Stakeholders: ‘We want to fix this issue for good’

WASHINGTON – Complex rehab stakeholders, including NCART, AAHomecare, U.S. Rehab and state and regional associations, are working on a more comprehensive strategy for service and repair reform. 

While they hadn’t finalized that strategy at press time in early February, stakeholders say the main areas that need to be addressed are increased reimbursement for service and repairs, decreased administrative burdens and improved communication with consumers. 

“We want to fix this issue for good,” said Wayne Grau, executive director of NCART. 

A major reason for the reform: A growing number of right-to-repair bills that allow consumers to buy parts directly from manufacturers and repair their own equipment. Bills have been passed in Colorado and New York and have been introduced in 16 other states. 

Increase reimbursement 

While providers are seeing a 6.4% or 9.1% reimbursement increase for Medicare in 2023, depending on their location, that’s not enough to cover their increased costs for service and repairs, stakeholders say. 

"The provider doesn’t make money – most of the time, they’re losing money – on repairs,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates. “The reimbursement rates for what they’re doing isn’t adequate at all, even with the increases in 2023. It helps, but it’s not enough to cover the increases in cost of goods and staffing and fuel and overhead.” 

What’s more, Medicare is only a portion of any provider’s payer mix, with the increase not guaranteed for other payers like private insurance and Medicaid, stakeholders say. 

Decrease burdens 

Private insurance and Medicaid can also be a challenge because, unlike Medicare, they often require prior authorizations and other administrative burdens that significantly slow down service and repairs, stakeholders say. A backlog due to the COVID-19 pandemic has compounded the issue, they say. 

“What happened when COVID hit was, all of our CRT providers saw more requests for repairs,” Grau said. “This is at the same time they’re being burdened with labor shortages and the supply chain affecting their ability to get parts. It was a huge backlog, and we still have issues with labor shortages and supply chain.” 

Stakeholders are making headway in some states like Massachusetts, where the Medicaid program has decided not to require prior authorizations for repairs under $2,000, stakeholders say, but it’s a state-by-state and payer-by-payer battle. 

Improve communication 

Stakeholders want to improve communication between providers and consumers to better reflect the current environment, they say. 

“There can be this belief that the reason the chair isn’t being fixed is our fault,” said Gerry Dickerson, who sits on the Executive Committee of NRRTS. “We can fix any chair, taking into consideration the quirks around parts and how they’ve always been a problem and now you have supply chain issues. We can fix it if we have the part, but we can’t fix it without your insurance company’s prior authorization.”