Not All Equipment is Alike: The Need for Expertise in DME

There is a growing trend in the workers’ compensation industry for carriers and excess carriers to contract with network services providers, under the belief that having a menu of services supplied by a single provider will somehow streamline the process and cut costs in the area of claims management.

The reality, however, is that the result is often a company that specializes in nothing, while attempting to deliver everything. So, too, carriers, excess carriers and third party administrators (TPAs) often trust that their durable medical equipment (DME) provider is delivering the best equipment selection for each individual injured worker involved, for a truly fair price.

This is not always the case.

In selecting DME for an injured worker, there are several key factors that must be considered to assure the equipment is functionally precise, medically appropriate and certain to provide the best outcome for both the injured worker and the carrier/client. Overlooking the essential parts of the DME selection process can result not only in a piece of equipment that does not serve the injured worker effectively, but also significant costs to the carrier/client when equipment is inappropriate for a given individual and/or has to be replaced because of poor evaluation techniques and lack of knowledge by the evaluator.

An added truth that is rarely talked about are the significant mark-ups applied by many network services providers and hidden in lump sum bids. Once a bid is passed through two, three, sometimes four layers of subcontractors, costs quickly escalate and quality of care suffers.

In this series of two articles, we will share the essential components you need to know and expect from your DME provider to assure the equipment selection on each of your claims is functionally precise and medically appropriate for each individual injured worker, offering the most quality and durability for the long-term, as well as fairly priced and specific to the needs being addressed in each claim.

To be certain your DME choices are functionally precise and appropriate to each individual injured worker involved on a claim, it is imperative your provider take into account the following essential steps:

1)First and foremost, a skilled assessment should be handled by assistive technology professionals (ATP), to ensure accuracy in equipment selection. Having an assessment provided by someone with the appropriate medical background will assure an informed, exact selection is made. This one step can save enormous time, frustration and money.

For example, an injured worker who has paraplegia has elected to have a manual wheelchair custom built to their needs. Without understanding the natural progression of paraplegia in some cases, the chair will not meet the needs of the claimant for long. Does the claimant have shoulder issues, are they active, do they have good trunk stability, what is their reaction time? Each of these considerations has to be made for appropriate selection. Only a seasoned ATP is capable of this.

2) Second, any strategic partnership you develop with a DME provider should include complete transparency in their billing process. If the costs you are provided are truly fair, reasonable and honest, there is no need to hide where the price came from in the first place. You have a right to know exactly what you are paying for, item by item. This will be covered more in-depth in article two.

3) Any reliable DME provider should provide complete and total service after a sale. If they are truly knowledgeable about the equipment they are providing and have the medical knowledge to make an informed selection for the individual involved, they will have no problem standing by their equipment if or when any concerns arise.

For example, a standing frame wheelchair may be requested by a therapist/client as part of their rehabilitation package. While standing frame chairs are excellent choices for some users, many claimants are unable to actually use the feature that the chair provides. A seasoned ATP with complex rehabilitative knowledge will know to ask certain questions before recommending. Has the claimant been in a formal standing program? If so, how long have they participated? How long can they tolerate standing? Do they have blood pressure issues that prevent standing? Have they tried a separate free standing frame first and now need it integrated into their chair? These are all valid questions that should be asked when considering a cost heavy piece of DME that is all too often recommended because of its appeal.

As in many other areas of workers’ compensation claims, time is quite often of the essence in providing DME to allow the injured worker to experience the greatest functional independence and safety as possible. DME providers with skilled assessment professionals and true expertise in DME should be able to visit the patient location to assess them for their custom equipment within 48 hours of receiving a claim assignment.

So, too, it should not be unreasonable to expect a full evaluation report within a 48-72 hour time frame and include two to three options for equipment selection.

Once a carrier authorizes a piece or pieces of equipment, your DME provider should be able to complete the ordering, delivery, set up and instruction that goes along with the purchase within a reasonable amount of time. If the DME provider is certain of the appropriateness and quality of their selection(s), a one year, no questions asked, service program covering all parts and service calls should be a reasonable expectation on the carrier’s part.

The next time you think of purchasing DME for one of your injured workers, ask yourself this:

• Does my provider have experienced, knowledgeable ATPs with medical knowledge and industry-specific expertise?
• Can my provider give me specific functional and medical reasons for their choices and options for me to consider?
• Does my provider back their choices up with a warranty and guarantee of timely service and delivery?
• Do I know exactly who is evaluating my claimant? Can I contact them if need be?

In part two, we will address the financial costs involved in dealing with a DME provider that either lacks the experience and knowledge to provide an accurate, individualized functional assessment; who fails to back up their product selection with a warranty and guarantee of service and delivery; and/or who fail to operate with complete transparency in their billing practices.

Lauren Underhill is president and CEO of CorLife and CorSupply LLC, both headquartered in Green Bay, Wis. The firms specialize in durable medical equipment and disposable supplies, respectively, and do business exclusively with workers’ compensation/auto liability insurers, excess insurers and TPAs.