Mobility: From a Kid's Point of View

The pediatric mobility market brings certain challenges and a need for special expertise, but the it can be a successful arena for home medical equipment (HME) providers. Although reimbursement for pediatric mobility products is not generous, it has been less affected by cuts than other product areas. Providers must consider the unique pediatric issues to take full advantage of the pediatric mobility market and to provide the best service for their customers and referral sources.

Making Improvements

More manufacturers are entering the pediatric mobility market, and many are offering new products and improvements to existing designs. One important addition is crash-tested manual wheelchairs, said Paul Bergantino, president of Wallingford-based Connecticut Rehab and Medical Products.

Sunrise Medical, Longmont, Colo., and Invacare Corp., Elyria, Ohio, offer wheelchair attachments, which cost approximately $200, that allow a wheelchair to be tied down to the transporting vehicle, he said. Crash testing is limited to wheelchair frames with manufacturer-approved seating systems.

"You cannot have just anybody adding anything on there for a seat. If you crash test the frame (and) the seat fails, it is kind of useless," said Tom Whelan, director, product management, seating and pediatrics, Sunrise Medical. "The necessities of crash testing mean that you have to crash test the whole device. The market dynamics are for buying those components separately and putting them together from different manufacturers."

Although Sunrise requires that the crash-tested frame include an approved seating system, some providers remove it and add other seating, he said. Sunrise is working with other seating system manufacturers to crash test Sunrise's frame with other systems.

In addition to new products, old products are being used in new applications, such as power chairs for children as young as three years.

"Five or 10 years ago that was unheard of," Bergantino said.

Increasing Options

Pediatric mobility products today have more options and more sophistication than in previous years. Providers have more choices than they once had in seating systems and frames, and products are easier to adjust than previous models to customize fits for each child and to accommodate growth.

"As long as I give them good measurements of what I want done, (manufacturers) can do just about everything for us now," said Chuck Nichols, ATS, CRTS, seating specialist, Advanced Rehab, Alpharetta, Ga. But modification of existing products has been more common lately than new products, Nichols said.

Bob Boyd, product designer and product manager for scooters at Bruno Independent Living Aids, Oconomowoc, Wis., said Bruno added adjustability features to its seating but has few new pediatric products.

One common modification among manufacturers is adding color choices and attempting to reduce the clinical look of the products.

Pearl Goldstein, vice president of Brooklyn, N.Y.-based Wenzelite Corp., said Wenzelite it making its products more colorful to appeal to children and to parents.

"We are trying to combine the maximum support and positioning that is available with a look that is both cheerful and attractive, something parents would not mind having in their homes," Goldstein said.

However, reimbursement often precludes color.

"Most everything now has color. For a lot of parents here it doesn't make a difference because they are not going to buck for the extra (cost)," said Judy Switalski, PT, New Berlin Therapies, New Berlin, Wis. "They are only going to get what the funding source will pay for. So often times color is not a real big issue."

Accommodating Growth, Transportation Needs

But there are some critical issues in pediatric mobility, and growth is the most important. Children grow annually, but payers will not reimburse for a new product every year. So, manufacturers have responded by creating products that can accommodate a child growth.

"If I can get two years out of a seating system, as long as there is not any major changes in condition, I feel pretty good about being able to handle the growth," Nichols said. However, he expects a wheelchair frame to last five years.

Switalski said providers need to be aware of growth potential and consider growth when working with pediatric patients. For example, children with cerebral palsy usually grow taller but not wider. Children with spina bifada may grow wider but not a whole lot taller.

"Kids will always grow so you need products that grow in several different ways," Switalski said. "All of the manufacturers are very aware of that."

Most payers want a wheelchair to last between three and five years. A documented, major condition change may persuade a payer to reimburse for a new product sooner, but providers should select products considering five-year use.

"It is going to become harder and harder to get reimbursed for growth unless it is a reasonable period of time, which is tough with kids," Whelan said.

Transportation is another issue. Providers must consider not only the patient but also his or her parents or guardians who will transport the child. Parents want products that can be transported easily in their vehicles. Providers need to understand the family's routine and how it travels when considering different products. A manual wheelchair is more difficult to transport but gives the child self-propelling ability. A power chair gives the child more independence but is impossible to transport in some vehicles.

"You need to provide the proper support, but you need to have something that is easy for parents to use. You need to combine those two areas," Goldstein said. "We have to try and make it as easy as possible for (parents)."

Achieving Serendipity with Team Members

Working with pediatric patients means working with a team. In addition to the child's parents, providers must navigate the needs and wants of a physical therapist, a school therapist, teachers and the doctors. Team members do not always agree on the child's needs or how to meet those needs.

"Often the hardest thing to do is to make sure everybody on the team has the same vision for this child," Switalski said.

Switalski advised HME providers to let the team come to a consensus and work from there. The parent or guardian who carries the insurance is the ultimate decider, she said.

Most payers will pay for one mobility product per patient, and that product must last for several years. Since reimbursement often will mean the child will have the product for several years, it is imperative that parents and therapists understand all options and choose the best product for short- and long-term use. Switalski said providers must inform the patient's family about all products not just reimbursable ones. Parents often are anxious and in grief about their child's situation, and providers must work with them to displace any stigmas they have about wheelchairs or other products.

"Many parents are not ready to say: 'OK, I can put my child in a power chair because they often feel they have given up the hope of walking then,'" Switalski said. "(Using a power chair) is not a step backwards into disability. It is really a step forward to independence."

It also is important to consider functional and cognitive skills when choosing a pediatric mobility product. A child who can physically use a power chair may not have the mental capacity to understand the responsibility and dangers of what can be a "350-pound weapon," Switalski said. But if a kid has the necessary cognitive skills and a little functional ability, they usually can use a power chair.

"If a kid can move anything, you can just about get them driving now if you have got the time and money for it," Nichols said.

The pediatric mobility product market is growing and can be a potential profit center. There are many products available, and providers must be cognizant of what is available and of issues facing pediatric patients. Knowing what issues children and families face and how to work with the therapy team makes the HME provider an important asset to patients and referral sources.

This article originally appeared in the September 1999 issue of HME Business.

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