Washington
CMS' new fee schedule for power mobility devices slashes
reimbursement by more than 40 percent for some equipment, prompting
stakeholders to warn that it will be difficult, if not impossible,
for providers to remain profitable in the rehab business.
As of press time, the updated fee schedule was set to take
effect Nov. 15.
“The new pricing is going to be devastating,” said
Rita Hostak, vice president of government relations for Longmont,
Colo.-based Sunrise Medical and president of the National Coalition
for Assistive and Rehab Technology. “For a lot of suppliers
it's going to mean they're not going to be able to provide product
anymore.”
Hostak said many of the providers she talked to after the fee
schedule was issued Oct. 2 indicated they were trying to decide
whether to allow their rehab techs to continue performing
evaluations.
“The bottom line is that we won't be able to service the
custom wheelchair market anymore without Medicare retracting this
new fee schedule,” said provider Jim Greatorex, president of
Portland, Maine-based Black Bear Medical, adding that layoffs in
the sector are likely.
Greatorex said he fears that private insurance companies, which
often look to Medicare when creating their own policies and fees,
will insist on similar cuts.
As an example of the drastic fee reductions, Hostak said
reimbursement levels for both the Group III no-power option and
single-power option wheelchairs have dropped by 32 and 34 percent,
respectively.
“Those are substantial hits to an industry that didn't
already have significant margins to begin with,” she
said.
Particularly with regard to complex rehab products, providers'
service component is expensive when it comes to time and labor,
Hostak said. In addition to clinicians' evaluations, and hours
involved in proper fitting and adjustment, providers also must make
extensive home assessments.
The Restore Access to Mobility Partnership, a coalition of
manufacturers and suppliers, noted that a supplier who has been
receiving a $6,500 reimbursement from Medicare for a wheelchair
needed by people with the most severe physical disabilities would
only receive $3,800 after the new pricing is effective.
In an explanation accompanying the fee schedule, CMS said that
from 1995 to 2003, expenditures for power wheelchairs increased by
2,705 percent, from $43 million to $1.2 billion. “In
response, CMS has developed a comprehensive strategy to address
timely and appropriate coding, payment and coverage of PMDs,”
the agency said.
According to a CMS spokesperson, prices were set using the
gap-filling process, which is familiar to the industry. “We
shared this information with the industry and took their comments
into account in setting the fee schedule prices,” the
spokesperson said.
Reimbursement Woes
According to an NCART survey of 54 complex rehab
suppliers:
76 percent said they will no longer supply these chairs if the
proposed Medicare reimbursement cuts take effect.
78 percent said they will be unable to provide chairs already
ordered by the severely disabled because the reimbursement does not
cover their equipment and service costs.
96 percent said they believe that severely disabled Medicare
beneficiaries will no longer get the devices they need to ensure
their safety and functionality.
