Powering Up

Reports of fraud and abuse, the subsequent government crackdown and a CMS revamp of the Medicare mobility benefit have left both providers and manufacturers of power wheelchairs uncertain of the future. Yet the industry could emerge better off, say those working in the sector.

For one, providers can say goodbye to the all-inclusive K0011 billing code — long a source of frustration — and hello to a bevy of new codes tailored for specific uses. Add new Medicare coverage policy based on functional criteria, set for imminent release as of press time, and experts say both high-end rehab and basic power chair sales are poised for growth.

“I see growth in all [power chair] segments, but in consumer power, I see the largest growth,” says Mike Serhan, executive vice president of Drive Medical. “The majority of the market is consumer power … and [it's] much easier to get into. You need to fit a person to a chair, but it's a relatively easy fit.”

“[High-end rehab] is alive and well,” says Tom Rolick, vice president of business development for Permobil. “These people need a power chair, and they're getting them.”

“Once we're through this whole coding process, I think you'll see reasonable growth again,” says Mark Sullivan, vice president and category manager of rehab products at Invacare. “Just look at the demographics.”

New Coverage Policy, Different Industry

Who qualifies for a power chair, and what kind of documentation should back it up? Those have been up-in-the-air questions during the past year. But Medicare's new coverage policy should provide the answers.

A policy draft released earlier this year is rooted in a function-based definition of “non-ambulatory,” and takes prescribing clinicians through a “stepped” approach. Which chair a patient receives will depend on that patient's ability to perform activities of daily living in the home. The new policy will apply to all mobility aids, including 49 new power wheelchair and scooter codes. The new codes will take effect Jan. 1, 2006, and are grouped into categories that describe the product's use. (See page 40 for a breakdown.)

“Our customers are being asked to re-evaluate how they provide product and, as a manufacturer, we have to change our business model,” says Paul Banz, senior marketing manager, power, for Sunrise Medical. “I think our customers are taking their time to understand the new regulatory changes, but they are still providing products to the people who need them.”