Task force teases out issues

ARLINGTON, Va. - The Clinician Task Force (CTF) has given stakeholders more ammunition in their fight to stop CMS from applying competitive bidding pricing to accessories for complex rehab manual wheelchairs.

The CTF in September wrote a letter to Reps. Lee Zeldin, R-N.Y., and John Larson, D-Conn., sharing examples from clinicians of how the cuts have impacted their ability to provide the most appropriate equipment to Medicare beneficiaries.

“It is very clear to those of us who routinely evaluate clients with profound disabilities in our wheeled mobility and seating clinics across the country, that access to CRT products, especially critical components used with CRT manual wheelchair bases, is on a steady decline,” wrote Laura Cohen, executive director of The Clinician Task Force, a nationwide network of 50 physical and occupational therapists.

Here's what Cohen had to say about how the cuts to accessories for complex rehab manual wheelchairs are just the tip of the iceberg.

HME News: You surveyed a number of clinicians before writing the letter. What did you find?

Laura Cohen: While access is on a steady decline, teasing apart the barriers or the issues of why a person can't get what they need is difficult. What we find happens in the clinic is, the supplier will say, “That's not covered; they can't get that,” and it really needs to be more of a conversation with us about why. Does their coverage exclude it? Is it a non-covered item? Is it a payment issue, or a coding issue? Or is it a coding issue that causes a payment issue? The therapist can help facilitate those challenging conversations, because we don't have a financial horse in the game.

HME: So it sounds like you found that the cuts are only one of a number of issues affecting complex rehab overall?
Cohen:  The coding system is so antiquated it groups dissimilar products together in the same HCPCS code. Products that are different in features and functions, and products that have different clinical indications are in the same code. Therefore, the data that CMS collects is unable to distinguish if people today have access to the same technologies they had prior to competitive bidding due to the flawed HCPCS coding system.  Technologies with very different costs placed in the same HCPCS code are paid the same amount. As a result CMS will systematically underpay for the most complex devices resulting in the access problem we see for Complex Rehabilitation Technology (CRT) items. Rather than establish new HCPCS codes and group similar technologies together CMS has selected to consider a toe loop, heel loop and leg strap “comparable” to a foot box any type and to establish the payment amount they just added those three items together. They're not comparable. This practice is leading to big access problems that are hard for the patient, the average therapist and even front-line providers to understand.

HME: Are there efforts to resolve these coding issues?

Cohen: There have been for more than 10 years. We have the technology to solve a lot of problems, but once we create solutions, we're unable to obtain new HCPCS codes, new coverage and new payment policies. Some of it has to do with coding and some of it has to do with the also antiquated gap-filling methodology.

HME: Have we seen any progress?

Cohen:  The good news is that in its recent proposed rule CMS recognized that there are some issues with gap-filling and asked for input. We hope CMS will collaborate with stakeholders to explore solutions to these complex problems and find some new solutions.