The Good, the Bad And the Unknown

With new reimbursement guidelines and aging baby boomers who have a growing interest in staying active, the home medical equipment providers participating in HomeCare’s 2006 Mobility Survey told us they like what they see in the future for the mobility market.

They’re just not so sure about what’s going on in the meantime with changing codes, rules and documentation requirements for claims.

About CMS’ new function-based mobility coverage policy, most say they feel the “stepped” approach is a step in the right direction. Said one provider, “I believe some changes were great and will ensure that the client receives the appropriate equipment.” But, said another, “getting the professional community to understand the objectives and to consistently arrive at the same conclusion and same equipment recommendation is the problem.”

Added still others, educating physicians about their new responsibilities in supplying chart notes or documentation to support medical necessity is a demanding job for providers and time-consuming for physicians. Respondents overwhelmingly said they felt physicians/referral sources have not been adequately informed about their unaccustomed role in the process.

“We’re trying education to show that just documenting the [mobility assistive equipment] in patient charts should be easier, but we’re meeting serious resistance,” wrote in a survey respondent, who added this doctor’s statement: “Medicare only gives us 15 minutes with each patient now, and you want me to spend five of those minutes on paperwork.”

Along with confusion over exactly what documents will be sufficient, providers also registered frustration about “flip-flopping” on rules. “Flip-flopping on issues makes it difficult for providers and referrals,” one respondent said. Agreed another, “It would be a lot easier if Medicare would change the rules just once. Changing the rules and then changing them back and then changing them partially … Who really understands what is going on?”

While the majority of respondents seem to like new requirements such as the face-to-face physician exam and a home assessment for power mobility, lack of clarity in claims guidance continues as a theme.

“The most challenging aspect of my DME business is dealing with the ongoing CMS policy and regulatory changes, qualifying criteria and documents required. CMS never provides the necessary guidelines and/or forms to implement its requirements,” summed up one provider.

Fielded in January, this year’s survey drew responses from 203 HMEs across the country. With mean annual revenue of $6.3 million, respondents told us their mobility business represents, on average, 33 percent of income; more than two in 10 (22 percent) said it makes up 50 percent or more. On average, respondents have 154 mobility customers, with 38 percent reporting 250 customers or more.

Participating providers say the five most popular mobility products they carry include: walkers/mobility aids (95 percent); standard manual wheelchairs (94 percent); scooters/POVs (84 percent); power wheelchairs (83 percent); and heavy-duty/bariatric manual wheelchairs (82 percent). The most popular mobility accessories offered are seat cushions (59 percent); baskets (56 percent) and equipment holders (51 percent).

Currently, 28 percent of respondents say manual wheelchairs account for the biggest portion of their company’s mobility sales. But for 2006, the largest group (21 percent) expects scooters to be their fastest-growing mobility segment, followed closely by power wheelchairs (19 percent).

Nearly two-thirds (64 percent) of the HMEs who answered our questionnaire said Medicare is their largest payer for manual wheelchairs, and almost half said that program is their largest payer for power wheelchairs. On the other hand, almost a third (32 percent) singled out retail/cash sales as the biggest share of their scooter sales.

Respondents carry an average of three wheelchair brands, with 39 percent carrying three to four brands. In the scooter market, 32 percent of providers report carrying two brands, with another 26 percent carrying three to four brands. Six in 10 respondents offer service/repair of wheelchairs/scooters onsite.

When they are purchasing mobility equipment, providers said, product quality and price are the most important considerations.

While only 11 percent of survey respondents expect their mobility revenues to decline this year, most of the remaining participants were split as to whether their mobility sales will increase in 2006 or remain the same as 2005 levels (43 percent vs. 42 percent respectively). Of those who do expect an increase, however, most are looking for it in double digits.

Check the information in this section to find out more about providers’ expectations for the 2006 mobility market. For a complete copy of the survey results, visit www.homecaremag.com.

SURVEY FAST STATS

• Nearly nine in 10 respondents (89 percent) are involved with the mobility market.
• On average, respondents have 154 mobility customers, while more than a third (38 percent) have 250 or more mobility customers.
• Mobility business represents, on average, 33 percent of respondents’ annual revenue; two in 10 (22 percent) indicated it makes up 50 percent or more.
• Standard manual wheelchairs (28 percent) account for the largest portion of respondents’ mobility sales.
• Respondents expect their single fastest-growing mobility product in 2006 will be scooters/POVs (21 percent), followed by power wheelchairs (19 percent).
• More than half (53 percent) of respondents said their company focuses primarily on the geriatric market for mobility sales, while another 38 percent focuses on the disabled market.
• Two-thirds of respondents think CMS should have kept the CMN for power equipment claims reimbursement.
• More than one-third (38 percent) find it more difficult to deal with CMS’ new algorithmic approach to mobility equipment coverage. Twenty-eight percent are not sure how they feel about it.
• Forty-one percent of respondents report having to educate physicians/referral sources about their increased responsibilities in providing chart notes and patient records to document the medical necessity for mobility equipment.
• When power wheelchair claims are denied, respondents say it’s usually due to insufficient documentation (22 percent) or a question about medical necessity (22 percent).
• Respondents overwhelmingly (84 percent) think that CMS’ “in the home” restriction for mobility equipment coverage needs to be addressed.

For the Record

Survey methodology conforms to accepted marketing research methods, practices and procedures. Data was collected Jan. 11-15, 2006. Percentages are based on responses from 203 companies. Not all respondents answered every question, and some totals may add to more than 100 percent due to multiple responses.

What Providers Said About …

CMS’ new approach and rules for coverage of mobility equipment:

“CMS should simplify the two-page face-to-face form or just use a simple detailed CMN and make the physician personally liable for medical necessity, not the provider.”

“Difficult to get required documentation from physicians. They are used to just writing [the] order.”

“Doctors do not like to do narrative evaluations, and it is very difficult to get them to read the whole CMN, let alone an explanation of the algorithmic approach.”

“It is very confusing, time-demanding, will artificially cut the demand for the product because of the increased demand on doctors’ time.”

“Most information regarding the new mobility requirements have been geared toward the wheelchair/power wheelchair market, and it is very difficult to find out what other providers are doing to meet these requirements for the smaller, frequently purchased items like canes, crutches and walkers. Documenting the algorithmic approach has been a nightmare, and there is little guidance available as to how to protect us and meet these extensive guidelines.”

“In theory, it seems to be a logical approach. However, getting the professional community to understand the objectives and to consistently arrive at the same conclusion and same equipment recommendation is the problem.”

“We have been using the algorithmic approach since November for manual wheelchair evaluations and have not yet been asked to submit supporting documentation to the DMERC during a post-payment audit for the wheelchairs provided. So, I am unclear as to whether we have accurately interpreted the documentation expectations and have prepared ourselves appropriately to support our claims.”

“Easier to get appropriate equipment, harder to gather documentation.”

“It would be a lot easier if Medicare would change the rules just once. Changing the rules and then changing them back and then changing them partially … Who really understands what is going on? They don’t.”

“Trying to teach the referral source is impossible with all the uncertainty of the requirements.”

“Not all cases are black and white. The questions make it difficult to address all areas of need.”

“Physicians are furious! We’re trying education to show that just documenting the MAE in patient charts should be easier, but we’re meeting serious resistance. One doctor’s statement: ‘Medicare only gives us 15 minutes with each patient now, and you want me to spend five of those minutes on paperwork. I’ll just refer everyone to a PT.’”

“Physicians were not adequately trained for the new requirements. The documentation requirements for standard equipment have also not been adequately explained.”

“The face-to-face exam report has done nothing but create more paperwork for an already overly paperworked environment.”

“The face-to-face requirement is good, as well as the home assessment requirement. [These] two things may help cut down on fraud, and the physician should know what the capabilities of the patient are with a face-to-face exam, so the paperwork should be more accurate.”

“The most difficult aspect of this change is getting the physicians to comply … CMS should make more effort in informing physicians of their requirements and responsibilities instead of putting that on providers.”

“Physicians need to do their part so we are able to provide what the patients require.”

“We have been giving multiple in-services regarding the NCD and IFR to clinicians who refer to us. All agree with us that the function-based coverage is a positive move and algorithm logical.”

“We need clarity and consistency. The rules should be easy to understand and quantifiable.”

“We’ve had surprising success with dealing with the doctors’ new roles. However, we have done a lot of educating, and that helps. I think this is hardest on the doctors and will make them think twice about prescribing equipment because of all the hassle for them. After all, they were not trained in mobility equipment; they were trained in healing.”

“I think filling out the CMN made it too easy for beneficiaries to obtain equipment fraudulently. By going off of the chart notes, it gives a greater depth to the history of a beneficiary.”

“Providers need to know if they are going to be reimbursed for PMDs. Without some sort of CMN, we can never be sure.”

“I’m all for less paperwork, and I hope that is where this will lead (although I am a little skeptical).”

“At this time, we will not provide a power wheelchair to a Medicare patient.”