ADA Access is Patriotic and Profitable!

Guest blog post by Bob Vogel

It is unfortunate that media reports on Americans with Disabilities Act (ADA) access (Title III) usually focus on financial costs to businesses or municipalities, when the reports should be pointing out that ADA access is patriotic and profitable.

The crucial link to ADA access and patriotism became clear to me while doing research for an article and I interviewed Anthony Goldsmith, a Civil Rights Attorney, and member of the legislative committee of Californians for Disability Rights Inc., the oldest and largest membership organization of persons with disabilities in California.  Goldsmith recalled his father telling him about his time in the Army during World War II.  While stationed in Maryland he trained French troops to help liberate their nation. During this period Goldsmith’s father traveled to the nation’s Capitol and saw President Roosevelt getting carried up steps into congress in a way that would avoid people knowing that the President was paralyzed–something most people knew, but avoided talking about.

Goldsmith’s father told him how powerful this image was, and how it made him think, “What will happen to me if I come back from the war badly hurt, maybe without legs?  How will I get around?  How will I have a family? How will I support myself?”

The passage of the ADA in 1990 is a powerful reminder of how far our country has evolved in areas of freedom and equal rights since that time.

“Support Our Troops!”  This popular saying is often seen on ribbon-shaped stickers. It’s a great message and something we can all agree on. Our troops have pledged to defend our country and defend our freedoms including the freedom of equality–something we sometimes take for granted. They’ve pledged their defense even if it results in their permanent disability or untimely death.  For this we owe them our eternal gratitude.

According to the Bureau of Labor Statistics, over 600,000 veterans who served in Iraq and Afghanistan have a service-connected disability (injured while in the military). The latest U.S. census puts the total number of veterans living with service-connected disabilities at 3.4 million.

Imagine how cool it would be to start a campaign where businesses and municipalities that are accessible (curb cuts, ramps, accessible parking, etc.) put up signs and/or stickers proudly saying “In support of our troops we are 100% ADA accessible.”!!!  I submit, the most important step a business can take to show that they support our troops is to inves time and effort to ensure they meet ADA access standards. A fully accessible business shows respect for the freedom and equality that our troops have fought for.  Imagine the respect and sense of “thank you for your service” this would show our troops—taking action, providing access and equality as a sign of thanks and respect.

On the other hand, imagine what it must be like for veterans that became disabled fighting for our freedom when they are excluded from entering a business, or excluded from parts of it because it isn’t accessible, only to hear the same tired old excuses those of us with a disability have heard for years;  “I didn’t know we had to be accessible” or “I thought this business was “grandfathered in. (There is no such thing)” Or worse, “Gee, we didn’t think there is a problem. We’ve never seen people in wheelchairs in our business.”  Umm, you have steps coming up to your entrance…  Think of the message this conveys to our troops.

Unfortunately ADA access and business is often portrayed as an “Us vs. them issue.” It isn’t. ADA access is an US issue—a disability can happen to anybody at any time, and if you live long enough you will acquire some type disability.  Unfortunately, most media stories incorrectly focus on cost or difficulties in understanding ADA access law.. It is rare that media stories point to the many of resources available to help businesses become accessible, starting with a $5,000 per year federal tax credit for access improvement. To help businesses understand ADA access laws and codes, the ADA National Network has links to ADA Regional Centers will help businesses understand access requirements. See Resources  www.adata.org

In addition to being patriotic, ADA access is profitable, allowing an estimate of probably 40% more consumer dollars into a business!  A good example of this profit is the National Disabled Veterans Winter Sports clinic, an annual event held in early April in the tiny village of Snowmass, Colorado.  During Winter Sports Clinic, going into its 27^th year, over 400 veterans with disabilities spend an amazing week getting introduced to a variety of adaptive sports including skiing, sled hockey, scuba diving, cross country skiing and rock climbing.  Joining the veterans are their families and friends – the numbers easily add up to 1200 people or more customers for local businesses. The event happens during a slow, financially difficult time of the season; a time when businesses would normally be laying people off. Instead the event fills hotels, ski lifts, and brings in over one million dollars to businesses in the village.

Similar numbers are seen at the National Veterans Wheelchair Games—held in a different U.S. city each summer.  The summer games are twice the size of the Winter Sports clinic.  Hosting the summer games is a coveted honor for a city, not to mention the millions of dollars it brings to the businesses of the host city.

The Veterans Winter Sports Clinic and Summer Games are a good example of the consumer dollars a business with ADA access brings in—consumer dollars that non-accessible business leaves on the table.  According to the most recent census, nearly 20 percent of people in the United States have a disability. This number is quickly growing as the baby boom generation ages.  Not having access means one in five consumers cannot spend their dollars at a business; now add in family and friends of a person with a disability–logic and basic math dictates that businesses that are not fully accessible unknowingly lose out on 30 to 40 percent of potential consumer dollars.

The bottom line–ADA access is patriotic and profitable!  An accessible business shows support and respect for our troops.  Furthermore, ADA access is profitable–the question for businesses isn’t “Can you afford to become accessible?” the question is, “How can you afford NOT to be accessible?”

 

Resources

ADA National Network: www.adata.org.

Click on Regional Center on the lower left part of the page to find ADA Regional Center.

Californians For Disability Rights, Inc.: http://www.disabilityrights-cdr.org

Checklist for Readily Achievable Barrier Removal:  http://www.ada.gov/checkweb.htm

United States Access Board:  www.access-board.gov/

 

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

How SCI And Gluten Created A “House Worthy” Mystery

Guest blog post by Bob Vogel

The month of May marked the final episode of  “House”, the TV show about a misanthropic medical genius who headed a team of diagnosticians. A theme of each episode was a medical mystery–the patient’s life hanging in the balance. The symptoms would mimic a malady or disease, tests would appear to confirm it, yet the treatment often wouldn’t work, sometimes it made matters worse until at the last moment Dr. House would notice a seemingly insignificant symptom or clue that would lead to a completely different and correct diagnosis, the cure was usually simple.

SCI (spinal cord injury) can often produce symptoms worthy of an episode of House.  Paralysis creates so many changes in the way a body works and reacts that it is paramount for those of us with SCI to learn what “normal” is for our body and to make note of any changes, like increase or change in spasticity or pain, and communicate these changes to the medical professionals that work with us to maintain our health.

At 52, I’m in my 27^th year as a T10 complete paraplegic and I recently went through a four-year long “House worthy” medical mystery of my own. At first the symptoms were subtle, I started feeling really run down and fatigued, something I chalked up to a combination of being in my late 40’s and a full-time dad.  Then I started getting a noticeable increase in neuropathic pain (a combination burning, pins and needles feeling) in my legs and an increase in spasticity.  I brought this up to my primary care physician and he did a complete blood workup and urinalysis—all of which came back normal.

Then I started getting patches of itchy scaly skin on my right hand, a dermatologist confirmed it was psoriasis, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/ ,  a condition caused by stress and or some type of inflammation, and she prescribed an anti-inflammatory cream.

The next symptom came on suddenly, severe neuropathic pain in my right abdomen at my injury level (at the belly button line)—it felt as if my pants were pulled up to my belly button and were scratching my skin.  The pain came on so suddenly I wrote the date in my “SCI journal.”  The area became extremely hypersensitive, and the neuropathic burning extended below the level of sensation on my abdomen.

Working in conjunction with my primary care and PM&R physicians, I tried everything from senna, a prescription laxative, to see if the pain was caused by constipation to various tests including an abdominal CT scan to rule out obvious (perhaps serious) problems and a spinal X-ray to check for disc problems, and scoliosis.  All came back negative—good news but no closer to an answer.

Three years went by. The symptoms remained with no answers.  Then I started writing a column on syrinxs (the formation of cysts on a spinal cord due to scar tissue from SCI) for my column Para/Medic http://www.newmobility.com/articleView.cfm?id=11770&srch=syrinx in New Mobility magazine. When I interviewed Dr. Scott Falci a Neurosurgeon at Craig Hospital in Denver, Colorado, an expert on the subject, a syrinx seemed to explain the onset of my spasticity and neuropathic pain.  If this was the case I was looking at two surgeries, a 6-hour surgery to remove my rods, and another extremely complex surgery to fix the syrinx.  Dr. Falci cautioned it is a serious surgery and is usually done if there is loss of sensation (sensation level moves higher).  I had kept a log of my sensation level from the day I was injured—thankfully it hadn’t changed.

Dr. Falci said the main way to diagnose a syrinx is a case history, and by ruling out all other possible causes for the symptoms, I had ruled out most of them. A complete urological workup was done and ruled out kidney and bladder stones as possible causes for the symptoms.

By now I had endured four years of unexplained pain and fatigue; symptoms that were putting my everyday life on hold and seemed to be caused some something related to my SCI, most likely a syrinx, something that would mean the possibility of two major surgeries and a long recovery.

A follow-up appointment with my primary care doctor uncovered a clue that led to a “House” moment.  Determined to help find an answer, my doctor ordered another blood panel, this time it showed I was anemic. I was referred to gastroenterologist for an endoscopy (small tube with a camera that goes through the mouth into the stomach and small intestine) and colonoscopy. The endoscopy revealed my small intestine was inflamed and had several tiny ulcers in it—a biopsy was taken from my small intestine and the results showed I had celiac disease http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION – a condition caused by a reaction to gluten, which is found in wheat, barley and rye.  To put it another way, I have gluten intolerance, meaning I’m allergic to wheat, barley and rye.  A blood test confirmed that I have a “very high” sensitivity to gluten.

When I first got the diagnosis I had to chuckle because I had made sport of the media coverage of stars ranging from Oprah to Victoria Beckham touting how they had switched to gluten-free diets.  When I would hear friends discussing the diet I say, “Oh boy, here we go again” and jokingly adopt a smug sounding voice and say “Excuse me waiter, is there wheat in this water? Because I’m gluten free!”  Oh the irony!

I started eating gluten-free over a month ago.  It was tough at first, especially when I realized that most beers are made out of wheat! When shopping I had to bring my reading glasses and a magnifying glass with me for the ingredient labels. Wow was it eye opening! It seems anything with more than three lines of ingredients has wheat in it, and a bunch of unpronounceable “additives” that probably aren’t healthy.

Perhaps this was nature’s way of telling me to get back to healthy (and tasty) eating.  In my athletic days (usually broke) I snacked on fruits, and cooked my meals lots of stir fry vegetables with just a bit of meat (inexpensive and healthy).  In the past decade or so I’d gotten into the habit of eating “toy food” (food that comes in a microwave or fast food wrapper), which probably isn’t good for me, and is adding a “spare tire” around my mid-section.

I’ve figured out the easiest way to shop gluten-free is to stick with fruit, vegetables, chicken and fish.  I’m also figuring out a “go to” list of gluten free staples and I’ve discovered a number of gluten free beers!  My favorite so far is Red Bridge by Anheuser-Busch.

And just like an ending to a “House” episode, it is working!  When I went gluten-free my symptoms slowly started to diminish, and within four weeks they were gone!  The neuropathic pain in my stomach and legs is gone, my leg spasticity has quieted down, the psoriasis on my hand is all but vanished and I seem to be getting my energy back.

The point of this isn’t to suggest everybody jump into being gluten-free, rather to offer one more tool in the myriad of possibilities when trying to solve problems associated with SCI.  I was lucky that one simple cause explained and got rid of so many symptoms.

When it comes to gluten sensitivity, literature suggests it is still a grey area that effects a small part of the population. WebMD research suggests that 5% to 6%–about 18-million Americans—have some degree of gluten sensitivity.  In various articles experts point out that although blood tests for gluten sensitivity have high degree of false negatives, if people are having symptoms that may be caused by gluten sensitivity (see resources) it is still a good idea to get a blood test. They further suggest that even if a blood test is negative, try a gluten-free diet for 2-4 weeks and see if symptoms improve.

As for me, I feel the diagnosis of celiac disease was like dodging a bullet—it has eased or eliminated severe symptoms and is giving me my energy back. I’m hopeful that avoiding toy food and getting back to a healthier eating pattern will also help me loose my “spare tire”.

 

Resources:

Celiac Disease; http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=symptoms

Gluten-Free Diet; =Gluten Allergy; http://www.webmd.com/allergies/guide/wheat-allergy

Gluten Sensitivity: Fact or Fad?; http://www.webmd.com/diet/news/20120220/gluten-sensitivity-fact-or-fad?page=2

Para/Medic, Syrinx and Pain;  http://www.newmobility.com/articleView.cfm?id=11770&srch=syrinx

Syrinx, “Untethering the Invisible Knot”, http://www.newmobility.com/articleView.cfm?id=11376&srch=Syrinx

Wheat allergy; http://www.webmd.com/allergies/guide/wheat-allergy

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

Upcoming FREE Webinars

United Spinal Association is hosting several FREE webinars as a part of their webinar series. You can find more information on their website at unitedspinal.org.

ADA Training Webinars
Puerto Rico Building Codes–March 23, 1pm-3pm EST (Click Here For Details)
Virgin Islands Building Codes–March 30, 1pm-3pm EST (Click Here For Details)

United Spinal Association’s Accessibility Services program is teaming up with Cornell University’s Northeast ADA Center to host free Americans with Disabilities Act (ADA) training webinars.

In conjunction with the Northeast ADA Center, Accessibility Services will host four live, instructor-led on-line programs that will provide attendees with an overview of the 2010 ADA Standards for Accessible Design.

The webinars focus on the areas where accessibility requirements found in the 2010 Building Code of Puerto Rico and the Virgin Islands differ from federal accessibility requirements.

They will highlight the effective dates for the new regulations to ensure that design and building professionals are aware of their obligations under the law. The differences between the 1991 ADAAG and the newly release 2010 ADA Standards for Accessible Design will also be covered.

 

Domestic Violence and Disability
Tuesday, March 27, 2012 3:00 PM – 4:00 PM EDT

This webinar will explore the intersection of domestic violence and disability. Information will be provided about programming and services available at Barrier Free Living, Inc. and the importance of specialized programming for survivors of domestic violence living with intellectual and developmental (IDD), physical and/or psychiatric disabilities.

Click here to register.

 

Eliminating Medicare Restrictions
Thursday, March 29, 2012 2:00 PM – 3:15 PM EDT

Medicare has undertaken many changes to therapy services, prescription drug coverage and medical equipment purchases critical to beneficiaries with disabilities. These changes have serious impacts on the accessibility, affordability and quality of needed care. This webinar describes those issues within the Medicare program that impact you.

Click here to register.

 

Financial Planning and Your Child
April 5, 3pm-4pm (EST)
Speaker: Chris Jones, CFP; Center for Wealth Preservation

This webinar will discuss the role of Special Needs Trusts, both first party and second party trusts and the various options on how they might be funded.

Click here to register.

 

What You Need to Know About SSDI and Medicare
Wednesday, April 18, 3pm-4pm (EST)
Speaker: Tai Venuti, MPH, Manager of Strategic Alliances–Allsup, Inc.

This presentation is designed for people who have questions about filing for Social Security Disability insurance SSDI benefits and subsequent Medicare eligibility. It includes a brief history of SSDI, explains the three main SSDI eligibility criteria and the five steps in the SSDI application process, and describes the full range of benefits that come with SSDI, including Medicare eligibility. Becoming eligible for Medicare means reliable access to healthcare, however, understanding how your options work and comparing all the plans available can be frustrating and confusing. This presentation will provide information on the steps you should take when deciding how to use your Medicare benefits. We’ll educate you on all the parts of Medicare – Medicare Parts A, B, C and D, plus Medigap – and what they mean to you. We’ll also let you know what you should think about when considering a Medicare plan.

Click here to register.

 

The Ins and Outs of Manual Wheelchairs–Matching the Wheelchair to Your Life
Thursday, April 26, 2pm-3:15pm (EST)
Speaker: Ann Eubank, LMSW, OTR/L, ATP; VP Community Initiatives–UsersFirst, a program of United Spinal Association

UsersFirst is hosting a webinar in the structure of radio show where a wheelchair expert will answer any and all of your manual wheelchair questions. We will get into the specifics of the manual wheelchair: the different types, sizes, weights, wheel sizes, backs, seats, wheel position, the best way to push a wheelchair, etc. You name it and we will talk about it.

If you want, tell us your questions or issues prior to the show and we will address them live on the air. Drop us an email at usersfirst@unitedspinal.org. Registration info coming soon!

 

Contact Ziggi Landsman at United Spinal for more information.

Ziggi Landsman
VP of Online Relations
United Spinal Association
zlandsman@unitedspinal.org

Note: The text used is directly from United Spinal Association email and website.

Why there is such a big price difference in medical products that look so similar

Guest Blog Post by Bob Vogel

Evaluating a product by price alone can be confusing and misleading. Why do two cushions that “look” similar have significantly different prices? This is an important question, especially when it comes time to order your next cushion. In order for a DME (durable medical equipment) cushion to be sold as a medical device in the US it must comply with a specific set of rules and tests set forth by the FDA. These rules and tests are a good thing — I want to be sure that the cushion under my butt has been tested and proven to protect my skin.

However, there is a big difference between doing the minimum required to meet regulations and doing the maximum to ensure that wheelchair users have the best skin protection possible.

The first expense is research and design costs associated with making a cushion before it can be submitted to the FDA for approval to be sold. Companies like ROHO (and other market leaders) spend a tremendous amount of money in this area, while other companies that might make similar looking products spend very little in this area. ROHO continually invests money in research and design in an ongoing effort to make the best product for consumers. Research costs include a prototype tool for every research cushion — something that is very expensive with no guarantee that it will ever reach the consumer — laboratory studies, clinical studies, and support papers for the research. Examples of published ROHO papers and research can be viewed here: http://www.therohogroup.com/roho institute

The FDA has a specific set of rules and tests it requires for DME complex rehab cushion to be sold as a DME product in the US. The manufacturer has to be registered with the FDA and pay associated fees on an annual basis and must meet FDA quality system regulation (QS) manufacturing requirements for designing, purchasing, manufacturing, labeling, storing and servicing medical devices (in this case, cushions). The manufacturer has to have traceability of the product (cushion) and report if there is any kind of recall or adverse event with the product.

The FDA inspects manufacturing facilities and if an inspection or an FDA audit finds there isn’t compliance with its rules, the FDA can shut down the plant.

ROHO takes quality control much further than the FDA model with its quality management systems’ being certified to two ISO standards — ISO 9001:2008 and ISO 13485:2003, which is a medical device quality standard. Manufacturing all ROHO cushions, except the PostureLITE™ by ROHO Cushion at its plant in Belleville, Illinois, ROHO is able to maintain the highest levels of quality control in every aspect of every cushion.

An example of ROHO quality control is the neoprene used to make its cushions. Instead of relying on an outsourced compound, ROHO compounds and mixes its own neoprene and every batch is tested to ensure each cushion maintains the highest standard. To further enhance quality control, each ROHO cushion has a unique serial number that ties it back to the specific date that it was made and processes under which it was manufactured in order to pinpoint any issue regarding quality if needed.

Each and every ROHO cushion goes though multiple layers of quality inspection to ensure each cushion performs to specification before it is shipped.

Another important thing to consider when ordering a new cushion is warranty return policy and customer service — a manufacturer expense that ROHO feels is of vital importance. If you have a problem with a ROHO cushion you call customer service and give them the serial number of the cushion and tell them the problem. Customer service will be able to immediately tell the manufacture date, exact model and size of cushion and warranty information. If it is under warranty, they will send you a new cushion right away, and have you send your old cushion back in a pre-paid shipping box. This enables ROHO to examine the cushion, document the problem and further enhance quality control by gaining knowledge to take steps to work on eliminating problems and improve cushions.

An example of this is, years ago ROHO identified an area of wear on the cushion where the cell met the base of the cushion. To address this, ROHO Engineering spent a great deal of money to redesign the cushion so the cushion cells had a more gradual taper. The redesign meant great expense for re-tooling for all cushions, but the end result was a longer wearing cushion for the customer.

When it comes to qualifying for reimbursement for a DME cushion, most insurance companies follow Medicare guidelines — the product has to meet a Cal-117 Fire safety test, the cushion must have minimum of an 18-month warranty and show that the cushion will pass a Simulated Immersion Laboratory test — a test that measures a cushion’s ability to allow cylindrical devices (meant to simulate a human pelvis) to sink 40 mm into a cushion with a 31-pound load without bottoming out — about 18 months of use. 40 mm is the goal because it simulates immersion of the entire pelvis.

Unfortunately, the Simulated Immersion Laboratory test does not measure pressure, meaning you could end up with a cushion that passes all of the tests, yet puts tremendous pressure on bony areas of the pelvis and puts the user at risk of a pressure ulcer.

Which brings us to another example how ROHO goes the extra mile for consumer safety. ROHO, in conjunction with Sunrise Medical, has spent considerable time and a huge sum of money to develop a superior Simulated Immersion Laboratory test device — one that is in the shape of a pelvis, designed to address the most difficult seating/pressure challenge. The device has eighteen sophisticated pressure sensors imbedded in the indenter at typical pelvic pressure points so you can see the actual pressure readouts on the pelvis. The device is designed to measure all 18 points when immersed at 40 mm in the cushion — the goal is equal pressure distribution on all areas without any high pressure points. An analogy is a scuba diver under water — they have a ton of force applied to them but it is equally distributed so they don’t develop problems.

To make seating safer for all consumers, ROHO and Sunrise have done all of the testing and research on their Simulated Immersion Laboratory test device, and are offering the research and plans for the device to testing agencies for free to try and raise the bar and make seating better and safer for all consumers.

When looking at your next cushion, do your research:
• Where is the cushion manufactured?
• How long is the warranty? (ROHO cushions’ warranties are 24-months and 36-months depending on model).
• What is the warranty policy?
• Is the manufacturer continually improving the product?
• Does the manufacturer include research papers about its product on its website?

The bottom line of all this is, there are a lot of cushions that “look” like a ROHO but cost less — performance, seating and positioning and how a cushion protects your skin, how a cushion protects your bottom, should be the bottom line on cushion choice. And as always, it is vital to ask and make sure the exact make, model and size of cushion are included on all therapists’ and physicians’ prescriptions as in “ROHO^® Quadtro Select^® High Profile^® Cushion, 16″ X 16″.

 

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

Why You Need to Ask for Your Cushion by Name

Guest blog post by Bob Vogel

In my experience with DME (durable medical equipment) dealers, competition leads to quality. I was injured in 1985 — a T10 complete paraplegic — my first cushion and wheelchair were covered by Medicaid and provided by a local DME dealer. In the 90’s I worked as a sales rep for a wheelchair manufacturer, selling to and working with DME dealers. After that I worked as a sales rep for a DME dealer.

In my experience, a good DME dealer has the knowledge and takes the time to properly fit and provide the best cushion, wheelchair, etc., to meet their client’s needs. DME dealers strive to provide the best service and best products to meet our needs because it’s the right thing to do, and because it’s good business. We have the power to take our business to another DME dealer and word of mouth — good or bad — is powerful when it comes to business.

Unfortunately, because of competitive bidding, this paradigm is changing. The CMS (Centers for Medicare and Medicaid Services) competitive bidding program has DME dealers bidding to see who can provide equipment in a certain category for the lowest price — for you and I this category complex rehab, from cushions  and wheelchair backs to manual chairs and high-end power chairs. Round I of competitive bidding is already in place in 9 regions. Round II of competitive bidding is looming on the near horizon with 91 regions including the largest cities in the country.

Under competitive bidding, instead of Medicare beneficiaries having five to ten Medicare providers to choose from that compete based on the quality of the products and service they provide, we may only have one in our region — eliminating the competition and the need to provide quality products and service. Have a local DME dealer who didn’t win the bid that you have been going to for years? Tough. Don’t like the way the winning bid DME dealer does business? Tough. It’s not just Medicare — Medicaid and many private insurance companies have track records of following the Medicare competitive bidding guidelines.

The way competitive bidding is set-up encourages DME dealers that are only concerned with profit to underbid DME dealers that are truly concerned with providing the right product for their client. As an example, let’s take a look at a common type of cushion. Let’s say your skin and seating requires a ROHO^® HIGH PROFILE^® Single Compartment Cushion — the government HCPCS (Healthcare Common Procedure Coding System) code for this type of cushion is E2622. Now let’s say there is a dealer who is only in it for profit, winning the bid, and becoming the only game in town. Medicare’s Pricing, Data Analysis and Coding (PDAC) for E2622 includes 915 different cushions. According to this data, every cushion on the list will protect your skin just the same. If dealer only who is in it for profit carefully goes through the list they will find some real “bargains,” including a layered foam cushion with a 1/4″ gel cover that retails for $39. But hey, it fits into the code so it “should” protect your skin just like a ROHO HIGH PROFILE Single Compartment Cushion — right? Wrong!

When I left rehab in 1985, my therapist sent me home on a memory-foam cushion saying it “should” protect my skin just as well as the ROHO HIGH PROFILE Single Compartment Cushion I had requested. Despite regular weight shifts, I developed a tiny pressure ulcer within 3 months. Regular mirror-skin checks enabled me to catch it right away — I got the ROHO Cushion and was able to heal at home, feeling like I had dodged a bullet.

A dealer only interested in profit could submit a lowball bid of say $250 for this category — win the bid and start shoving $39 cushions under clients while collecting $250 per cushion from Medicare.

This is why it is vital that you, working with your clinician, request the exact cushion that you need on a doctor’s prescription/documentation. Because even if you are in an area that already has competitive bidding, there is a clause in competitive bidding that says if a doctor’s prescription specifies the make, model and product, then the winning bidder — the DME dealer — has to provide that cushion, or find another winning bidder DME dealer that will provide the cushion. As competitive bidding looms, it is more important than ever for each of us to advocate for our proper seating. Make sure your prescription includes exactly what your seating needs are, for example ROHO® HIGH PROFILE® Single Compartment Cushion (4″). Make sure the size of the cushion needed is included on the prescription, for example 16″ x 16″.

In addition, there is still time to phone, email, or write your representative and senators and tell them you do not want competitive bidding. Explain that while competitive bidding may save money in the short term, the wrong cushion risks life threatening pressure ulcers that will cost taxpayers in excess of $50,000 per occurrence in hospitalization alone.

So what can you do to change the outcome?
1. Send letters to your representative and senators. It’s OK if you don’t know what to write, we have a letter already written and all you have to do is fill in the blanks.
2. Go to competitivebiddingconcerns.com and fill out a form to record your personal struggles with getting mobility equipment.

To view the list mentioned in this blog, go to the Medicare Pricing, Data Analysis and Coding list (PDAC) https://www.dmepdac.com/dmecsapp/do/search. Next, scroll down to the green bar that says “Search DMEPOS Product Classification List.” Under the green bar to the right, type in E2622 and click on the purple GO button and all 915 cushions that meet the criteria for this code will appear.

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog.

Next Page »