Medicare policies inconsistent with cost-effective aging at home strategies

WASHINGTON, Dec. 13, 2012—States across the country are finding new ways for senior citizens to age at home, a health care strategy that seniors prefer and one that reduces public spending on nursing homes and other care facilities. But the policies and regulations implemented by Medicare often run counter to this trend, actually making it more difficult for beneficiaries to receive power wheelchairs and remain independent in their homes.

As reported by PR Newswire, as far back as 2001 President George W. Bush announced a New Freedom Initiative that was designed to increase access for people living with disabilities and expand educational and employment opportunities, while promoting full access to community life. It was also anticipated that government policies would move towards helping Medicare beneficiaries age in their homes, which is frequently the most cost-effective way of caring for them.

However, over the past decade Medicare policies and regulations have done the opposite: the many changes are dismantling the home medical equipment network that provides power wheelchairs and other medical equipment that is vital to allowing beneficiaries stay independent in their home.

The biggest problem has been the decision two years ago to turn the Medicare mobility benefit into a rental program, a process in which beneficiaries no longer own their power wheelchairs after the first month and instead rent them. While fueling uncertainty among beneficiaries, the change has been financially devastating to many businesses now forced to pay manufacturers for the power chairs and then receive 13 monthly rental reimbursement payments from Medicare. Many businesses don’t have the cash flow to sustain operations.

Another obstruction is the flawed competitive bidding system that actually limits competition in geographic areas. In many jurisdictions, businesses have stopped providing power wheelchairs to Medicare beneficiaries or gone out of business because a low-ball bidding process has caused unrealistic reimbursement rates for the products provided.

In addition, the Centers for Medicare & Medicaid Services (CMS)—despite years of criticism—has not fixed the process for documenting a patient’s medical need for a power wheelchair. Decisions are still made inconsistently, with each region essentially adopting its own guidelines even after a prior authorization process has been implemented. The providers of power wheelchairs are also subjected to excessive and costly audits that disrupt their businesses.

“It is very frustrating for the providers of power wheelchairs that CMS has made it more difficult for them to get power wheelchairs to Medicare beneficiaries,” said Tyler Wilson, CEO and president of the American Association for Homecare. “Studies show considerable cost savings from allowing beneficiaries to stay independent in their homes.”

Seniors and people living with disabilities say it is their preference to stay in their homes rather than be placed in nursing homes and care facilities. Wilson noted that the Affordable Care Act was supposed to make the government smarter with its health care spending, but he said the CMS power wheelchair policies are instead squandering tax-payer money on nursing homes fees and emergency room visits when a better implementation of the Medicare power wheelchair benefit could be helping to bring down those costs. In fact, the Bowles-Simpson presidential commission on federal budget reform supported home and community care programs, calculating that if more such programs were implemented Medicaid could save up to $12 billion over the next eight years.

A study published in Health Affairs in 2009 underscored the potential saving from allowing people with disabilities to be treated in their home rather than in care facilities and nursing homes. Over a 10-year period, the study determined that long-term care spending under Medicaid was cut by eight percent in states that had home and community-based care programs. More importantly, states that relied on nursing homes and other care facilities had their long-term cost increase by almost 9 percent.

Because of the considerable savings, several states are implementing community and home care programs. Tennessee recently adopted a program following states such as Oregon, Vermont, Arizona and Texas. In October, New Jersey announced that CMS had granted their request to implement a home and community treatment plan for five years. Furthermore, the vast majority of Americans age 50 or older say they want to remain in their homes as they age.

So clearly, CMS recognizes the financial and patient advantages to treating beneficiaries in their homes, but repeatedly fails to implement policies that assist Medicare patients in being cared for at home. Power wheelchairs are obviously a key component in helping seniors and physically disabled Medicare patients remain in their homes.

“There is obviously a contradiction in CMS policies,” said Wilson. “States are being allowed to adopt home and community treatment programs, but Medicare patients continue to face new hurdles in receiving home medical equipment, such as power wheelchairs, that help them stay in their homes. We need smart and consistent health care polices.”

The American Association for Homecare represents durable medical equipment providers and manufacturers who serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility devices, medical supplies, inhalation drug therapy and other medical equipment and services in their homes. Members operate more than 3,000 home care locations in all 50 states. Please visit www.aahomecare.org.