CMS didn't think through capped rental change, providers say

WASHINGTON - The day-to-day reality of providing certain complex rehab equipment as capped rental items is unrealistic, providers say.

“CMS is asking DME companies to provide complex rehab and finance Medicare over 13 months, when we have to pay the vendors back in 60 days,” said Patrick Mahncke, president of Denver, Colo.-based USA Mobility. “From a business standpoint, it's very difficult to do that.”

On April 1, CMS plans to make 78 codes capped rental items, including manual wheelchairs with tilt-in-space and power-assist, and pediatric manual wheelchairs.

Even if providers have the financial wherewithal to continue to provide these products, they cringe at another aspect of dealing with rental equipment: having to retrieve individually fitted equipment from users if they change insurance providers or enter a care facility before ownership transfers to the user.

“What do we say, 'Sorry ma'am, we have to take the wheelchair?'” asked Michele Gunn, a seating specialist at Orlando, Fla.-based Browning's Health Care. “It's horrible and ridiculous.”

Further complicating matters: Sometimes, only certain parts of the wheelchair would be a capped rental item—other parts would be purchased. Does that mean providers would have to retrieve only parts of the wheelchairs?

“This obviously hasn't been thought through,” said Mahncke.

Making these products capped rental items will also affect the fitting process, as providers will have to keep in mind that they may want to rent out the equipment again.

“If this is our future, customization is going to go away,” said Patrick Mazey, operations manager at Medco in Orange Park, Fla. “We're going to need to order parts that are conducive to pass on to the next client.”

Facing all of these complications, providers are putting a lot of stock in industry efforts to reverse CMS's decision. If those efforts are not successful, providers expect access to be threatened.

“We're at a size where we can accommodate (these changes), but a lot of companies can't,” said Mike Ballard, president and CEO of National Seating and Mobility. “This is very serious for smaller providers, which generally do a high percentage of Medicare business. We're going to see more and more go out of business or decide they can't take on so much financial risk or that Medicare's not worth it.”