RAMP: Data Shows Decline in Power Wheelchair Utilization

WASHINGTON–The Restore Access to Mobility Partnership said
Medicare claims for power wheelchairs have “declined significantly”
since 2003.

When CMS announced reimbursement cuts earlier this month, the
agency noted that total expenditures for power wheelchairs
increased 2,700 percent–from $43 million to $1.2 billion–from
1995 to 2003.

But RAMP, a coalition of power mobility manufacturers and
suppliers, said Thursday that utilization has decreased since 2003
when CMS began to crack down on fraud in the sector.

Before 2003, RAMP acknowledged that there was an increase in
fraudulent activity, when the number of reimbursed claims jumped
from 46,219 in 1998 to 228,676 in 2003, but since then, utilization
has declined, the coalition said.

Citing data from the SADMERC, the coalition noted a 29 percent
drop in reimbursed PMD claims from 2003 to 2004, when the number
decreased from 228,676 to 162,507. In 2005, reimbursed claims rose
8 percent to 175,140, but according to RAMP, this was in line with
a 7 percent increase in people eligible for Medicare.

“The government’s own data clearly shows that big increases in
utilization ended in 2003,” Mal Mixon, chairman and CEO of Elyria,
Ohio-based Invacare, said in the RAMP release. “It is certainly
misleading for CMS to contend that some big, recent surge in
utilization calls for these draconian cuts in reimbursements that
will make it difficult for beneficiaries to receive
wheelchairs.”

RAMP also said that advanced technology and increased demand are
part of the reason for the increase in power mobility usage rather
than only fraud and abuse.

“Since 2003, when the fraud was on the decline, the utilization
rate has stabilized with an acceptable rate of growth based on
demand for the product,” said Scott Meuser, CEO of Pride Mobility,
Exeter, Pa. “Our problem today is that CMS has introduced a new
pricing structure that will penalize legitimate businesses and send
the utilization rate spiraling downward because Medicare
beneficiaries won’t be able to get the product after their
physician prescribes it.”