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[whose] timelines on their product were extended by months,” Mullen said. “So we would have pretty much the whole chair in, but there were certain components on that prescription that we didn’t even have an ETA on. There’s a point when we have to go with something else. So then the prescription has changed.
“One of the things becoming a major concern is batteries for power wheelchairs. Apparently, there’s a shortage of the plastic that they use on those batteries, and we’re having open-ended back orders. We don’t sell hot dogs and pool tables. The products that we have, it’s very difficult for people to do without.”
NRRTS President Gerry Dickerson, ATP/CRTS, works for National Seating & Mobility (NSM) and said that while he’s aware of supply chain problems, he hasn’t personally experi- enced much difficulty so far. “Everybody’s market is different; you can have huge regional differences, let alone huge national differences,” he said. “With NSM’s management ability and every- body pulling together, we’ve just been able to pull from resources to get things done so people can get moving. NSM’s supply chain management group did enough predicting. They were completely on top of stuff that made our lives in the field that much easier. When we do get into a problem — maybe it is a battery or a joystick — the word goes out: ‘Anybody have this?’ And we get so many responses that we typically get things resolved.”
Cathy Carver, PT, ATP/SMS, is a member of the Clinician Task Force (CTF) and was CTF’s Executive Director when the pandemic began in 2020.
“I think the frustrating part is not having a direct line of communication to what the supply chain issues are,” she
said. “I’ll have one supplier say, ‘Oh, we can’t get this part,’ or ‘So-and-so has stopped shipping this.’ But if I ask the very next supplier I’m working with, they don’t know that or have not heard of those issues. So as the clinician, trying to figure out what product is going to be best and available for my consumer, I have two different messages.”
Carver suggested that bulletins from manufacturers could help: “Invacare sent out a blast e-mail a few months ago, which I so appreciated. It went out to suppliers and to clinicians across the country about what their current situation was.
“As a clinician, I would love those updates straight from the manufacturer that lets us know about supply chain issues, like if they are low on batteries or a certain switch or cushion cover. One [manufacturer] cannot provide a certain type of switch box right now. That doesn’t keep us from still doing their chairs. We can still do power functions through other ways, they just don’t have that switch box. So that’s good to know as a clinician.”
CRT’s process — in which a clinician works with many suppliers, who work with many manufacturers and sales reps — complicates the issue, Carver added. “I think each supplier has different people they communicate with at the manufacturers to get updates, and it’s not always the same from the independent to the regional to the national suppliers. As a clinician, you’re in a difficult spot. You have to trust what they’re saying, but if you run it by someone else, you don’t get the same message.”
Mullen now asks reps about supply issues: “A lot of times, [the problem is] the shipping of the raw material. Some manufac- turers are experiencing trouble with certain foam compositions because they’re not able to get the chemical to make the foam. These are questions we’ve never [had to ask] before.
“When manufacturer reps come to my door, I always ask them: ‘What’s your supply like? Tell me what you’re finding shortages on.’ A big part of my role, almost like an agent representing my client, is being able to get them the product they need. If item
A is similar to item B, but it’s an onshore manufacturer vs. an overseas manufacturer, as long as that onshore manufacturer is able to get the raw product, I’m probably going to be able to get it more reliably.”
Mullen factors that information into his equipment recommen- dation process: “We use a lot of sheets of ABS for making custom wheelchair components, and I tried to get some and learned there’s a shortage,” he said as an example. “My supplier will give me two sheets, and he doesn’t know when he’ll get more. When we’re bringing out assessment equipment, we’re trying to build our assessment equipment with product we’re going to be realis- tically able to provide to the client.
“With our company, every Monday morning we have a start-up meeting for the week. Our shipping receiver gives us a heads-up on what he’s seen in terms of back orders. We used to have one binder of purchase orders open. For the last six months, we have three binders. These purchase orders are remaining open longer, and that’s changed the rates of our billing, too.”
Those delivery delays cause other issues: “Some clients’ conditions change, or they pass away and that sale is no longer available. The manufacturer wants to get paid because part of the prescription is at my door. The wheelchair is here; that’s the most expensive part. But the cushion, a lesser part of the invoice, is holding up the whole thing. In the meantime, we’ve had to pay the manufacturer for the wheelchair. It makes it harder to keep the lights on.”
HOW COVID HAS CHANGED CLIENTS
COVID has impacted all of healthcare, but even when hospital admissions return to more normal levels, COVID’s impact on CRT clients will remain.
“We’re going to have that 18-month window where people stopped getting their colonoscopies, bladder scans, bone-density scans, therapies, getting their medicines refilled,” Carver said. “Things like that are setbacks and will take time to catch up.
“From a wheelchair and seating perspective, I think the progression or the worsening of things is probably postural.
If you could not walk or push a manual chair prior to the pandemic, you still cannot, but now you might need a different back or cushion because your trunk weakened, you gained or lost weight, you now can’t do a pressure relief. So we need to modify your seating or go to the next type of chair. But I think a lot of it is more postural changes that we could have probably stayed on top of had they been able to continue with therapies.”
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