1. Manufacturer and Vendor Relationships Sept 16, 2009

2. Historical Perspective Re-use historically was viewed as “closets” –MDA, ALS –Churches –UCP CMS demonstration project and GAO reports encouraged Medicaid programs to develop re- use guidelines New Jersey was one of the participants in the demonstration project and the pilot project for re- use

3. Historical Perspective New Jersey model- DME and wheeled mobility –Single contractor- responsible for pick-up and delivery, warehousing, cleaning, modifying, repairing and refurbishing equipment, as well as education and other services –Local suppliers still worked seating and mobility clinics and participated in technology assessments- no reimbursement for their time/labor –Suppliers submitted prior authorizations as was done previously- but under re-use program, the reviewer was required to use a previously owned item if one was available that worked for the recipient.

4. Flaws in New Jersey Model Re-used product was required if available- no choice given to the recipient No communication with manufacturers or response to –Requests to provide training –Requests to track serial numbers for FDA purposes –Offers to check and validate reliability of products Single contractor- excluded local suppliers from participating No reimbursement to local supplier when they provided assessments yet did not ultimately sell a product because a “suitable” product was re-used No clear guidelines to determine whether a re-used device was “suitable” –Lack of clinical and functional comparison of product requested and product provided –No follow up to determine if clinical or functional needs were met –Complaints from clinicians of inappropriate technology was ignored –Even something as simple as color- devastating to a adolescent- pink wheelchairs should not be forced on boys. Socialization and the need to fit in impacts a child’s ability to develop and learn. $ Savings rather than clinical outcome was the driver.

5. The Rest of the Story Harsh resistance from supplier, manufacturer and clinical community Strong efforts to stop the re-use mandate in the NJ model Articles were written in magazines reporting a death related to the re-use program* Ultimately the program was cancelled. Definitely tainted industry views or re-use

6. Providing a product is not enough; it must be the right product Consumer satisfaction is important Ensure desired clinical and functional outcomes are met Product safety and liability Brand Protection- A consumers view of a manufacturer is formed by their experience Concerns regarding mandatory use of previously owned devices by payors Service- If not handled by the re-use program, it falls back on the manufacturer Product tracking –FDA requirements The Vendor/Manufacturer Perspective

7. Critical Program Features Clear procedures for determining product integrity Medical model –Physical evaluation –Technology assessment –Ensure appropriate technology match Vendor involvement Trained staff –Cleaning –Programming, adjusting, repairing Serial number tracking

8. Unintended consequences Medicaid seeking savings- requiring re-use for all recipients New sales/innovation connection –Drop in new sales reduces R&D for innovation –European re-use program acknowledged decrease in innovation and drop in new devices available for re- use- not sustainable program Technology solution failure Decrease in local suppliers as new sales drop –Fewer suppliers to service and repair equipment

9. Establishing Relationships with Industry (manufacturers and suppliers) Establish purpose of these programs is not to replace the sale of new equipment but to make additional equipment more readily available. Create a collaborative focus rather than a competitive one by allowing suppliers another way to serve their customers –Most people accessing a reuse program have no other way to pay for devices –For customers that have insurance or alternative funding, the program should allow the supplier to provide additional needed equipment Provide mutual marketing and demonstration opportunities Be a referral source. All suppliers to access equipment for evaluation and/or short term needs.

10. Maintaining Relationships with Manufacturers and Suppliers Ongoing reuse staff training Quality assurance procedures Collaborative events including manufacturers and suppliers Marketing opportunities Referral and information resource –Refer to local suppliers when funding is available or no appropriate product is available. Suppliers can often help secure alternative funding.