By Rick Wyche, ATP, Director, Business Development ATF Medical
Cheap can be very expensive. All too often adjusters forget this when selecting durable medical equipment (DME) for injured workers with complex needs.
Instead of thinking broadly about the person’s medical condition, challenges, and goals, they focus on how little they can spend on some specific item. It’s not their fault. Few worker’s compensation professionals receive adequate training on handling patients with catastrophic injuries, much less the different types of equipment and their benefits.
New products and features come to market all the time, and without decades of relevant experience, it’s impossible for an adjuster or case manager to determine which product is best for a specific injured worker – or why it costs what it does.
The internet helps alleviate cost concerns by providing price transparency for some basic DME. An adjuster can look up the price of a cane, bedpan or a basic wheelchair and see if they are being over charged and find better deals on many standard products. While this type of price transparency helps save some dollars along the way, it can also lure carriers and other payers into viewing DME for catastrophic cases as a commodity.
While simple canes and walkers may qualify as commodities, the specialized equipment for catastrophically injured people decidedly does not. Price-shopping does not work in complex care.
Providing medical equipment for workers with complex injuries is a high-touch proposition, requiring clinical evaluation, in-depth product knowledge, and experience. It should consider the injured workers’ total health care needs, including transportation, nursing, companion, and adaptive housing services.
Let’s look at one often-expensive purchase – a power wheelchair. Deciding on the most appropriate wheelchair for an injured workers’ condition and living space requires an extensive clinical evaluation that includes:
- Medical status and expected changes
- Measurements (height, weight, hip-width and seat-depth)
- Muscle tone and strength
- Range of motion, balance, posture, and flexibility
- Skin integrity
- Home, work, and outdoor environments
- Injured employee’s goals and family needs
Treating the purchase of sophisticated medical equipment for catastrophic cases as a commodity is a big mistake. Here is a real example of how price shopping delayed recovery, irritated the injured worker, unnecessarily increased claim cost, and caused major aggravation for the adjuster.
DME Provider A sent a trained Assistive Technology Professional (ATP) to evaluate the injured worker’s condition, home and needs. The ATP quoted a power wheelchair that was uniquely suited to the injured worker. The adjuster zeroed in on the price (custom power chairs are generally high dollars) and requested an estimate from DME Provider B. The second provider priced the initial quote without a second evaluation, provided a smaller amount, and won the bid.
That’s good, right? Well, no.
Provider B had no experience with this product line and ordered the wrong seating system. The technicians did not know how to program the chair and just dropped it off at the home and left. Without proper setup and patient education, the injured worker was unable to use it. By the time the adjuster dealt with the mistake, the injured worker was angry and had retained an attorney. Now the claim’s overall costs are escalating, and the carrier has paid at least $25,000 for useless equipment.
This case illustrates several important lessons. First, it’s not about the cost of the single item. It’s about delivering a total solution — the right care, education and equipment to facilitate the highest levels of functionality, mobility, and independence for a specific person. Focusing on the price of one element created problems and drove up the overall cost of the claim.
Second, selecting high-end equipment requires clinical knowledge, a great deal of experience, and a thorough understanding of the products’ features and benefits. The DME provider should be able to demonstrate its expertise with the equipment.
Third, a chair needs to be fitted to the injured worker, and the patient and caregivers need to be educated in its use and benefits. Injured workers must understand how to access the features that best address their conditions and how to care for the product. Technicians should return to the home a month or so after delivery to determine patient satisfaction and to make sure equipment is being used correctly and that it’s on track to produce the desired clinical outcomes.
Down the road, the equipment will require ongoing maintenance, service and parts replacements. The DME vendor needs to stay involved in the claim, rapidly responding to questions and service requests, and maintaining and repairing equipment. Staying in touch like this helps technicians observe changes in the person or the equipment, alert adjusters to potential health issues, and recommend adjustments to prevent wounds, shoulder surgeries or other problems.
If these services aren’t part of the equipment agreement, they should be. They are vital to protecting the health of the injured worker and ultimately containing the overall cost to the claim.
Equipment selections should also be forward thinking. Case in point: a therapist conducted a seating clinic for a quadriplegic who will never walk again and recommended a Permobil F-5 Virtual Stand (VS), a power chair that also stands the injured person up. Only a few manufacturers produce power chairs with a standing function and this company has made them the longest and has the most comprehensive models.
Sticker shock prompted the carrier to request two other quotes on power chairs with standing features. There was only one other manufacturer that made a comparable chair, but its chair had only been on the market for two months, and nearly all new-to-market equipment has issues.
The adjuster then asked for a chair without the standing feature. Yes, that would cost less than a standing chair in the short term. However, standing provides the best type of pressure release to prevent wounds. Wound treatment can cost upwards of $100,000 and may require hospitalization. Standing also facilitates better bowel movements, reducing the cost of constipation medications, not to mention improving the person’s quality of life.
Obviously cost containment is always important, and assistive technology specialists seriously consider product prices when analyzing options. If a less expensive chair works just as well, it’s the obvious choice.
Often, though, the higher-priced product is more appropriate and much more cost-effective over the life of the claim. Equipment that enables more functionality and independence reduces other costs by avoiding some home modifications, reducing caregiver hours and even facilitating return to work in some cases.
Zeroing in on short-term savings on the price of a single item is basically just hoping that high-cost issues won’t develop. Instead, focus on the desired outcomes and trust the company managing the equipment needs of catastrophic claims to recommend outcomes-oriented solutions that make the most of medical equipment, in-home nursing care, and home modifications.
About Rick Wyche
As Senior Director of Business Development, Rick Wyche leads sales and account management efforts for ATF Medical. He joined the company as an intern in 2008 and immersed himself in the industry in ways that give him in-depth, practical experience and understanding of catastrophic equipment solutions in workers’ compensation. Rick holds the Assisted Technology Professional (ATP) and Certified Environmental Access Consultant (CEAC) credentials and helps injured workers learn how to use their mobility and catastrophic care equipment in addition to managing marketing responsibilities. He has a Bachelor of Science degree in Conflict Analysis and Resolution from George Mason University in Fairfax, Virginia and works out of ATF Medical’s corporate headquarters in Woodbridge, Virginia.
About ATF Medical
ATF Medical is a medical equipment and supply company that provides comprehensive, clinically based equipment and adaptive housing solutions to fulfill workers’ compensation claims. It is dedicated to improving the lives of injured workers—especially those with complex or catastrophic injuries—by equipping them for independence and the highest functional outcomes.
ATF Medical boasts a team of highly trained and experienced assistive technology and rehab specialists, occupational therapists, and adaptive housing experts who collaborate with adjusters and case managers to select the best solution for the case. The company orders and delivers the equipment and educates injured workers and their caregivers on its use. ATF Medical stays involved for the life of the claim, maintaining and servicing equipment and monitoring the injured employee’s progress.
Known for its stellar service and clear, frequent communication – with customers and injured workers, the company delivers substantial savings to customers without compromising care, quality or service. Clients include workers’ compensation insurance carriers, ancillary service providers, employers, and other payers. Headquartered in Woodbridge, Virginia, ATF Medical can be reached 877-880-4283 or www.atfmedical.com.