Adaptive Equipment Service and Repair: A Guide for Disabled Persons and Caregivers
By Adam J. Langino, Esq.
Introduction
Disabled persons rely on complex rehabilitative technology (“CRT”) service companies to properly order, supply, repair, and replace their equipment so they can participate in their community. As disabled persons say, “their wheels are their legs.” Unfortunately, sometimes CRT service is untimely, incomplete, or incorrect. The following information may be helpful if you have an issue with a CRT service company.
Background
There are over 2.5 million wheelchair users in the U.S.i Market research indicates that the wheelchair industry will grow 7.0%, reaching 8.09 billion dollars by 2026.ii In 2018, the powered chair segment held the largest market share.iii A power wheelchair is a Class II medical device.iv The major manufacturers are Permobil, Pride, and Invacare. These manufacturers rely on service providers to help market, sell, and service their products like a car manufacturer relying on local dealerships.
The largest service provider in the United States is United Seating & Mobility (more commonly known as “Numotion”). Numotion has 150 locations, 2,800 employees, and serves more than 260,000 people.v For many disabled persons, Numotion is their only option for sale, service, or repair. As many disabled persons are aware, Numotion is expanding at an exceptional pace by acquiring smaller, local family-run service companies.
From my research, it appears the driving force behind Numotion’s expansion is economics. In 2018, AEA Investors, a venture capital private equity firm, purchased a controlling interest.vi AEA Investors was founded in 1968 by the Rockefeller, Mellon, and Harriman family interests as “a private investment vehicle for a select group of industrial family offices with substantial assets.”vii According to the Harvard Business Review, “venture money is not long-term money.”viii Venture capitalists invest in companies, help them grow, and then sell them for a profit.ix
Safety Standards
Service corporations, like Numotion, primarily profit by receiving private insurance or federal government reimbursement for obtaining, replacing, and servicing powered wheelchairs for disabled persons. Depending on the options, power wheelchairs can cost upwards of $50,000.00. They are complicated and expensive pieces of equipment. Disabled persons typically must be their own advocate in ensuring service is timely, correct, and meets their needs to fully participate in their communities. There are federal standards, industry standards, and Numotion standards that govern servicing wheelchairs safely. All disabled persons and caregivers should be aware of these standards when dealing with their service providers.
Federal Standards
The federal standard for CRT service is found in the federal government’s Medicare service guidelines. For example, as a U.S. Medicare Durable Medical Equipment Prosthetics/Orthotics of Supplies service provider (commonly referred to as a “DMEPOS”); there are federal service safety standards that CRTs like Numotion must follow. The rules require service companies to do the following:x
Repair or replace, free of charge, Medicare-covered item that are under warranty.
Maintain proof it instructed beneficiary on the device.
Answer, respond to beneficiary complaints and maintain documentation of such contacts.
Maintain, replace, at no charge or repair cost any Medicare-covered items it has rented to beneficiaries.
Provide clear, written or pictorial, and oral instructs relating to use, maintenance, and hazards of equipment.
Have competent technical personnel to deliver and set up equipment, items, and services, and train beneficiaries and caregivers.
Assure all equipment and item(s) delivered are consistent with the beneficiary’s needs, risk, and limitations.
Ensure the recipient can use all equipment and items provided safely and effectively in the settings of anticipated use.
Provide follow-up services.
Have at least one trained technician at each service location.
Industry Standards
In addition to federal standards, there are industry standards that CRT service companies should file. For example, a disabled person typically works with an Assistive Technology Professional (commonly called an “ATP”) to select equipment that best fits their disability. ATPs should be certified and the Rehabilitation Engineering and Assistive Technology Society of North America (commonly “RESNA”) is the primary U.S. certifying organization. Many CRT companies, like Numotion, advertise that their ATPs are RESNA certified, therefore, it is important for a disabled person to be aware of RESNA’s Standards of Practice and Code of Ethics that ATPs are required to follow.
RESNA’s “Code of Ethics” is available online and can be found here (Source: https://bit.ly/3Ix4lEf). As it pertains to service, RESNA requires its members and CRT service providers to “hold paramount the welfare of persons served professionally,” “practice only in their area(s) of competence and maintain high standards,” and “issue public statements in an objective and truthful manner.”
RESNA’s “Standards of Practice” are also available online and can be found here (Source: https://bit.ly/3IpxcdD). RESNA has twenty-two standards “set forth fundamental concepts and rules considered essential to promote the highest ethical standards among individuals who evaluate, assess the need for, recommend, or provide assistive technology.”xi For example, RESNA requires that ATPs “keep paramount the welfare of those served professionally,” “engage only in those services that are within the scope of their competence, their level of education, experience, and training,” and should “provide technology that minimizes consumer’s exposure to unreasonable risk.”xii
If a CRT service company or an ATP violates RESNA’s “Code of Ethics” or “Standards of Practice” they may be reprimanded by RESNA’s “Professional Standards Board.” If you want to report an issue to RESNA, you may do so here (Source: https://bit.ly/3JC3TFZ). If you have concerns about whether your ATP is certified, RESNA maintains an online searchable database of certified professionals (Source: https://bit.ly/3woBDmo).
Internal CRT standards
Typically, CRT service companies send technicians to assemble, diagnose, repair, or replace adaptive equipment in the field. Despite the complexity of most adaptive equipment, at many CRT service companies, a technician job is nearly an entry-level position, pays near minimum wage, and does not require certifications. Nonetheless, CRT companies have internal standards their technicians must follow. For example, Numotion technicians should “perform a safety and performance inspection at every service appointment” where the technician checks each bolt and does a thorough inspection of every part.xii Many CRT companies provide their technicians with service checklists to help with their inspection. If you have concerns about whether your technician is properly doing his or her job, ask to review the checklist, ask to complete it together, or ask for a copy after your appointment so you can make sure all of your concerns were properly noted.
Conclusion
I hope that you find the above helpful in advocating on your behalf with your CRT service provider. If the unthinkable happens and you or a loved one a catastrophically injured due to a service issue, please feel free to reach out. I am licensed to practice law in Florida and North Carolina and co-counsel claims in other states. If you would like to learn more about me or my practice, click here. If you want to request a free consultation, click here. As always, stay safe and stay well.
i Koontz AM, Ding D, Jan YK, de Groot S, Hansen A. Wheeled mobility. Biomed Res Int. 2015;2015:138176. doi:10.1155/2015/138176
ii Fortune Business Insights. Wheelchair Market Size, Share, & Industry Analysis, by Type (Manual & Powered), by Application (Wheelchair Market Size, Share & Trends Analysis Report by Product (Manual, Electric), By Category (Adults, Pediatrics), By Application (Homecare, Hospitals), By Region, Competitive Insights, And Segment Forecasts, 2019 – 2026. Report ID: FBI100523
iii Id.
iv 21 CFR 890.3860
v https://www.numotion.com/about-us
vi https://www.aeainvestors.com/aea-acquires-numotion/
vii https://www.aeainvestors.com/aea-acquires-numotion/
viii https://hbr.org/1998/11/how-venture-capital-works
ix https://hbr.org/1998/11/how-venture-capital-works
x DMEPOS Supplier Standards, 42 C.F.R. 424.57(c)
xi https://www.resna.org/Portals/0/Documents/Standards%20of%20Practice%20(final%2010.10.08).pdf
xii Id.
xiii https://www.numotion.com/products-services/service-and-repair