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by: Liz Beaulieu - Wednesday, November 25, 2009

Feast your pre-Thanksgiving eyes on this...

I was poking around NCART's Web site this afternoon and watched this video of Sean Carter walking for the first time after being in a wheelchair for more than four years due to a traumatic brain injury. His mom says, "This, to us, is the first step of the rest of Sean's life. We're giving him the ability to walk again." Sean's first step comes at about 2 minutes and by 3:08, he's well on his way.

Liz Beaulieu

by: Liz Beaulieu - Monday, November 23, 2009

As part of today's and tomorrow's Webinar, NCART distributed a "working definition" of complex rehab. The definition is one of the first steps in creating a separate benefit for complex rehab. Here are some snippets of the definition, abridged and in yellow, followed by comments and questions:

The products: The definition includes manual and power wheelchair systems, adaptive seating systems, alternative positioning systems and other mobility devices that require evaluation, fitting, adjustment or programming. Augmentative and alternative communication devices may be added at a later date.

The separate benefit will cover only Group 3 power wheelchairs. The word on the street is that there is a list of about 250 codes being considered.

The person: Individuals with 21 diagnoses, including traumatic brain injury and cerebral palsy, as well as “other disability or disease that is determined through individual consideration,” may require complex rehab products and services.

The word on the street is that the "individual consideration" clause is a catch-all of sorts. For example, there may be an individual that doesn't meet the requirements for a Group 3 power wheelchair, but he still needs alternative controls. The definition is written in a way to cover that individual.

The process: Consideration is given to a person’s immediate and anticipated medical and functional needs, including activities of daily living, mobility, positioning, pressure relief and communication. The provision of complex rehab has two components: clinical (physical/functional evaluation, treatment plan, goal setting, preliminary device feature determination, trials/simulations, fittings, function-related training, determination of outcomes, and related follow-up) and technology (evaluation of the home environment, transportation assessment, technology assessment, equipment demonstration/trial/simulation, product feature match to determine physiologic and functional needs, configuration, fitting, adjustments, and product-related training and follow-up).

Both include trials, simulations, fittings. Duplication of efforts?

The professionals: The clinical services are provided by a licensed/certified PT or OT. The technology-related services are provided by a certified, registered or otherwise credentialed complex rehab technology supplier.

Why didn't they mention any of the certifications by name (ATP, RTS, CRTS)?

Check back in tomorrow for my story on today's Webinar.

Liz Beaulieu

by: Liz Beaulieu - Thursday, November 19, 2009

Ann Eubank, executive director of The Users First Alliance, has posted videos of wheelchair users on the organization's Facebook page. Eubank shot the video at the recent Abilities Expo in Atlanta and she plans to share them with members of Congress. In an e-mail she posted to the NRRTS listserv, she said:

To make change in DC  we HAVE to have the voice of the consumer with us. Our message that we are  not making enough money does not hold much water, especially with health care reform."

Eubank encourages providers to shoot their own video, asking consumers for their name; condition; why their wheelchair is important; and what would happen without it or with the wrong or no equipment. E-mail your video or photos (with the same info) to Eubank at anneubank@usersfirst.org.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, November 18, 2009

A few blogs ago, I wrote about an editorial in the recent AARP Bulletin titled "The Case of the Expensive Wheelchair." Simon Margolis, executive director of NRRTS, has crafted a response titled "The Case of the Misinformed Editor."

The crux of Margolis' argument: The press (and members of Congress and officials at CMS, for that matter) should keep their hands off of complex rehab. Instead, it should focus on consumer power:

These are the suppliers that are gaming the system. These are the suppliers that, through often misleading advertising, create a need among seniors and other viewers for power wheelchairs that didn’t exist before. These suppliers provide equipment in a manner that circumvents the rules set up by Medicare. Somehow they get away with it. In fact, these suppliers have been fined millions of dollars by the OIG, yet they are still allowed to take the American taxpayer’s money as a Medicare supplier."

Those are some strong words. But then again, Margolis is one of a group of stakeholders that's trying to divorce themselves from consumer power by creating a separate benefit for complex rehab.

Read Margolis' full response here. Just click on breaking news.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, November 17, 2009

If you didn't listen to this morning's media conference call on national competitive bidding–sponsored by the Pennsylvania Association of Medical Suppliers (PAMS)–you missed out on one hell of a speaker in Lucy Spruill. Spruill is a wheelchair user and director of public policy and community relations for United Cerebral Palsy of Pittsburgh. She joined Reps. Glenn Thompson, R-Pa., and Jason Altmire, D-Pa., in criticizing competitive bidding. Here are some snippets of what she said:

On reduced access:

“(The first round of competitive bidding) would have shunted all of the work currently being done by eight or 10 small- to medium-sized companies in this area to two companies. And the business already exceeds the capability of all those companies. There are often very long waits between ordering a wheelchair and getting it delivered and long waits for getting repairs. If the number of providers is drastically reduced, that’s just going to make a bad situation just completely intolerable.”

On the chaos:

The last time around, it wasn't unlikely that a person who needed, for example, a power wheelchair, oxygen and diabetic supplies, could end up having to deal with three different companies to get their basic medical needs met, some of which would have been out-of-town companies. Let me tell you that is so difficult for an older person or a person with disabilities who's living alone with a complex medical condition."

On the hidden costs:

We're very concerned that if we, again, end up with inexpert bidders, that we're going to consistently get equipment that's not right for us. We know when that happens, one of the results is secondary conditions like bed sores, pneumonia and other infections; depression from staying in the house; and placement in institutions, which is very expensive."

Powerful stuff–stuff that all members of Congress and officials at CMS need to hear.

Liz Beaulieu

by: Liz Beaulieu - Monday, November 16, 2009

Don Clayback and crew are moving forward with plans to create a separate benefit for complex rehab, and they want to move forward WITH you.

As such, they've scheduled two more Webinars:

Both Webinars are one hour long. Topic of discussion: "This Webinar will provide an update on activities to date and the next steps that are being undertaken to prepare for legislative and regulatory action as we move into 2010."

Liz Beaulieu

by: Liz Beaulieu - Friday, November 13, 2009

NCART went live this week with a redesigned Web site that’s chock full of resources. The site has been designed to provide information in an easy-to-access format, with sections on advocacy, position papers, Medicaid, educational material, policymakers and members.

“With the coverage and funding issues now and those that lie ahead, our Web site will serve as an important tool in telling the complex rehab technology story and protecting access to these important products and services,” stated Don Clayback, executive director, in a release.

Other features of the site include a database of rehab technology suppliers and a video library.

Check it out!

Liz Beaulieu

by: Liz Beaulieu - Thursday, November 12, 2009

A few blogs back, I wrote about the AARP's support of national competitive bidding. In an editorial in its November bulletin, the AARP delivers another blow to the HME industry, this time specifically to power wheelchairs.

"The Case of the Expensive Wheelchair" reads like a greatest hits of the criticism hurled at the power wheelchair industry in the past year:

  • Utilization: In 1997, Medicare and Medicare beneficiaries paid just over $100 million to buy or lease power wheelchairs; today they pay more than $1 billion.
  • The recent OIG report: The OIG has examined thousands of vouchers and invoices for wheelchairs and reported that the average annual cost to Medicare in 2007 was $4,018, nearly four times the $1,048 paid by suppliers. For more elaborate power wheelchairs, the average Medicare allowance was $11,507, almost twice the $5,880 price paid by suppliers. The 9.5% cut that went into effect Jan. 1 brought the average payment down to $3,641 in 2009, still three times the price paid by suppliers.
  • A quote from Sen. Chuck Grassley, R-Iowa. "At a time when every health care dollar counts, it's infuriating to lean that the government is throwing away money and is still overpaying for power wheelchairs. This translates into hundreds of millions of dollars wasted and cost beneficiaries millions of dollars in copayments. it's only common sense that you don't pay more for something than is on the price tag."

It was hard for me to take the editorial seriously. If you saw the editorial in the bulletin (not online), it featured a picture of the equipment in question. Too bad it's a picture of a scooter and not a power wheelchair.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, November 11, 2009

Did the National Capital Region Transportation Planning Board read my blog yesterday, where I questioned why Manila had Wheelmobiles, a public utility vehicle specific for wheelchair users, but many cities in the United States don't?

They didn't, of course, but it was kind of timely this morning, when I saw this article in the Washington Post about the board's plan to have 20 wheelchair-accessible cabs out on the road in Washington, D.C., starting in December. Currently, none of the city's 6,500 cabs are equipped with a wheelchair ramp or lift.

Most neighboring areas, like Arlington, Montgomery and Prince George's counties, and Alexandria, already have wheelchair-accessible cabs.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, November 10, 2009

WheelmobileCheck out this article about the Wheelmobile, an "air-conditioned public utility vehicle that caters to anyone using a wheelchair and in need of transportation." The Wheelmobile is a gutted Kia 2700 or Mitsubishi L300 that can transport two people in wheelchairs and two able-bodied companions. It features locking belts that are connected to rails on the floor to keep the wheelchairs in place. To date, there are four Wheelmobiles in use, two rented out for special rates and two available for day excursions on a first come, first served basis.

But don't look for a Wheelmobile in the United States.

They're only in Manila, in the Philippines. The only Wheelmobile I could find in the United States was the Wheel of Fortune's Wheelmobile, a 39-foot long bus that travels the country auditioning contestants for the show.

What does THAT say about our country?

Liz Beaulieu

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