On Notice

When Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully announced his concern about the increased use of motorized wheelchairs (K0011s), he put the HME industry on notice that it is time to deal with this issue.

In response, our industry must develop a reasonable plan with multiple goals: We must educate policy-makers about why there has been an increase in the use of motorized wheelchairs. We must provide regulators with a process to ensure that all claims for motorized wheelchairs are medically necessary for those receiving them. Finally, we must initiate strategies that will give our industry greater credibility with policy-makers.

At the outset, providers must agree that there are two markets for motorized wheelchairs. The high-end rehab provider primarily serves consumers with permanent total disabilities, such as spinal cord injuries, etc. The consumer mobility provider serves seniors with a variety of chronic conditions that impact their ability to ambulate. I believe we would all agree that the majority of growth in motorized wheelchair use can be attributed to the consumer mobility market.

Changing Demographics

Why has there been such growth in this segment? Demographics, technology development and consumer awareness are three primary reasons.

When you look closely at those who are receiving motorized wheelchairs, you see that on the whole, these products are medically necessary.

Most motorized wheelchair users are over 70 years old, with an average age of 75. The demographics for this particular age category have increased dramatically, and the demands of this senior mobility market will continue to grow.

Improved Technology

Only five to 10 years ago, there were very few motorized wheelchairs on the market that were appropriate for operation in the average American home. Since then, manufacturers have developed motorized wheelchairs that, in both size and maneuverability, are capable of full use within most homes. They require few, if any, structural modifications to the average dwelling.

One of Medicare’s criteria for covering a motorized wheelchair is that the wheelchair be usable in the beneficiary’s home. However, before the technological developments in today’s motorized wheelchairs, Medicare would not cover these items, because the products were not usable within the person’s home — even though there were people who needed them.

Consumer Awareness

Seniors and other beneficiaries are becoming increasingly aware of the motorized wheelchair options available in today’s market. Information sources such as the Internet have given consumers a better understanding about various home health care items — as well as about the sophisticated technology — that can improve their quality of life. Once aware of the home health care equipment and services that are available, consumers often discuss the potential features and benefits of certain items, such as motorized wheelchairs, with their physicians.

At the same time, more beneficiaries are being treated by physicians for a variety of chronic illnesses and diseases, the accumulation of which can result in significantly reduced mobility. Most physicians now think that it is better for these patients to be able to get out and interact with family and friends than to be cooped up in their homes. Thus, doctors are more inclined to prescribe motorized wheelchairs that enable their patients to remain active.

While growth in the use of motorized wheelchairs has increased in the consumer mobility market for several reasons, our industry must let policy-makers know that that this equipment is necessary — and that motorized wheelchairs can improve beneficiaries’ lives.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is an attorney with the law firm of Epstein, Becker & Green in Washington, D.C. Bachenheimer previously worked at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 202/861-1825 or e-mail at [email protected].