Wanted: bricks and mortar for K0011s

Monday, September 30, 2002

CMS cannot be deaf to the multitude of rehab professionals who are complaining about what's happening with K0011 power wheelchairs in their respective markets. The laundry list of questionable business tactics is seemingly endless. Talk to a handful of rehab providers and you'll hear stories of Internet and TV-based marketers that qualify unqualified (re: ambulatory) beneficiaries for power chairs; that ship boxed wheelchairs to patients and don't bother to either assemble them, or check the beneficiary out on in the chair; that make no provisions for post-sale service on a product that typically lasts five-to-six years.

It's no wonder that rehab dealers fear these bump-and-run companies are going to kill the code.

Whether these anecdotes are merely the visible tip of the iceberg of an enormous problem, or barks from a dog that really can't hunt, we can't really say. Not today anyway. Both Region A and Region B declined to talk to us about K0011 investigations this month. I don't know why. If it is a problem, if your investigators are finding that a lot of these horror stories are grounded in reality, and not chit-chat, then why not say it?

But let's take these stories at face value. I talked to one Medicare beneficiary this month, Mary Holley, who said her son put her power chair together because the company that shipped it to her, Sarasota, Fla.-based American Medex,, merely rerouted it from the manufacturer. Later, when she needed service, American Medex couldn't help her because the company didn't have a physical location nearby.

I think it's reasonable to assume that everyone would deplore this type of business practice. And yet, it's not illegal. Nothing in Medicare says you've got to provide service to beneficiaries who need power wheelchairs. Nothing in Medicare says you've got to be there for follow-up service.

The rules of engagement need to be changed so that what happened to Mary Holley in South Portland, Maine doesn't continue happening. What happened to her should be made illegal.

There's widespread support among rehab professionals who believe you've got to have a physical location in the geographic region you plan to service as a Medicare provider. Ninety-fiver percent of 107 HME NewsPoll respondents believe you should. Doug Harrison, who as CEO of the nation's largest K0011 supplier, strongly agrees that companies ought to maintain a physical presence in the markets they serve.

Medicare has made a physical presence one of the ground rules for participation in its competitive bidding demonstration projects. Florida Medicaid has made it a precondition for participation in its competitive bidding program. So why doesn't Medicare change the rules of engagement for companies that are looking for $5,000 - $8,000 from Medicare every time they roll a K0011 out the door?

One counter argument to increased regulation comes from those who would let the market weed out poor suppliers. But that's wishful thinking, isn't it? The same market forces that apply to you and me when we buy a car don't really make sense when we're talking about people in their seventies and eighties who need wheelchairs. HME