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On the Editor's Desk

by: Liz Beaulieu - Tuesday, September 22, 2009

[caption id="attachment_262" align="alignnone" width="150" caption="Claire McCaskill"]Claire McCaskill[/caption]

Forget about cutting reimbursement for power mobility devices. If Sen. Claire McCaskill, D-Mo., had her way, she’d cut the entire benefit out of Medicare. That’s what she said during Fox News Sunday.

Well, I don’t know how many ads you’ve seen for scooters on cable TV, but I’ve seen a lot of them,” she said. “Those are scooters paid for by the American people, and a lot of them are going to people who don’t need them. It’s one example of many examples where we’re paying for services instead of outcomes.”

Host Chris Wallace then brought on Fox News medical correspondent Dr. Mark Siegel, who called McCaskill’s idea “absolutely outrageous.”

Siegel, a practicing internist and an associate professor at New York University School of Medicine, pointed out that 69% of those who use power wheelchairs aren’t elderly people (who, in McCaskill’s mind, may or may not need them) but disabled people.

My mother-in-law has multiple sclerosis,” he said. “She’s confined to a wheelchair; she’s paralyzed. My father-in-law has diabetes. He can’t walk; he can’t push her around. Her only life is that motorized wheelchair, and Medicare should pay for it.”

Liz Beaulieu

by: Liz Beaulieu - Monday, September 21, 2009

Another mainstream media outlet has published a story on efforts to cut reimbursement for wheelchairs.

BusinessWeek on Friday detailed efforts to eliminate the first-month purchase option for power wheelchairs in "Clash over Wheelchairs in Health-Care Reform." The magazine quotes Eric Sokol from the Power Mobility Coalition (PMC):

The elimination of the purchase option will drive Medicare power mobility suppliers out of business and hurt domestic manufacturing of power wheelchairs. It could impact access to needy beneficiaries who will then end up in institutional settings, ultimately costing the government more money."

The magazine also includes some interesting third-party analysis of the efforts:

In a preliminary report released on Sept. 16, the Congressional Budget Office estimated that provisions in the new Baucus bill regarding power wheelchair reimbursements would save an estimated $800 million over 10 years. The most concentrated savings would come in the first year: $300 million worth. Marilyn Moon, vice-president and director of health programs at the American Institutes for Research in Washington, says the savings could come from not purchasing the chairs when people would be using them for less than the 13-month rental period, or by discouraging those who may not truly need a wheelchair from acquiring one.

And:

There's a thousand different stakeholders and interests affected by these provisions," says Edwin Park, a senior fellow for health policy at the Center on Budget and Policy Priorities in Washington. "Suppliers and providers will always argue that changes in reimbursements will adversely affect beneficiaries. In some cases they might and in some cases they probably won't."

Liz Beaulieu

by: Liz Beaulieu - Friday, September 18, 2009

RESNA posted an update on its efforts to create a specialty certification for seating and mobility to its Web site this week. The association anticipates the new certification will be available via computer-based testing beginning February 2010. A few new details:

  • RESNA seeks input on naming the new certification. The certificaiton will be a modifier to the current assistive technology professional (ATP) certificaiton. RESNA envisions the modifier being added to the ATP with a slash or hyphen. For example: ATP-SMS (seating and mobility specialist). Send your suggestions to this address.
  • Applicants for the new certification must be an ATP and obtain four points from a combination of some of the following activities: direct clinical service (1,000 hours of direct customer service experience in seating and mobility); clinical service delivery; advocacy—community, client, profession; mentoring/supervision in seating and wheeled mobility; presentations/formal instruction; learning/continuing education; publications; or research.

Will you take the test?

Liz Beaulieu

by: Liz Beaulieu - Thursday, September 17, 2009

I spoke with a wheelchair provider yesterday who says he's turning a six-digit loss last year into a six-digit gain this year after making some hard decisions. The provider has downsized his product line (from a full line to wheelchairs and disposables) and his payer mix (from Medicare to just Medicaid, private insurance and cash). Unfortunately, that has meant more downsizing: from four locations to one and from 38 employees to 19. While those weren't easy decisions to make, the provider said:

Medicare has kind of been winnowing away at us for years. When it becomes unprofitable, you can't keep doing it. It's foolish to pay them for the privilege of doing business."

Read this provider's story in the November issue.

Liz Beaulieu

by: Liz Beaulieu - Wednesday, September 16, 2009

Here's another sign that it's tough to be a wheelchair provider these days: The Midwest Association of  Medical Equipment Services (MAMES) has added a "special event" for wheelchair providers to the schedule for its Fall Conference later this month. The rehab event, which takes place Sept. 30 in Bloomington, Minn., includes courses on documentation requirements, ATP roles and responsibilities, and accountability, all taught by familiar names like Laura Cohen and Julie Piriano. Register online.

If you're in the Minnesota area, you might want to check it out.

Liz Beaulieu

by: Liz Beaulieu - Monday, September 14, 2009

My e-mail inbox last week was flooded with bulletins and letters from various rehab groups criticizing the OIG's latest attempt to justify reducing reimbursement for power wheelchairs (See blog and NewsWire story). Here are some of the highlights:

  • U.S. Rehab's Jerry Keiderling to Sen. Charles Grassley, R-Iowa: "In one of your press releases dated Sept. 2, 2009, you verbally condemned the rehab and power mobility industry for wasteful Medicare spending. I am appalled at (your comments). I believe that had you fully examined the report, you would have found it to be incomplete and totally inconclusive from a great lack of pertinent data. This industry has been attached by CMS and mandated so deeply that a realistic four to five percent profit margin is the actual norm—not 400 percent."
  • NCART's response: "The service and operating costs (non-product costs) involved with complex rehab products are significant and are very different than those for a standard power wheelchair provider. These operating costs are over and above the product cost. A 2008 industry study indicated on average complex rehab company's non-products costs were nearly equal to the acquisition costs of the products. Products costs were 50% of the claim and the service and operating costs were 45%. These service and operating costs must be recognized."
  • NRRTS's Simon Margolis: "What the OIG has done, wittingly or unwittingly, is attach meaning to meaningless, incomplete and misstated numbers. They may have what they consider to be appropriate data, but seemingly no knowledge of what they are missing and definitely no wisdom to understand the significance of the information. There is at least one positive note sounded by this report. That is the clear differentiation between standard power mobility and complex rehab power mobility devices. This bodes well for the future of our efforts to further carve-out our complex rehab niche.”
  • From the Power Mobility Coalition (PMC): "If readers incorrectly draw conclusions that low acquisition costs equates to high profit margins, then the PMC questions the completeness of the study and its usefulness to policymakers.  To obtain a more accurate and complete measure of power wheelchair pricing, the PMC insists that the OIG conduct a thorough analysis that examines both acquisition costs and mandatory provider outlays necessary to partner with the Medicare program."

Liz Beaulieu

by: Liz Beaulieu - Thursday, September 3, 2009

In “Power Wheelchairs in the Medicare Program: Supplier Acquisition Costs and Services,” the OIG found that, in the first half of 2007, Medicare allowed, on average, $4,018 for standard power wheelchairs that cost suppliers $1,048. Medicare and its beneficiaries paid suppliers $2,970 beyond the acquisition cost to perform an average of five services and cover general business costs.

Medicare allowed, on average, $11,507 for complex power wheelchairs that cost suppliers $5,880. Medicare and its beneficiaries paid suppliers $5,627 beyond the supplier’s acquisition cost to perform an average of seven services and cover general business costs.

To perform the study, the OIG requested documentation from suppliers that showed what they paid for 375 standard and complex power wheelchairs. It also requested documentation of the services that they performed in conjunction with supplying the power wheelchairs. It did not, however, determine the cost of performing these services or other general supplier business expenses, such as billing, accreditation, staff salaries or facility maintenance.

Wait a minute...

Why didn't the OIG take the next step and determine the cost of services and business expenses? Since many of the industry's arguments for preserving reimbursement have to do with the cost (and importance) of the services providers furnish and the business expenses they have (especially compared to Internet providers), isn't that where the rubber hits the road?

Is that what the OIG's eyeing for its next missive? Are providers prepared to justify $2,970 per standard power wheelchair and $5,627 per complex power wheelchair to cover services and business expenses?

Liz Beaulieu

by: Liz Beaulieu - Tuesday, September 1, 2009

The folks over at Alpine Home Medical Equipment in Salt Lake City sponsored a bike ride traversing 80 miles and climbing 6,400 feet over the weekend to raise money to provide children with new wheelchairs.

The second annual "Ride for a Reason" raised about $8,500. Alpine already has two children in mind for new wheelchairs: one child has arthrogriposis multiplex congenital, a rare congenital disorder characterized by multiple joint contractures; and one child has muscular dystrophy. Both were recommended by the local Shriners Hospital for Children.

“There are some families that fall through the cracks,” said President Jay Broadbent. “This is our way of trying to help them out.”

Check out the October issue for the full story—and pictures!

Liz Beaulieu

by: Liz Beaulieu - Monday, August 31, 2009

Erika Bogan of North Carolina was crowned Ms. Wheelchair America 2010 last week. Bogan, from Huntsville, is working on a bachelor’s degree in psychology. She began using a wheelchair in 2002 after an automobile accident. The runners-up were: Kimberly Yeoman of Utah (fourth runner-up); Amber Marcy of Michigan (third runner-up); Alyson Roth of California (second runner-up); and Jannette Saxton of Washington state (first runner-up). Bogan succeeds Michelle Colvard of Texas, Ms. Wheelchair American 2009.

Wait a minute: A while back, I posted a blog about Kate Matelan of Pennsylvania being crowned Ms. Wheelchair USA 2010.

Ms. Wheelchair America

Ms. Wheelchair USA

Shouldn't these programs join forces?

Liz Beaulieu

by: Liz Beaulieu - Friday, August 28, 2009

[caption id="attachment_221" align="alignleft" width="150" caption="The Wheelchair Recycler"]The Wheelchair Recycler[/caption]

If NRRTS wants more consumers to participate in its CELA lobbying day on Capitol Hill, I think Simon Margolis should call David "The Wheelchair Recycler" Heim, who has been in a wheelchair since a car accident in 1995.

I first read about Heim in the Boston Globe earlier this year. The Jan. 29 article detailed how he had just re-opened his business repairing and refurbishing wheelchairs and providing them to people for affordable costs. He had temporarily closed the company because he didn't have the space or money to keep up with demand.

I read about him again this week in USA Today. It turns out that he has received grants from the Christopher and Dana Reeve Foundation and has moved into his own 1,000 square foot space. He even has vans to pick up donated chairs.

Heim has helped more than 500 people get wheelchairs since he started his company in 1998.

Don't you think Heim would have quite a story to tell lawmakers? Coverage for power wheelchairs is so poor—often insurance will only pay a fraction of the $5,000 to $25,000 price tag—that there's a need for someone like Heim, a need that he has a hard time keeping up with.

Liz Beaulieu

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