Capitol Hill legislators to state their case for quality standards - both for rehab suppliers and Medicare DMEPOS providers under national competitive bidding. Though they realize that their position on competitive bidding isn't popular within the industry, Kruse believes the program is inevitable and that the focus should be on damage control instead of a futile prevention strategy. “We should use this as an opportunity to raise the professionalism in the industry,” he said. “Right now it's easier to get a DMEPOS number than a driver's license.” HME