"Texas Rehab Providers have a good day"

Make a note; Tuesday, February 17, 2009 was a benchmark day for Texas Rehab Providers.

I know it might sound overly dramatic, but yesterday may have been one of the most important in the evolution of the Rehabilitation Technology Supplier industry within the State of Texas.

For those of you who are not aware, yesterday The Texas Department of Health and Human Services (HHSC) conducted the first of a series of public rate review hearings regarding the reimbursement rates applicable within the Texas Medicaid Program. While HHSC had announced several hearings to be held yesterday, the one of particular interest to rehab providers was the hearing relating to the proposed rate changes to a substantial number of E codes. E codes are of course the codes under which most mobility and seated positioning products are provided. In its announcement, HHSC had proposed to re-price many of the E code reimbursement fees to an amount equal to, or in many cases, a fraction of the current Medicare reimbursement rates for the same codes.

The result of the proposed rate change, if ultimately implemented, would be to dramatically reduce the reimbursement available for a large spectrum of pediatric mobility and seated positioning equipment. The reduction would be of such substance as to simply make it economically impractical for providers to deliver many of the pieces of equipment regularly provided to the pediatric patient base of Texas Medicaid.

With pretty short notice, the leadership of the Greater Texas Rehab Providers Council (TXRPC) assembled a task force of providers to compile data and analysis on the proposed rate changes. They then rallied a sizable group (I am estimating 30 – 40 providers) to attend and testify at the formal hearing in opposition to the proposed changes. This was in and of itself a testament to the maturation of the industry as the group was able to hit the task running. While the response, organization, and content was impressive the real reason I believe the industry had a good day is that for the first time that I am aware of the industry was able to clearly and effectively articulate to HHSC rate and policy staff (there were a sizable number in attendance which is not normal) that using the Medicare reimbursement rates as the benchmark for establishing Medicaid rates on mobility and seated positioning equipment is at its core flawed.

The industry presented an organized, professional, and concise detailing that simply applying the Medicare Established allowable to a code and using it as the applicable Medicaid allowable would serve to totally dismiss the following factors:

1. Medicaid and Medicare serve very different demographic bases, and
2. A Medicare allowable is generally based upon factors relative to a far less complex and less costly product universe than is typically utilized within the Medicaid program, and
3. Medicaid presents dramatically different cost factors in its prescribed distribution model than are applicable in the Medicare program model.

What the ultimate result of the hearing will be is yet unknown. If they were listening (I believe all indications pointed to they were) we may for the first time have opened a door of understanding which could provide the foundation for a major shift in how reimbursement rates are established in the Texas Medicaid Program for mobility and seated positioning equipment. I’d say that makes it a good day.

"DOES PAPERLESS REALLY MEAN LESS PAPER?"

In the short run I wouldn’t count on it, but that really isn't the point.


Today most Rehab Technology Providers are extremely interest in moving operations to “Paperless”. So what is the big deal? Have we all gotten the green bug and want to reduce the demand for paper pulp, do we simply want to hold down our monthly office supply costs, or is there something more to this?

“Paperless” means different things to different folks, but at its core the concept of paperless really has a lot more to do with how we process, manage, and store information, then how much paper we actually use. Paperless generally addresses what has broadly become known as "Document Imaging". A step back in time might be helpful here to understand the scope of the issue.

If we reflect back a relatively short distance in time, most of us will recall the days where most business transactions took place in person or by mail. Patient Charts were photocopied and mailed, claim forms were on hard copy and mailed, and there always seemed to be a rush at 4:00 pm each afternoon to get the day’s mail to the post office drop box. If you needed something real fast you used Fed Ex for overnight delivery. While those might have been simpler times, with the broad acceptance of the FAX machine, we began to enter the digital age. With the fax, we could cut transaction times down by removing the snail mail time, but we still relied on a piece of paper with information on it. The standard phrase of “could you please mail me a copy” turned almost overnight to “just fax it to me”. The fax dramatically changed our access, availability, and our processing time. We could get patient data more quickly, and we could communicate large amounts of information between parties including doctors, vendors, and patients in less time than ever before, but at the bottom of it all we still relied on data printed on a pieces of paper. Our focus was on moving or replicating that paper from point to point in the process. In fact with cover pages, re-faxes due to phone line drops and machine jams, we generally ended up with more pieces of paper going into the file. The hard copy file remained and in most cases today still remains, for most providers, the central receptor of transaction data around which most back office activity takes place.

Then the Internet came along. We entered the age of email. As our desire to communicate more and more on the digital highway of information went up, the demand went way beyond that of simple printed words. We wanted pictures, videos, and voice transmission capabilities, and while all of this got better and better it generated a tremendous need for increased computer and Internet speed. Who remembers that distinctive dial-up modem sound that always proceeded the proverbial “you’ve got mail” and what about that long wait to download a single page of data to your screen? Well where there is demand, there will be supply and today we have Internet and computer speeds that continue to make jumps in astronomical proportions. Now we can download, scan, send via email, or access documents with stunning clarity and at speeds measured in just fractions of seconds. Well sure this makes sending relatives the family vacation photos or watching the latest U-Tube video offering a lot easier, but if your not positioning your back office operations to take advantage of these new functionalities then you haven't yet got the "paperless" bug.



The increase in quality and clarity in document scanning, transmission, and storage may offer the provider one of the most important practical enhancements to revolutionize how we actually operate. We now have the ability to turn the hard copy file into simply an archive storage bin and begin using a digital file as the core of our processing. Now virtually all the data you maintain on a client along with the equipment and services you provide them can be coordinated within a relatively simple and affordable computer system and be available at a click of the mouse.



Just think how much time is spent looking for files in the office, much less actually doing something productive with the information in them. If you have multiple locations or have centralized processing, just think how much more efficient processing digitally instead of manually can be. Simple things like an Rehab Technology Supplier (RTS) scanning a client's insurance card while at clinic, and virtually immediately having that record be available for your funding staff to begin checking on available benefits. What about one location receiving a clinical evaluation but needing to get it to the funding coordinator at the central office? What about being able to have more than one department take action on a case simultaneously without having to wait to get the file. The options are extremely exciting.



If you have not yet started planning or at least exploring how to integrate "Document Imaging" into your current operations there is no better time than now. "Paperless" may not cut your monthly office supply bill, but it very likely will change the basic way you do business.

“A GOVERNMENT BIG ENOUGH TO GIVE YOU EVERYTHING YOU WANT, IS STRONG ENOUGH TO TAKE EVERTHING YOU HAVE."

This famous quote is often attributed as originating as far back as Davey Crockett, but in more recent times it was used by President Gerald Ford in an address to the US Congress in 1974. It might be a sage warning to us all as the President and the U.S. Congress moves forward with an economic stimulus bill that is just short of $1 Trillion Dollars. Yes folks, that is Trillion with a Capital “T”. That is a number the late Carl Sagan did not even need to use to describe distances across the universe.

There is no doubt that the US economy is in need of a shot in the arm, but the real question is will the cure end up killing us instead. Sure the current state of affairs has impacted a broad range of individuals and businesses, and the rehab provider is no exception. Any economic recovery package will have to be broad reaching, but make no mistake about it there is nothing free in this world and the spending being proposed by the US government in this plan will have to be paid for at some point in time. Pair that with the stated objectives of the current administration to achieve a redistribution of wealth in the US and the economy of the future may be far different than anything we have ever known.

“TEXAS REHAB TODAY GOES LIVE”

This is the inaugural post to “Texas Rehab Today”. There will be no balloons, no bands; no buffet luncheon; and no headline news, just frank discussion about the challenges, opportunities, and in some cases even the silliness of what the rehab technology supplier must do on a daily basis simply to try and make a reasonable living in a professional manner. For those who may not be familiar with the rehab technology supplier industry, the business of a rehab technology supplier, in its simplest form, is the design, sale, and fitting of mobility (wheelchairs) and seated positioning equipment (the cushions, pads, straps, braces, and other similar components that might be added to a wheelchair) to those among us who by virtue of illness, accidental injury, or otherwise need these enabling pieces of equipment to facilitate a quality of life most of us who do not need such equipment take for granted..

Over the days and weeks ahead my hope is that “Texas Rehab Today” will provide a forum to identify needs, shed light on problems, explore possible solutions, and in so doing serve to enhance the quality of products and services offered, the financial stability of suppliers, and the professionalism by which the rehab technology supplier industry operates.