K0011: On the hot seat

YARMOUTH, Maine - Last year, after the injuries he sustained in a 1998 icestorm made walking an impossibility for William Brooks of Skowhegan, Maine, he responded to a power wheelchair television advertisement that promised to make him mobile again. Brooks phoned the company, got the chair, but is no more mobile today, and the chair is gathering dust in his home. In the last year and a half, he said he's used the chair for no more than five hours. "I don't have any control of my arms and legs, so I can't use it," Brooks said. "On the book that come with it, it says that model isn't any good for anybody without balance. And I don't have any." No one from the TV wheelchair company visited Brooks before delivering the chair, and when they delivered it, no one showed him how to use it. Brooks can't remember the name of the company that delivered the chair. But rehab professionals say what happened to Brooks is happening to Medicare beneficiaries all over America. Today, in the midst of a year during which the Medicare program will provide more than 120,000 K0011 power wheelchairs to its beneficiaries, rehab providers are up in arms over questionable marketing tactics, questionable end-user targets, poor post-sale service and K0011 retailers who don't bother to do an at-home assessment of the beneficiary. Doug Westerdahl, owner of at Monroe Wheelchair in Rochester, N.Y., said he's extremely concerned the large volumes of K0011 chairs distributed by retailers. "I talk about this almost every single day," said Westerdahl. "It scares me to death to think of what may happen to all of us supplying [K0011 chairs] legitimately." Westerdahl, like many rehab professionals, said he doesn't begrudge his competitors' success, but he does begrudge the kind of success that comes from short-circuiting rehab protocols that involve several hours of "face-time" with a consumer. "You go to the customer's home. You perform a customer evaluation.," he said. "You provide them with a product specifically designed for them. You deliver it. You show them how to use it, and you go back and do more training if you need to. You provide service." That didn't happen when Medicare beneficiary Mary Law, of Holley, N.Y., received a power chair from Sarasota, Fla.-based American Medex two years ago. She said no one from the company visited her at home to measure her and fit her for a chair. When the chair arrived, it came disassembled in a box. Her son put the chair together. Two years later, when the battery charger failed, American Medex was unable to service the chair itself. They company referred her to area dealers, and for a long time she was unsuccessful in finding help. "I called so many place so many times," said Law. American Medex did not return calls for this story Finally, she contacted Monroe Wheelchair, which repaired the charger. But rehab providers are loathe to service chairs they haven't sold. Reimburse-ment for 'wrench time' barely covers costs. The real margin in K0011s comes in the initial sale, not the follow-up repair service. Not visiting seniors who need chairs may be the single greatest criticism leveled at the Internet and TV retailers. But face-time is not required by Medicare, according to Tim Hill, director of the department of program integrity at CMS, not even when the product at issue is a $5,000 - $8,000 power chair. "On the CMN today, it says 'do you need this in the home?'" said Hill. "It's a check box, and the doctor certifies that." That meager requirement has prompted growth in a market that, perhaps, has grown more explosively than any other code in the Medicare line-up. In 1995, Medicare purchased 8,962 K0011s, according to SADMERC data obtained by one manufacturer. Through an average annual growth rate of 55% in that time frame, that number had ballooned to 110,457 in 2001. And there's no telling where that number tops out. "There are so many beneficiaries out there," said Hill. "They haven't even begun to scratch the surface." Hill likens the tremendous growth in the K0011 market to the tremendous growth in the prescription drug market. "Once the consumer starts going to his physician to say I want this, it's very difficult to control." Rehab providers believe this explosive growth is going to 'kill the code,' as explosive growth in the lift chair market killed reimbursement for that product in the 1990s. Providers say Medicare paid about $1300 for seat lift chairs until one Midwest dealer exploited the code, and killed it. Today, Medicare pays only for the lifting mechanism in the chairs. Retailers are "leading the K0011 code down the very same path," said Rexford Maxey, president of Penn York Medical Supplies in Binghamton, N.Y. At the nation's largest provider of K001is, the New Braunsfel, Texas-based Scooter Store, they also talk about fears that the dramatic rise of the K0011 might also 'kill the code.' Though nobody's business would be as severely impacted by a killed code, Scooter Store President Harrison is more sanguine about the threat to his business. A power wheelchair "is not a want item. It's not a jet-ski or a big plush upholstered thing," he said. "It looks like a wheelchair. It is a wheelchair. I defy you to bring me an 80-year-old beneficiary, who is ambulatory and who can walk and can get around but would rather get around in a wheelchair. The answer is not no, but hell no." Nevertheless, seemingly for every rehab provider you talk to, there's a story about a K0011 retailer who sold a power chair to someone who can walk and who therefore would not qualify. "What in God's name are these fraud and abuse inspectors doing?" Maxey wonders. The fraud and abuse inspectors aren't talking. Tricenturion, which handles fraud and abuse for the Region A, declined to comment for this story. When HME News contacted Dr. Adrian Oleck, the medical director for Region B, which is tougher than any other region when it comes to the K0011, he referred us to CMS. At CMS, Hill said most of the complaints he fields about the K0011 are from Medicare beneficiaries who see the ads on TV and in direct mail and want to know why Medicare is paying for the chairs. He doesn't get a lot of complaints from Medicare beneficiaries who buy from Internet and TV retailers. "I suspect that is because they are getting a $6,000 wheelchair they are using to get around the mall in," said Hill. While the K0011 has been a real boon to some retailers, the awesome growth in that market has largely passed by the traditional wheelchair provider. Some rehab professionals resent this. "I'd like an easy one every now and then," said Ken Green, a branch manager at National Seating & Mobility in Lexington, Ky. "If I can do a wheelchair with a captain's seat out of the box every now and then, I'd like to." But Green, like most NRRTS members are pointed in the wrong direction for that kind of sale. While they're busy building relationships with physical therapists, occupational therapists, physicians, rehab centers and other referral sources, companies like the nation's largest K0011 retailer, the Scooter Store, are focused on the consumer. The long simmering gripe against companies that market K0011s to consumers bubbled over at NRRTS this summer, both on the organization's message boards and in a strident editorial by NRRTS president David Kruse, published in the group's summer newsletter. The NRRTS boards took the Scooter Store to task for its business with seniors. Kruse's editorial lambasted the company for "pushing product without regard to the patient…Medicare (you and I) is footing the bill. What can we do?" Harrison believes the attack upon his company was unwarranted. He said NRRTS would soon issue a retraction and an apology. NRRTS would neither confirm nor deny that it was backing off its attack on the Scooter Store. But if NRRTS regrets aiming its cannon at the Scooter Store, it is not likely to squelch the virulence that rehab professionals feel toward companies that, they believe, cross ethical boundaries when providing K0011 chairs to seniors. The Scooter Store is a favorite target among rehab professionals, and certainly the easiest to hit. For the fiscal year ending June 30, 2002, the Scooter Store sold 4,909 chairs to Medicare beneficiaries in the Region A DMERC, according to figures obtained by one New England rehab provider. The next largest purveyor of K0011s in Region A was Hoveround with 594. That success, said Doug Harrison, is part of the reason his company's name is bandied about as the bad guy among rehab professionals. "We're the big scary competitor that is chasing them out of the market in the geriatric side of mobility," he said. He insists there's no relationship between the size of his company and the sloppy business practices with which the Scooter Store has been charged. Harrison said the Scooter Store maintains 40 locations in 24 states. In fact, he says he shares some common ground with NRRTS members. "I do think a qualified individual should visit with a person before they finalize any type of delivery or type of equipment," he said. "Absolutely, and we do." That doesn't necessarily mean the Scooter Store believes it's necessary to do that evaluation before delivering the chair. "A power chair for a geriatric customer is a pretty simple fitting if you're talking about height and weight and the size of the house," said Harrison. After screening customers over the phone, he says the Scooter Store sells gets the right chair for the right customer about 80% of the time. That kind of pre-delivery telephone contact made for some supplier confusion when the Scooter Store delivered a power chair to an 86 year-old beneficiary, Weston Smith, in South Portland, Maine last year. Smith had been working with a local K0011 dealer, Topsham, Maine-based Majors Mobility. Majors had sent one of its people out to the Smith's house to assess his needs and discuss his options. In the meantime, Weston Smith, had been in contact with the Scooter Store, a company that had sent direct mail advertising to the Smiths many times. When the Scooter Store delivered a chair to the Smiths, the Smiths thought they were getting the chair from Majors. Smith's wife, Barbara, noticed that the chair was a different color than the one they'd talked about with the Majors salesperson. She said the Scooter Store rep told her they didn't have that color. "I went ahead and signed the papers," said Smith, still thinking she was dealign with a Majors rep. "We had been promised that [Weston] would have been guided into learning how to use this chair. But they didn't do anything. I kept talking to him, he was a personable young man." When Barbara Smith called Majors later, that's when she learned that her husband had made a separate arrangement with the Scooter Store. Smith contacted the Scooter Store and asked them to pick up the chair. When customers call back the Scooter Store - "usually when someone says I can't use this inside our house," said Harrison - the company retrieves the chair and initiates a recoupment. He said recpoupments represent 1.5% of his sales. Harrison also believes that much of the grousing by rehab professionals are part and parcel of urban myth that gets passed from person to person. Indeed, two Medicare beneficiaries contacted by HME News did not confirm the egregious examples of Scooter Store practices attributed to the Texas company by local rehab professionals. "To date the number of other providers who've called me [to talk about alleged improprieties committed by the Scooter Store] is literally zero," said Harrison. "It's none, which kind of tells me they're all getting made up and blown out of proportion." Harrison said nobody in the business does better follow-up with its customers than the Scooter Store. "One hundred percent of our customer base, for every unit we sell, gets contacted by us at nine days, 90 days, 6 months and then annually for life," he said. Rehab providers also cringe over the Scooter Store's use of the word free in its marketing. "Oh, God no," said Westerdahl when asked if rehab providers would ever use this kind of marketing tactic. "That kind of advertising is misleading." Harrison insists that the Scooter Store's Free Scooter Guarantee is a legitimate means of marketing, and moreover is a 'guarantee' that all rehab providers would honor. The 'free' in his guarantee does not refer to the fact that Medicare beneficiaries do not pay for the bulk of the costs associated with a K0011; it refers to what the Scooter Store provides to its customers if the company has pre-qualified a beneficiary and Medicare, after all appeals have been exhausted, rejects the claim. "They're all doing what I do," said Harrison. "They just don't market what they do." HME