Cuts strain provider, therapist relations

The complex relationship between rehab providers and physical and occupational therapists has always been a loaded one. But one industry source, who's involved in both communities, recently said: "It's as ugly as I've seen it in my career." Last year, CMS cut reimbursement for power mobility devices, on average, by 27%, making it more difficult for therapists to get the wheelchair that best meets their client's needs and providers to get that--and a reasonable profit. "It's unfortunate that we're put in two opposite ends of the spectrum again," said Mark Schmeler, a faculty member at the University of Pittsburgh. "Because providers and therapists need to be on the same page." The majority of therapists haven't fully grasped the "vast changes" to the rehab industry and their impact on providers, said Laura Cohen, co-coordinator of The Clinician Task Force. "Providers participate in the evaluation of the client, perform the home evaluation, conduct the fitting and deliver the equipment--all costly services, yet they're wrapped into shrinking reimbursement," she said. "Therapists don't always understand that." Cindi Petito, owner of Seating Solutions in Jacksonville, Fla., agreed: "They have no idea of the business end of it for the provider." At the same time, when providers say CMS won't cover a certain wheelchair, therapists no longer know if it's a coverage issue or a business issue for providers, Cohen said. "There's mass confusion," she said. Providers like Ron Reed said "savvy providers" make themselves part of a medical team that includes not only therapists but also physicians and beneficiaries. "If you present yourself that way, you become a quality addition to the staff rather than a pesky salesman," said Reed, owner and CEO of Benchmark Mobility in Indianapolis. "You have to show therapists that you know your stuff; at the same time, you need to show them respect." Simon Margolis, executive director of NRRTS, agreed providers and therapists must show mutual respect. "It's not the role of rehab technology suppliers to determine the role of therapists, and it's not the role of therapists to determine the role of RTSs," said Margolis. Margolis continued: "It's a very simple process, if people would stay the course: The therapist does an evaluation and assesses a patient's needs; the RTS does an assessment to match technology to those needs."