ATLANTA--With just a small window of time before the Jan. 1, 2009, implementation of a 9.5 percent reimbursement cut, complex rehab stakeholders are uniting to build a case for exemption from the reduction.
On Wednesday, the Rehabilitation Engineering and Assistive Technology Society of North America sent a letter to members of the U.S. Senate pleading for exclusion from the pay cut mandated by the Medicare Improvements for Patients and Providers Act, which also delayed competitive bidding.
The RESNA correspondence follows a Sept. 19 letter sent by the American Association of People with Disabilities to Sen. Max Baucus, D-Mont., chairman of the powerful Senate Finance Committee, expressing concern about the impending cut.
“Consumer groups have weighed in and now we have disability groups that have weighed in,” said Seth Johnson, vice president for government affairs for Pride Mobility Products in Exeter, Pa. “The clinicians and the physicians that make up the RESNA membership … are talking specifically about the impacts they know this is going to have on beneficiaries who need these complex rehab power wheelchairs and the services that go along with those products.”
While Congress elected to exempt complex rehab from any future competitive bidding program, it did not exclude the segment from the 9.5 percent fee schedule reduction that will be applied Jan. 1 to the products included in round one of competitive bidding.
Stakeholders have said that complex rehab providers operate on slim margins--of as little as 2 percent--and cannot absorb a 9.5 percent fee reduction without deep cuts to service and quality of products.
“We are concerned that with the impending 9.5 percent payment reduction, complex rehab suppliers will be forced to make significant adjustments to their business practices that will directly impact the services they provide,” RESNA’s letter said.
Some of those impacts could include decreased beneficiary access, decreased access to demo/trial and simulation equipment, substitution of recommended products, less robust products and a decrease in essential services, according to the organization.
“[The fee reduction] will jeopardize many beneficiaries’ access to the full range of products and services necessary to meet the unique and individual physical and medical needs of many people with disabilities,” AAPD said it its letter. “People with severe physical disabilities often need a power wheelchair that is specifically designed so they can maintain independence. With the current provision, many power wheelchair users will not be able to receive adjustments, repairs, replacement parts and access to the full range of products available to make modifications to their current power wheelchairs.”
The probable impact on quality and accessibility was borne out by a recent survey sponsored by the National Coalition for Assistive and Rehab Technology. According to the 184 complex rehab companies that responded to the survey in September, “the impact on revenue and profitability will be reflected in both the services provided by complex rehab companies and product choice available to people with disabilities,” NCART officials said.
According to the survey:
--77 percent of the companies reported that the reimbursement cut would affect 20 percent or more of their revenue;
--51 percent said it would affect 40 or more percent of their revenue;
--66 percent said profitability would decrease by up to 20 percent;
--87 percent said the reduction would either reduce or eliminate altogether their off-site assessments and evaluations;
--88 percent would reduce or eliminate providing demonstration and trial equipment;
--95 percent would have to reduce or eliminate product choices; and
--91 percent said their ability to perform repairs and servicing at the customer’s home would be affected.
Sharon Hildebrandt, executive director of NCART, said she was prepared for providers to say they would be adversely affected by the fee reduction, but the “magnitude of pain” was a surprise.
“I think I expected that half of the companies would show an impact, when in fact it was [far greater],” she said. “The margins are really quite small so there is not really a whole lot of wiggle room in there to digest 9.5 percent cuts. Their options are really just to change the product or cut services.”
Already, she said, providers are steeling themselves against the looming cut by establishing formularies. For example, Hildebrandt said, “They are not including all the bases that they have in the past for power wheelchairs.”
As well, she said, some providers have said the cut will force them out of business. “I think we’ll see more consolidation, bigger [companies] coming in and buying up the smaller ones,” Hildebrandt said.
In spite of what could be a devastating effect on both beneficiaries and providers, both she and Johnson believe the chances are slim that the cut will be either stalled or canceled.
“I don’t see an opportunity to do anything for this year. We’ll have to do it next year with the next Congress,” said Hildebrandt.
“It is going to be extremely difficult to get anything done before the implementation date,” said Johnson, noting that Congress has adjourned because of the Nov. 4 election.
However, he said, “We hear that Congress is going to come back for some kind of lame duck session.” The RESNA and AADP letters could help jumpstart support in Congress and that would improve the chances for an exemption, he said, adding: “But there is clearly not a vehicle to attach this to at this time.”
The chances are relatively good, both Johnson and Hildebrandt said, that, like competitive bidding, the fee reduction will be implemented, then possibly pulled back.
“Unfortunately, it looks like that might have to happen,” Hildebrandt said.
She is already considering a second survey. “I sort of envision us doing a comparable survey once we get into 2009,” she said. “This one was in anticipation of the cuts. Once we get to 2009, I’d like to see us do another survey to see what the impacts of the cuts [really are].”
It’s those results, she believes, that might speak most strongly to Congress. “Anecdotal evidence doesn’t do it. It isn’t that helpful. They want to see the actual numbers,” she said. “They want to know in actuality what is happening, and we owe them that. If we say this is going to happen, we have to put our money where our mouth is and not just cry wolf.
“If it doesn’t happen,” she continued, “then we have no basis for seeking an exemption for the 9.5 percent reduction.”
Like other complex rehab stakeholders, however, Hildebrandt doesn’t doubt that there will be damage to both providers and beneficiaries, but especially to the latter.
“Ultimately, it’s the consumer that will suffer. Providers will cut back as much as they can, but it’s the consumer who will be affected,” she said.