Playing by the Rules

Although manufacturers acknowledge the power wheelchair market may be flat at present, they say this is not cause for alarm. The attitude stems, in part, from confidence that the market will begin to grow again within the next 12 months, as unsettled coding issues are expected to be resolved.

More important, however, manufacturers predict that, even in a slow market, providers who follow the rules and who quickly adjust to a new system of documentation for power wheelchair claims will be just fine.

“The market will start building again,” states DuWayne Kramer, president of Kansas City, Kan.-based Leisure-Lift. “Right now, there is a lot of confusion among dealers about codes — they are scared because they don’t know what to do. But people who are [documenting the products] right and sending their information are getting paid. They simply have to follow the rules.”

If nothing else, the basic need for power wheelchairs continues to grow as the nation’s aging population expands — in more ways than one: Not only is the population getting older, more people are becoming obese and experiencing the sometimes debilitating side effects of the condition. Leisure-Lift’s Kramer says the bariatric power mobility market is, well, constantly growing.

“People who need power mobility products will get them,” Kramer says. “The market won’t be … like it used to be, but providers will still make money.”

First, the Bad News

Industry experts agree unanimously that, at least for now, the power wheelchair market is on hold. The present market is in “a holding pattern,” says Mark Sullivan, vice president and category manager, rehab, for Elyria, Ohio-based Invacare.

“We are waiting for new codes, and we still don’t have a fee schedule,” he says, adding that although CMS’ final rule for power mobility products goes into effect June 5, the exact criteria for claims documentation and supplier standards is “still muddy.

“Until there is clarity in these areas … there’s still too much conjecture,” Sullivan says.

Other manufacturers agree. Pieter Leenhouts, vice president of standard products for Longmont, Colo.-based Sunrise Medical, says the uncertainty and resultant price pressure has made the market “relatively stagnant, and probably declining.

“There are a lot of question marks about what’s really going to happen, what CMS is doing with coding, who should get what kinds of products,” Leenhouts says.

“Without 100 percent clarity, it’s hard to say what is going to happen [in the market].”

Now, the Good News

Manufacturers of power wheelchairs predict the segment will begin to gain momentum before the year is through — a direct result of coding clarification underway at the SADMERC that is expected to be completed by the fall or sooner.

And last month, the Centers for Medicare and Medicaid Services moved one step closer to clarifying new power mobility standards. In the final power mobility rule, published April 5 and scheduled to take effect June 5, CMS said physicians and treating practitioners would have 45 days after the date of a face-to-face patient examination to supply medical records to HME providers. Providers also must receive a prescription for the equipment within 45 days of the exam or 45 days after the patient has been discharged from the hospital.

The rule eliminates the power mobility certificate of medical necessity, replacing it with a doctor’s prescription, face-to-face exam and patient records documenting medical necessity. However, the final rule fails to specify exactly what documentation should be included with reimbursement claims, and in it, CMS even states that it “cannot develop an all-inclusive list of documents or information that Medicare contractors may request during audits.”

“There is no type of document that, taken alone without regard to substantive content, will guarantee that the beneficiary’s clinical condition meets the conditions for payment,” CMS said. “It would be misleading to suggest otherwise.”

With the final rule in place, however, power wheelchair makers are optimistic that final codes will be released soon. Jim Ernst, Leisure-Lift’s vice president of product development, expects power mobility codes to be finalized and announced in the next six to 12 months, while Invacare’s Sullivan believes CMS will clarify coding and other issues sooner, “in the next two to three months.”

The Need Is There

HME providers hardly need reminding this is one industry that, for better or for worse, exists because the consumers served by medical equipment will always need the products. And, as the consumer base continues to grow, the market will remain viable.

“From a consumer power perspective, we all realize that the underlying need is there,” Leenhouts says. So, he explains, from a unit perspective, the market will continue to grow. From a “dollar perspective,” however, growth is still unclear.

Most experts agree with this assessment. While the power wheelchair market still will be profitable, the size of the profit will likely decrease as the effort required to earn the profit will increase.

“Providers might have to adjust to not making as much money,” adds Ernst.

“They have been getting good money [for power wheelchairs], but that’s not what they’re getting with the rest of their products. They’ll have to adjust their mindset to acknowledge that … And they will have to do a little more work to get that money.”

Focus on Right Products

The confusion surrounding Medicare codes has not stopped product development, according to Scott Higley, vice president of sales for Exeter, Pa.-based Pride Mobility’s Quantum Rehab division. Instead, he says, “it has made us look at developing products for different needs.”

In fact, Higley and Kevin Quaglia, general manager for industry affairs at Pride, say the coding changes should benefit development by more accurately reflecting the distinct differences between products so providers know exactly what is available for their customers.

According to Leisure-Lift’s Kramer, while some might be waiting until the codes are determined to change or create new products, smart manufacturers should be able to anticipate what the codes will look like and can bring out new lines without waiting for official word from CMS.

“We’re making an educated guess,” Kramer says. “We have a good idea where we think [coding] is going.”

Most manufacturers say they view product development and Medicare coding issues to be distinctly different concerns.

“Our mission is to improve people’s lives,” says Leenhouts of Sunrise. “We don’t focus necessarily on Medicare codes; instead, we focus on whether we are developing the right products for consumers to use.”

Innovation in Electronics

Product innovations for power wheelchairs continue to occur in the expected components: bases, drivetrain and seating.

For example, manufacturers are developing specialized bariatric wheelchairs because they say the CMS code for these products (K-14) has been largely ignored in all the fuss surrounding the K-11 chairs. In addition, the bariatrics market continues to add end-users. In other areas, manufacturers continue to improve motor speed, increase battery life and add more maneuverability and drive.

However, the greatest and newest innovations are occurring in a part of the power wheelchair that some people may overlook: the electronics. Manufacturers are adding capabilities such as clocks, electronic photo albums, remote control capabilities for home televisions, text-messaging capabilities and more — all in an effort to make the equipment more consumer-friendly.

“Electronics is an area where we will continue to see huge innovations in both hardware and software,” Leenhouts says. “You can do a lot with a controller to make a chair a lot better.”

“People are looking for much more out of their chairs,” Higley adds. He details electronics innovations such as a graphic interface capability that allows the provider to correspond with the user via text message about problems the chair might be having; a clock built into the controller that replaces a wristwatch (which many power wheelchair users simply can’t use), but that works to time- and date-stamp messages from the chair so providers can see when errors occur and how frequently. Pride controllers also can support memory cards filled with graphics, such as photographs, that can be loaded directly onto the display screen.

“The next major, major innovations will come in the electronics area,” Higley says. “We’re pushing the envelope and … as a result, the customer has a much better chair than he did five years ago.”

Play by the Rules

As consumers benefit from product changes, manufacturers believe that providers ultimately will benefit from changes in this market, too.

For one thing, manufacturers are confident that the seemingly once-frightening coding and standards changes are moving in the right direction.

“Not only will the market for power wheelchairs continue to improve” as codes dictate the proper products for consumers’ needs, according to Higley, the industry environment will improve because of the relationships that have developed among providers, manufacturers and payer sources.

“I don’t know that there was always such an open dialogue as there is now,” Higley says.

The payers are “good, honest people, who want to get the claims through without violating the rules,” says Leisure-Lift’s Ernst. “There is no ‘we’ve got to get [providers]’ attitude.”

But, the experts say, providers need to be patient and smart about their business practice — and play by the rules.

“Some people are scared right now, but the others who have learned the rules are up and running,” says Kramer. “As soon as providers learn the rules and get a few claims through, they will realize the situation is not so bad.

“Providers can still make some good money [in the power wheelchair market],” he continues, “but they will no longer be able to [gain] their profit without any effort.”

That effort includes carefully assessing the total cost for a power chair.

“Don’t look at the lowest acquisition cost,” warns Leenhouts. “Look at the overall cost of the chair. You want to provide a good product, one that does not need to be serviced all the time.”

Higley agrees. “Provide high quality chairs and service. Focus less on price and more on cost,” he says. “You will not lose money by paying a little more for the product — you’re actually going to benefit in the long run.”

All these manufacturers agree that the power wheelchair market is a good investment for providers who follow the rules.

“If you pay attention and read the rules, Medicare will pay you for the product, period,” Ernst concludes.

Experts Interviewed:

Jim Ernst, vice president, product development, and DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Scott Higley, vice president of sales, Quantum Rehab division of Pride Mobility Products, Exeter, Pa.; Pieter Leenhouts, vice president of standard products, Sunrise Medical, Longmont, Colo.; Kevin Quaglia, general manager, industry affairs, Pride USA, Exeter, Pa.; Mark Sullivan, vice president and category manager, rehab, Invacare, Elyria, Ohio.