AAHomecare Survey: Mobility Providers Struggling to Adjust

WASHINGTON—A survey of HME companies released yesterday by
the American Association for Homecare found that many HME power
wheelchair providers have made “abrupt changes” in
their operations to comply with new Medicare policies.

The regulatory changes, however, have made it difficult for some
businesses to provide quality products and service, according to
the association.

Following is AAHomecare’s release on the survey
results:

The American Association for Homecare (AAHomecare) said more
than 125 businesses across the country were contacted for the
survey, providing the most extensive research to date on how
companies are adjusting to the federal mandates. These include the
controversial competitive bidding process for most home medical
equipment, replacing a first-month purchase option with a 13-month
rental program for power wheelchairs, as well as other factors,
such as extensive government audits and confusing guidelines for
documenting medical necessity for mobility assistance.

Many providers reported negative consequences ranging from
planning lay-offs, no longer offering power wheelchairs and going
out of business to the need to find additional warehouse space for
used equipment and struggles to perform repairs for some
patients.

Specifically, the survey found that:

• 65 percent said their ability to service Medicare beneficiaries
  has been compromised
• 48 percent said their repair policy has changed
• 45 percent said the area in which they service patients has
  changed
• 28 percent said their level of staffing has been impacted

“These companies are frustrated by government policies that are
creating obstacles to providing mobility assistance to Medicare
beneficiaries,” said Tyler Wilson, CEO and president of AAHomecare.
“Yet, many companies are making adjustments in their business
operations so that Medicare beneficiaries can continue to receive
power wheelchairs.”

Wilson said the business owners provided valuable insight into
how the actions taken by lawmakers and bureaucrats are impacting
providers and Medicare beneficiaries. Furthermore, Wilson asserted
that the government polices are yielding many unintended
consequences that must be addressed, including forcing providers to
“cherry-pick” the Medicare beneficiaries they can afford to assist,
while others may go without mobility assistance. These new burdens,
he said, are taking a toll on home medical equipment providers,
whose frustrations are evidenced in the survey responses.

Mark Nice of Central Medical Equipment Company in Harrisburg,
Pa., said that while government reimbursements for power
wheelchairs have declined, administrative costs are increasing.

“We now need more inventory and have to wait to recoup our
expenses,” he said. “I now need to have a person call every rental
each month and check on status. This will possibly lead to hiring
another billing clerk and an additional service tech at a time when
reimbursement has been severely impacted.”

Moreover, Nice said the policy changes will hamper Medicare
patients. “Patients will now be given the minimum equipment,” he
said, adding that adjustments for leg length, arm height and seat
to floor height likely won’t be made because the priority will be
on issuing wheelchairs that are already in a company’s inventory.
Nice also noted that the cheaper equipment that will now be
provided to Medicare customers will be lower quality than was
previously available, will likely need more repairs and may not
even last the five year period before beneficiaries are allowed to
replace it.

The 13-month rental policy, which was shrouded with controversy,
was implemented because the government contended Medicare
beneficiaries might die shortly after receiving mobility
assistance. The change was made despite studies by the largest
providers showing that between 86 percent and 94 percent of
Medicare patients lived longer than 13 months after receiving a
power wheelchair. Now, because of the policy, many businesses are
in the unfair position of rationing medical equipment that has been
prescribed for Medicare patients by their physicians. Small
businesses, in particular, are impacted because many only provide a
few power wheelchairs a year.

“Unfortunately, I have to consider the longevity of the patient
prior to a power chair order,” said Glenn Steinke of Air-Way
Medical, in Bishop, Calif. “If the patient may not live through the
rental cap, I will have to take back a very used chair. What will I
do with it then?”

Other providers acknowledged that they have to carefully select
customers who are less likely to need extensive repairs on their
chairs. “I have reduced the amount of chairs I will provide.” said
one business owner, who asked not to be identified. “I have to say
“no” to certain patients that I know will be heavy users of the
products that can cost me a lot in repairs.”

Nancy Oyen of Finley Hartig Homecare in Dubuque, Iowa, added:
“Several of our competitors are no longer doing electric
wheelchairs. We only do basic power wheelchairs – no rehab. We find
out patient history before accepting a patient – trying to
determine where they will be living in 12 months and overall
medical condition to determine if they will be alive throughout 12
months.”

But a provider in the Charlotte, N.C., area, who asked not to be
identified, said she is leaving the business altogether. Over the
past three years, she said her company has suffered through a 30
percent decrease in earnings due to Medicare cuts and the sluggish
economy.

“We are no longer offering Medicare power chairs at all,” she
said. “We simply can’t afford to buy high quality, new equipment
and put it out under the current rental arrangement. Medicare
beneficiaries want new equipment and we have no way of certifying
how rental power equipment has been maintained and cared for while
in the hands of any beneficiary.”

Since the beginning of the year, when the mandatory rental
policy replaced a Medicare patient’s option to purchase a power
wheelchair, she said, “We have already turned patients away. I
don’t even know where to send them. We are not physically in a
competitive bidding area, but most [companies] around us stopped
doing them last year due to the significant documentation
requirements. I guess they saw the writing on the wall. One lady I
spoke with had already called four companies and was still
searching. Let’s hope that she can find a reputable company before
she falls and requires a hospital stay.”

Janet Round of AWCS Medical, Inc., in Porterville, Calif., said
she has also stopped offering standard power wheelchairs.

“We will no longer be able to provide the standard power
wheelchair to our patient population,” she said, noting that
problems have arisen with other medical equipment on rental
programs. “The initial cost of the chair prohibits using it as a
rental. We have found too many patients think they own DME (Durable
Medical) equipment such as hospital beds, even when we have not
received the 13 months of rental. They move out of state with our
equipment or their family sells the equipment when the patient
expires and there is no way for a provider to recoup the loss. I
can’t take the chance of them taking off with the power chair when
we would have so much invested in the chair.”

Others providers are also concerned.

“Providing power mobility now has the word ‘RISK’ written all
over it,” said Serina Breen of Freedom Mobility Center, LLC, in
Rodeo, Calif. “The rigorous and time-consuming documentation
requirements required for power mobility along with the high risk
of charge back already make providing power mobility equipment
expensive and risky. Now with the elimination of the first month
purchase option, this adds even more expense and risk to providers
as we must purchase expensive equipment upfront and risk not being
able to recoup the cost of our investment. As a result, we will
provide less power mobility equipment to Medicare, and look to
build our business with other product categories and insurers
instead.”

Matthew Boyd of Hattiesburg Medical Supply, in Hattiesburg,
Miss., said, “We will be keeping less inventory and have changed
which models we carry. We are carrying less expensive models due to
the changes. Our service to our customers will be the same, however
these policies affect the quality of power chairs available. We
used to offer higher end chairs, but this is impossible now.”

Another provider, Donald Jones of Southern Medical Equipment
Corp., in Cullman, Ala., maintained that the government policies
are inconsistent with the needs of the Medicare beneficiaries, who
are prescribed power mobility to help them ambulate in their
homes.

“Consumer power chairs, in order to meet the Medicare
requirements, are only for patients that cannot walk due to a long
term disability,” he said. “The beneficiaries in this category are
rough on the equipment. There is no way that a dealer can afford to
finance the power chair and be expected to provide repairs on this
type of equipment for five years.”

Jones noted that if the rental chair is returned to the provider
prior to the end of the 13-month rental period, the provider will
have to pay to “completely refurbish the chair” before it could
even be rented to a new Medicare patient.

Wilson, of AAHomecare, said the survey comments unfortunately
reflect the current state of mobility providers across the
country.

“These business owners are committed to helping people living
with disabilities improve their quality of life,” Wilson said. “But
oftentimes government policies are obstacles. It’s very unfortunate
that Medicare beneficiaries are becoming the victims of bad public
policy.”