With increased demand and consumer expectations on a constant rise for more convenient options, community based outpatient facilities in the world of Complex Rehab Technology (CRT) are becoming more prevalent.

For this article, Numotion’s Tony Leo sat down to explore the concept of community based seating clinics with the owner and operator of Adler Therapy Group (ATG), Josh Adler.

TL:  Why did you start ATG with this model?

JA:  I knew that this very large metropolitan area was severely under-served with regards to adult seating clinic options. I also felt that having a second choice for parents to bring their kids is always better than feeling like the Children’s hospital was the only option. For this reason, Adler Therapy Group (ATG) was established with a wheelchair seating clinic along with outpatient PT, OT, and ST. 

TL:  Why is this community based clinic mode so popular?

JA:  We look at the seating clinic at ATG as a consumer model as opposed to a healthcare/hospital model. We realize that the current climate for reimbursement presents a challenge and that these clinics in a hospital are often viewed as something that a hospital system has to have in order to serve its patients, even if it is going to lose money. The way we view our seating clinic at ATG is a volume based business that succeeds because we are efficient and we are timely. Our goal at ATG’s wheelchair seating clinic is to schedule back to back evaluations with the suppliers alongside each appointment. Letters of medical necessity (LMN) are written during the 90 minute appointment, and about 95% of the time, are sent to the supplier’s processors by the end of the appointment. We are able to perform at this high standard by using a strong electronic medical record that has a built in seating template that evolves as Medicare and other insurers evolve. We want the client to have their equipment in 45-60 days, and we focus on working collaboratively with the MD, supplier and client to accomplish this task.

In addition to focusing on the efficiencies of the process, ATG serves the clients of Hampton Roads by going to their homes if they are home bound. These evaluations are reserved only for those clients that are unable to come to our seating clinic due to transportation or medical issues. This approach allows us to work with the home health therapist and utilize our expertise in writing wheelchair LMNs.

TL:  How has the funding model worked for you?

JA:  ATG has worked hard in the state of Virginia with insurance providers to establish a wide variety of coverage to diversify our patient mix. Funding has not presented itself as an issue as we ensure the CPT codes that we need to bill are covered and if they are not, we communicate which CPT codes are covered to ensure smooth billing.

TL:  What advice would you have for anyone considering starting a community based business focused on CRT?

JA:  Know the numbers. Know the competition. Make relationships with physicians that will be referring for wheelchair evaluations. Be prepared to work harder than you ever have, and don’t think you’ll be able to sit back and have somebody else do the hard work. There’s a reason that most people choose to work for somebody else. Owning a business is hard and it takes persistence to succeed. If you view the vendors as working for you, as opposed to with you as a member of the team meeting the client’s mobility needs, then you’ve already failed. Neither business can survive without the other. 

Be open to understanding all of the products on the market that the vendors use and understand why sometimes clients can’t always have everything they want because insurance won’t cover it. That doesn’t mean you advocate with insurance for what you believe is a medical necessity; however, if insurance does not cover it, you cannot expect the vendor to absorb it. This only builds resentment on both ends and is counterproductive.

TL:  What is in store for ATG moving ahead?

JA:  I feel the company can expand to 5-10 locations in the east coast. The market is ripe for the opportunity. By opening up more clinics, we can work together with suppliers which will ultimately be a win-win for all involved. As more people turn to alternative options in their community, ATG will be there for them to turn to in order to have their seating needs met quickly, efficiently and productively.

In conclusion, Josh Adler has outlined a good perspective of shifting market dynamics to fit changing expectations of the clients they serve. The question to be answered over time is just how disruptive this model will be to the historical norm. For that, we will all have to wait and see. 

Josh Adler, OTR/L, ATP lives in Virginia Beach, VA and has been practicing as an occupational therapist in the area since 2003. He has over 15 years of both pediatric and adult inpatient/outpatient therapy experience. In addition, he has been performing seating and mobility evaluations for the past 10 years where he has built professional relationships with many of the local durable medical equipment providers to ensure proper equipment prescriptions for clients of all ages from pediatrics to adults. In 2015 Adler Therapy Group was formed to become the therapy provider of choice by creating a positive and personal experience for the client and their family. Since then, ATG has expanded to three other sites in Hampton Roads and Richmond, VA. Josh Adler can be reached at josh@adlertherapygroup.com.