Power of the Option

Power wheelchair providers face an overwhelming challenge on Jan. 1, 2011, that will lead to significant access and quality-of-care issues for the patients they serve. Health care reform legislation passed in the spring contains a provision that dramatically changes the way businesses are reimbursed for providing power wheelchairs to Medicare beneficiaries. Delaying that policy is the best option to allow providers to prepare for the change and preserve access to wheelchairs.

Medicare beneficiaries who have been prescribed a power wheelchair currently have the choice of purchasing the equipment in the month it is first prescribed or renting it for 13 months, at which time ownership transfers to the beneficiary. Given the chronic, long-term conditions of power wheelchair consumers, the vast majority of Medicare beneficiaries elect to purchase their power wheelchair in the first month.

Power wheelchairs save Medicare millions of dollars a year by helping seniors and people with disabilities to remain independent and in their homes. The purchase of a wheelchair by a beneficiary who would otherwise rent the chair for 13 months also saves Medicare money in terms of total payments, with the one-time purchase by Medicare costing less than 13 rental payments.

Most beneficiaries who elect to purchase indeed end up needing the wheelchair for beyond the 13 months. Medicare only loses money in those infrequent cases where the beneficiary purchases the chair and where the ultimate need is for some relatively short period of time.

But Section 3136 in the Affordable Care Act, the health care reform law, eliminates the purchase option for most power wheelchairs.

The situation is critical. The new policy creates a cash-flow nightmare for both large and small providers. Capital or lines of credit to provide the equipment in this current economy is difficult to come by. Providers cannot afford to bear the burden of paying the up-front costs to procure the appropriate wheelchairs. According to AAHomecare’s analysis, the elimination of the first-month purchase option could slice cash-on-hand by as much as 40 percent in the first year.

Providers of power wheelchairs will struggle to make the significant changes to their business models to adapt to new payment models that front-load costs with reimbursements from Medicare spread over 13 months. If they are unable to achieve this, they will simply go out of business. So providers and patients will benefit by delaying the elimination of the first-month option for a year in the expectation that credit markets improve and providers are better able to secure necessary financing a year from now.

People with compromised mobility are at risk for falls and injuries. So without access to proper power wheelchairs, thousands of beneficiaries face the risk of increased hospitalizations, home health visits and other clinical services. Also, power wheelchairs often delay or eliminate the need to place a person in a long-term care facility and preserve independence and quality of life.

Andrew J. Imparato, president and CEO of the American Association of People with Disabilities, added his voice to this cause. He recently wrote to senators that consumers who need wheelchairs will fare better if an additional year is allowed for providers, manufacturers and the Medicare program to adapt to this significant change.

AAHomecare has partnered closely with consumer groups to work with legislators in both the House and Senate to delay the policy change for a year, which is the most realistic legislative option for a remedy. Consumer groups supporting this effort include the American Association of People with Disabilities, the National Council on Independent Living, the National Spinal Cord Injury Association, Paralyzed Veterans of America, the Association of Programs for Rural Independent Living, Post-Polio Health International and the United Spinal Association.

The Association encourages all HME stakeholders to discuss this issue with your members of Congress. Visit www.aahomecare.org/mobility for more information.

Stephanie Genge, 66, of Coronado, Calif., has severe arthritis in her back. But a power wheelchair has significantly improved her independence. “The power wheelchair has completely changed my life.”

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Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.