No wedges, please

In his commentary “”NSM's Ballard identifies K-11 problems and sees fixes” (April 2004), Mike Ballard tried to drive a wedge between suppliers of rehab power wheelchairs and K11 power wheelchairs. Such efforts will advance no one's interests, especially Medicare beneficiaries'. We endorse a number of Mr. Ballard's first principles. However, he fails to acknowledge the existence of responsible K11 suppliers who take their duties to both the Medicare program and its beneficiaries seriously. Responsible suppliers understand that the Medicare program struggles to balance two risks. First, Medicare risks paying for power wheelchairs when medical necessity is not present Responsible K11 suppliers understand they are held accountable for medical necessity of the equipment they place, and therefore work closely with physicians and other clinicians to ensure that only patients who truly need services receive a chair. The second risk includes Medicare denying payment when the beneficiary truly needs the device to function in the home. Mr. Ballard points to advertising as an unmitigated evil. However, it can be an effective tool to educate Medicare beneficiaries regarding available services if used responsibly. This means: - Following Medicare marketing guidelines, - Eliminating inappropriate inducements to beneficiaries; and - Taking responsibility for identifying those who are curious about the product but do not qualify. All suppliers serving patients needing power wheelchairs should be dedicated to ensuring that the qualified Medicare beneficiary can live an independent and fulfilling life. Creating divisions within the industry will not advance this objective. - Bryan Dylewski is CEO of Mobility Products Unlimited Critic in a glass house In your March 2004 article about stratifying service levels based on reimbursement, bioethicist Donald Light suggests the “entire U.S. healthcare system is unethical.” Does Dr. Light find all discrimination based on “money” to be “unconscionable” or just when it happens in the healthcare system? Does the University of Pennsylvania discriminate against students seeking an education based upon their income? Of course they do. Does Dr. Light discriminate against employers who can't afford to pay him as much as Penn? I suspect so. What is it that makes many from the academic world practically froth at the mouth as they consider unlimited healthcare the latest “right” they believe is now inalienable? The root problem with many American systems, not just healthcare, flows from unlimited expectations. While many may find it inefficient to spend so much money on what many other countries would view as hopeless medical causes, such domestic pragmatism tends to be limited to patients outside our own family. Until we face up to that dilemma more directly as a society, likely with a multitude of what some would view as “unconscionable” results, the “stratifying” of service levels is critical to delaying fundamental insolvency across the public and private healthcare system. - Alan Grogan is president of Grogan's Healthcare Supply in Lexington, Ky. Disappointing bias I am writing in response to the article, “Avenue Medical Drives PT Debate,” printed in HME News, April 2004. Having created an innovative service model that brings clinical and technical expertise to a rural area in Delaware, I am distressed to see our business presented in a negative view. It is disappointing that a respected industry publication such as HME News would present an article that does not accurately represent a company's innovative approach to service and treatment in a more informative and balanced way. The biased tone of the article and inferences that question the integrity of Avenue Medical are unfounded. The reference made to our business being “suspicious and dicey” is especially irresponsible. Avenue Medical's business has evolved over 30 years and the addition of a Wheelchair Seating Clinic is based on the growing needs of our community. In many rural communities, clients are making their own decisions about mobility, informed by family members, TV and direct marketing, and often resulting in the purchase of equipment that does not meet their needs. How could adding clinical expertise to a DME company do anything but raise the standard of care? - Adam Samuel, CRTS, is president of Avenue Medical Editor's note: We regret any inference in last month's article that may have called into question the integrity of Adam Samuel's business. We did not reference his business as “dicey” and “suspicious” but the process (to paraphrase other sources) of employing a PT to both evaluate the physical condition of a patient and then recommend equipment to that patient. Write on Connie Hess' commentary on page 13 (“Hold CMS Accountable,” March 2004) is spot on. This is the posture we need to have as an industry. As an industry we have been treated like this before, and we can count on it continuing if we do not adopt this mind set and take action accordingly. Thank you for publishing her comments. We need more of this. - Gary Waddington is manager of Stat Medical