Funding, care coordination key for kids

Pediatrics can be viewed as a complex puzzle consisting of disparate pieces that must fit together to furnish the comprehensive care each patient needs. HME providers serving this market are tasked with finding the funding, care coordination, clinical resources and medical equipment designed for growing bodies. 

It’s a major challenge that brings major rewards, says Amy Morgan, principal product manager at Lebanon, Tenn.-based Permobil. 

“The reality of serving as a CRT provider for pediatric clients requires the team to have a unique skill set to manage the various considerations such as physical growth, developmental milestones, progressing medical needs, funding and transitioning to adulthood,” she said. “But watching a young child playfully chase after a sibling for the first time thanks to her new power wheelchair, often brings smiles and tears of joy to onlookers.” 

In assessing the state of the pediatric market, Ian Hendry, Leckey Sales Director-North America for Fresno, Calif.-based Sunrise Medical, describes a unique landscape for unique patients. 

“Children diagnosed with special needs typically require equipment, treatment plans and the input of a team of highly specialized medical and clinical experts,” he said. “Kids with complex needs will require support through these services from a very young age as well as a variety of equipment, medication and often surgical intervention.” 

Family and caregivers are paramount in the pediatric patient’s support network, making them valuable care partners, Hendry said. They also present a challenge that providers need to address. 

“One of the biggest challenges in supporting kids with special needs is the training and education of families and caregivers in the correct use of equipment,” he said. “So often we see products not being used at home because the family has not been shown how to use it correctly or they do not understand the importance of using equipment regularly.” 

John Storie, vice president of sales–Eastern America for Duryea, Pa.-based Quantum, cautions that a large clinical and support team can sometimes be unwieldy. 

“When dealing with adults, matters are more cut and dry – usually the patient has a therapist, an ATP and a team of caregivers,” he said. “When dealing with pediatrics, multiple therapists, school systems, teachers and others are involved, which can actually make things more difficult.” 

Funding conundrum 

It’s an age-old story in pediatrics – chasing payer funding can be a roller coaster ride of ups and downs. The key to securing funding, Morgan says, is awareness and engagement in advocacy and policies at the federal and state levels. 

Groups such as the National Coalition for Assistive & Rehab Technology (NCART), Clinician Task Force (CTF), and National Registry for Rehab Technology Suppliers (NRRTS) are industry leaders in pediatric advocacy. 

“We encourage everyone to be closely connected with these organizations,” Morgan said. “Follow them on social media, attend their industry webinars for updates, and participate in the calls to action. We will accomplish much more if we all work together.” 

ATPs are the best local resource for grasping the general coverage rules because they are the ones constantly being challenged when inquiring about providing equipment, Hendry said. 

“States do change policy on certain product groups and frustratingly for families and providers, there is little consultation or transparency in the decision-making process or communication of policies,” he said. “If we had a magic wand, we could answer this.” 

Conversely, Storie maintains that “coverage is not too big of an issue.” If the product is coded and documentation is good, he says “insurances aren’t typically denying things. Medicaid in most areas isn’t too bad if the product is coded. The big thing with power coverage for pediatrics is that it is documented that the child has successfully completed a power mobility trial.” 

Plethora of products 

When assessing the type of products well-suited for pediatric patients, there is a wide range of categories for families to consider. Depending on the patient’s needs, choices can include seating (posture and function plus mobility), standers, gait trainers, bathroom products, night-time positioning and even wearable devices. 

By and large, mobility and bathing products are in highest demand, said Dustin Moss, clinical vice president of rehab at Port Washington, N.Y.-based Inspired by Drive. 

“They want products that allow them to stay active in their home and community without many limitations,” he said. “Not far behind mobility are bathing and activity-related items. Bathing products that assist both the patient and caregiver makes bath time easier and fun while activity chairs can provide comfort and relaxation for schoolwork, therapy or at-home family activities.” 

Providers must also consider the growth of the child and how much adjustment is built into the product, because “adjustability is very important for a successful outcome as the pediatric client grows,” Moss said.   

Parents also want products that are child-sized, aren’t scary and provide therapeutic options for developing new skills, Morgan said. 

“They are also often willing to try anything and everything that will help improve their child’s health and functional outcomes,” she said.