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On the Editor's Desk

by: Liz Beaulieu - Monday, January 11, 2010

Since all the buzz in the wheelchair market these days is the recent OIG report, I thought it would be interesting to put together a rundown of recent OIG reports on power wheelchairs and another on the way:

October 2007: The OIG investigates how Medicare pricing for power mobility devices stacks up against Internet pricing (Read our story here).

September 2009: The OIG investigates supplier acquisition costs and services for power wheelchairs (Read our story here).

December 2009: The OIG investigates documentation error rates for power wheelchairs (Read our story here).

Up next: The OIG investigates the appropriateness of power wheelchair claims. “In addition to determining whether beneficiary medical records supported the medical necessity of the power wheelchair, OIG will determine whether documentation from the suppliers and prescribing physicians was consistent,” the December report stated.

Industry reaction: It’s one thing to review whether appropriate pieces of documentation were submitted or not; it’s another thing to review the medical records of physicians.

“Who at the OIG will determine medical necessity?” asked Don Clayback, executive director of NCART. “Will they have a medical background?”

Liz Beaulieu

by: Liz Beaulieu - Thursday, January 7, 2010

The steering committee working on a separate benefit for complex power wheelchairs expects to hold a Webinar for providers and manufacturers on Jan. 22 to discuss a new white paper detailing proposed changes. It also expects to hold Webinars for consumers and clinicians on Jan. 26 and 28, respectively.

“What the different work groups are working on now is taking concepts and making them specific changes,” said Don Clayback, executive director of NCART, earlier this week. “The group working on coverage and policy changes—they’re spending the most time doing that.”

The committee’s timeline also includes securing consumer support in February, finding legislative champions in March and developing legislative language in April and May. The committee plans to bring Avalere Health back into the fold to help it develop legislative and regulatory language. It contracted the consulting firm last year to identify its options for creating a separate benefit.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, January 6, 2010

The legion of groups that represent wheelchair providers and manufacturers no longer includes the Power Mobility Coalition (PMC).

HME News called the PMC’s director, Eric Sokol,  this week and heard the following message: “You have reached the offices of the Power Mobility Coalition. The Power Mobility Coalition is now closed. For those who have inquiries regarding the PMC, please contact Steve Azia.” Azia, the PMC’s counsel, told HME News that the PMC has been closed for about a month.

“There are multiple organizations representing power mobility now, so it came down to industry consolidation,” he said.

Groups representing wheelchair providers and manufacturers include AAHomecare’s Complex Rehab and Mobility Council (CRMC), NRRTS, NCART and RESNA. Only the CRMC, however, represents standard power wheelchair providers and manufacturers; the rest represent mainly complex power wheelchair providers and manufacturers.

Another group, the Restore Access to Mobility Partnership (RAMP), closed in 2007 and rolled itself into the CRMC (then called the Rehab and Assistive Technology Council or RATC).

With a decreasing number of groups representing wheelchair providers and manufacturers, watch for the CRMC to gain power and play a bigger role, industry watchers said.

The PMC, which launched in 2000, made Medicare’s increasingly stringent documentation requirements its No. 1 priority. It also took on national competitive bidding.

“Over the years, we’ve testified before Congress and we’ve attended Open Door Forums,” Azia said. “We’ve done a lot to promote the power mobility benefit and to assure proper due process.”

Liz Beaulieu

by: Liz Beaulieu - Tuesday, January 5, 2010

rhb-bball1Mt. Carmel Medical Equipment in Pittsburg, Kan., sponsored a professional wheelchair basketball tournament at Pittsburg State University’s new student recreation center last month.

It’s the second year Mt. Carmel has sponsored the tournament.

“When people come to this for the first time, they walk away with an entirely different view of people with disabilities,” stated Gary Miller, Mt. Carmel’s director, in a release. “It’s an exciting way to help educate our community.”

Participating teams included the Rolling Razorbacks, the Minnesota Timberwolves and the Kansas Wheelhawks, all top-ranked teams in the National Wheelchair Basketball Association’s Championship Division.

“Anybody who has that competitive fire needs an outlet,” stated Jared Johnson, the coach for the Razorbacks, who also plays. “Your average able-bodied person can just get up and go to the gym and find a game or play some one-on-one. For us, it’s important to find a group like the NWBA to compete.”

Liz Beaulieu

by: Liz Beaulieu - Monday, January 4, 2010

There has been some interesting chatter on the NRRTS listserv today about the OIG report on power wheelchair documentation (If you're not part of the NRRTS listserv you should be; go here to sign up).

One provider outlined his concerns that the report, which states that three out of five claims for standard and complex power wheelchair claims did not meet Medicare documentation requirements during the first half of 2007, will be taken as another sign of fraud in the industry. The problem, he believes, isn't that providers are trying to slip documentation that's rigged passed Medicare, but that they're submitting documentation that has one or a few mistakes (not all Is are dotted and Ts are crossed). He believes it's a "documentation debacle," not a fraud debacle. Does that mean that a high-level quad shouldn't get his complex power wheelchair?

One stakeholder called into question the timing of the report. As you all know, Medicare implemented some drastically different documentation requirements in November 2006 and the OIG reviewed claims in the first half of 2007. Perhaps so many claims didn't meet documentation requirements because providers—and Medicare for that matter—were still working out the kinks?

I'll be making calls for a story on the report tomorrow, so I'll have more to report this week and in next week's HME NewsWire.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, December 30, 2009

Three out of five claims for standard and complex power wheelchair claims did not meet Medicare documentation requirements during the first half of 2007, the Office of Inspector General (OIG) states in a new report. Those claims accounted for $112 million of the $189 million in total improper payments allowed for that time period.

The OIG based its report on a review of 375 claims for standard and complex power wheelchairs.

Other findings in the OIG’s report:

  • Two out of five claims had multiple errors;
  • Suppliers submitted incomplete documents almost three times as often as they failed to submit requirement documents;
  • Complex power wheelchair claims had a higher documentation error rate than standard power wheelchair claims; and
  • Standard power wheelchair claims submitted by low-volume suppliers had a higher documentation error rate than those submitted by high-volume suppliers.

(Anyone else find this last finding especially interesting? Does it mean that a provider like The Scooter Store has the cleanest claims?)

The OIG recommends that CMS improve compliance with documentation requirements by conducting additional reviews of claims; recovering overpayments and considering further actions against suppliers that do not meet requirements; and increasing education for suppliers and prescribing physicians about requirements. Additionally, the OIG recommends that CMS take action on the sampled claims found to be in error. CMS concurred with the OIG’s recommendations.

To read the OIG’s report in full, go to: http://oig.hhs.gov/oei/reports/oei-04-07-00401.pdf.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, December 29, 2009

OK, so I don't know how the logistics of this would work out, but woudln't it be really cool if you were an RTS or ATP, or an OT or PT, and you attended one of these wheelchair Tai Ji workshops with clients who use wheelchairs? Or you learned enough about it that you could offer mini-workshops yourself?

That would be really cool.

The workshops are given by Dr. Zibin Guo, a University of Connecticut and Harvard trained medical anthropologist and Tai Ji master who has developed new specialized programs for people with limited mobility, including people in wheelchairs. He says Tai Ji improves their body and soul.

If you don't believe Dr. Guo, listen to Carolyn Rayborn, who was paralyzed waist down in a car accident (she's featured in the video at about 4:40). She says wheelchair Tai Ji "has helped me to regain my life and confidence."

There are several wheelchair Tai Ji workshop dates for 2010 on Dr. Guo's Applied Tai Ji Web site, including Atlanta on Jan. 30, Dallas on March 13 and right here in Portland, Maine on April 17.

Maybe I'll go. That would be really cool.

Liz Beaulieu

by: Liz Beaulieu - Monday, December 28, 2009

I get quite a bit of flack from my colleagues for using this blog to promote various industry Webinars and teleseminars (They think it's a cop-out). But I want to give NRRTS's teleseminar series for 2010 a shout out for two reasons:

  • Who's around this week to read this blog, anyway?
  • If you are around, many of you, like me, are getting ready to fill your 2010 day planners with appointments, and before you book yourself solid, you may want to take a look at what NRRTS has to offer. It's good stuff, especially if you need to meet NRRTS and/or RESNA continuing education requirements and don't have the budget to travel to CELA or Medtrade/Medtrade Spring.

From Jan. 19 to June 17, NRRTS has 12 teleseminars scheduled on everything from "Consumer Self-Advocacy: The Key to the Future of Complex Rehab" to "Anatomy and Disease Process for the RTS." All the teleseminars are scheduled from 5 p.m. to 7 p.m. EST for your convenience. Best of all, they're free this year for NRRTS registrants and only $20 for friends of NRRTS (FONs)—a $160  value. All others must pay $35.

Download the complete schedule from NRRTS's Web site. Look for "New from NRRTS."

Liz Beaulieu

by: Liz Beaulieu - Tuesday, December 22, 2009

Have you seen "Avatar," the new science fiction blockbuster movie from James Cameron, the creator of the Aliens and Terminator series? If you work with wheelchairs users, you might want to.

The main character in the movie is a young man named Jake Sully, a Marine and a paraplegic. Long story short: Sully, who uses a manual wheelchair,  joins a top-secret program that allows him to embody an Avatar and live an able-bodied life in another world called Pandora.

There are some pretty telling and touching scenes in the movie related to Sully and his disability. Here are a few:

  • Sully says his biggest motivators for joining the program are "being free" and having a "fresh start."
  • Sully says his spine could be fixed, but that "takes money," and he doesn't have any. (That's nothing new, huh? Money keeping a person with a disability from living the most independent life possible.)
  • When Sully wakes up on a stretcher as his Avatar in Pandora, he doesn't wait to stand up. He's held down by medical professionals and tethered to IVs, but he scrunches his toes,  jumps to his feet and, with a wide grin, starts walking then running.

While watching the movie, I wondered how wheelchair users would view it. I've seen a few blogs and articles by wheelchair users addressing this very topic. For David Morrison, for example, the movie got him thinking:

The idea that one can enter a world where there are no limits, no strange looks, no disabilities of any kind, and simply be yourself had me awe struck. Granted, technology may not be at that level for several years, but is this concept at all possible? What do you think?

Toward the end of the movie, Sully makes a decision to reside on Earth or Pandora. Which do you think he picks?

Liz Beaulieu

by: Liz Beaulieu - Friday, December 18, 2009

As you know from my last blog, the industry's first effort to preserve the first-month purchase option for standard power wheelchairs failed, because the CBO says the amendment that the industry crafted and Sen. Arlen Specter introduced would only save $200 million over 10 years (it needs to save $800 million).

Now a new amendment has been drafted that outlines an across-the-board cut phased in over a four- or five-year period, says Seth Johnson, vice president of government affairs for Pride Mobility Products.

We're waiting for a CBO score to see what the reduction would need to be for the amendment to be budget neutral," he said. "The amendment is drafted, but there's a blank where the reduction should be. The language is pretty straightforward. If we get back a CBO score that's reasonable, it could easily be introduced."

The amendment's best chances for being introduced are when leaders in the Senate and House of Representatives meet to combine their healthcare reform bills, Johnson said.

We've been told that it could be considered as part of the conference process in January," he said. "If it's budget neutral, they can just exchange one provision for another. You're not changing the dollar value involved."

Liz Beaulieu

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