Power wheelchair providers face an overwhelming challenge on
Jan. 1, 2011, that will lead to significant access and
quality-of-care issues for the patients they serve. Health care
reform legislation passed in the spring contains a provision that
dramatically changes the way businesses are reimbursed for
providing power wheelchairs to Medicare beneficiaries. Delaying
that policy is the best option to allow providers to prepare for
the change and preserve access to wheelchairs.
Medicare beneficiaries who have been prescribed a power
wheelchair currently have the choice of purchasing the equipment in
the month it is first prescribed or renting it for 13 months, at
which time ownership transfers to the beneficiary. Given the
chronic, long-term conditions of power wheelchair consumers, the
vast majority of Medicare beneficiaries elect to purchase their
power wheelchair in the first month.
Power wheelchairs save Medicare millions of dollars a year by
helping seniors and people with disabilities to remain independent
and in their homes. The purchase of a wheelchair by a beneficiary
who would otherwise rent the chair for 13 months also saves
Medicare money in terms of total payments, with the one-time
purchase by Medicare costing less than 13 rental payments.
Most beneficiaries who elect to purchase indeed end up needing
the wheelchair for beyond the 13 months. Medicare only loses money
in those infrequent cases where the beneficiary purchases the chair
and where the ultimate need is for some relatively short period of
time.
But Section 3136 in the Affordable Care Act, the health care
reform law, eliminates the purchase option for most power
wheelchairs.
The situation is critical. The new policy creates a cash-flow
nightmare for both large and small providers. Capital or lines of
credit to provide the equipment in this current economy is
difficult to come by. Providers cannot afford to bear the burden of
paying the up-front costs to procure the appropriate wheelchairs.
According to AAHomecare's analysis, the elimination of the
first-month purchase option could slice cash-on-hand by as much as
40 percent in the first year.
Providers of power wheelchairs will struggle to make the
significant changes to their business models to adapt to new
payment models that front-load costs with reimbursements from
Medicare spread over 13 months. If they are unable to achieve this,
they will simply go out of business. So providers and patients will
benefit by delaying the elimination of the first-month option for a
year in the expectation that credit markets improve and providers
are better able to secure necessary financing a year from now.
People with compromised mobility are at risk for falls and
injuries. So without access to proper power wheelchairs, thousands
of beneficiaries face the risk of increased hospitalizations, home
health visits and other clinical services. Also, power wheelchairs
often delay or eliminate the need to place a person in a long-term
care facility and preserve independence and quality of life.
Andrew J. Imparato, president and CEO of the American
Association of People with Disabilities, added his voice to this
cause. He recently wrote to senators that consumers who need
wheelchairs will fare better if an additional year is allowed for
providers, manufacturers and the Medicare program to adapt to this
significant change.
AAHomecare has partnered closely with consumer groups to work
with legislators in both the House and Senate to delay the policy
change for a year, which is the most realistic legislative option
for a remedy. Consumer groups supporting this effort include the
American Association of People with Disabilities, the National
Council on Independent Living, the National Spinal Cord Injury
Association, Paralyzed Veterans of America, the Association of
Programs for Rural Independent Living, Post-Polio Health
International and the United Spinal Association.
The Association encourages all HME stakeholders to discuss this
issue with your members of Congress. Visit www.aahomecare.org/mobility for more information.
Stephanie Genge, 66, of Coronado, Calif., has severe arthritis
in her back. But a power wheelchair has significantly improved her
independence. “The power wheelchair has completely changed my
life.”
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Tyler J. Wilson is president and CEO of the American
Association for Homecare, headquartered in Arlington, Va. You can
reach him at tylerw@aahomecare.org. For more
information on critical home care issues, visit the association's
Web site at www.aahomecare.org.
