ATLANTA — Medicare's elimination of the first-month
purchase option for Group 2 power wheelchairs is entering its third
week, and already problems are surfacing that reach beyond the
bottom line, according to mobility providers and others.
CMS implemented a new reimbursement model on Jan. 1 that
effectively turns standard power wheelchairs into rentals. Rather
than getting paid up front for the expensive products, providers
must now wait 13 months for the full payment.
Even though it is early in the game, stakeholders are reporting
issues ranging from beneficiary access to clear guidance on
provider compliance requirements.
"We're not thrilled with the process," said Jim Greatorex of
Black Bear Medical in Portland, Maine. "The problem we are seeing
is not so much financing, although we are certainly going to have
to limit our choices as to what people get. The biggest issue is
catching the clients who go into skilled nursing facilities and
having to take [the wheelchairs] away from them.
"We're having to be the bad guys. We're going to have clients
furious at us for taking their power wheelchairs away … We're
talking about a very emotional thing here."
He's also disturbed that patients who go 60 days without the
benefit because they are hospitalized or in another facility will
have to be re-evaluated all over again to prove medical necessity
once they are released.
"Again, who is going to be the villain in this?" Greatorex
asked. "Those are extremely negative experiences we are going to
have with our clients."
"There is more than a payment methodology change," acknowledged
Julie Piriano, director of rehab industry affairs for Pride
Mobility Products in Exeter, Pa. "There is some concern with regard
to effectively managing through the long-term, 13 months of capped
rental."
Documentation is relatively clear for static situations, Piriano
said, but beneficiaries are rarely static. They move around. They
travel. They go in and out of hospitals and nursing facilities.
Once released, they might go to a relative's home for a time rather
than their own home.
"There is no clear guidance once it gets complicated," Piriano
said. "The logistics of the documentation and the condition of the
equipment are really of concern ... When there is a break in
service like that, this is expensive equipment and you can't keep
track of where it went or who took it. That's a high-value asset to
lose."
The issue becomes even murkier if beneficiaries live outside a
competitive bidding area and travel into a CBA.
"Grandfathering rules do not apply," Piriano said. "So again,
there are a lot of down-in-the-weeds compliance issues that
providers are grappling with because they do want to provide the
equipment, but they want to make sure that once they receive the
money, they will get to keep it and not have to give it back
because of a technicality at the start of the program."
That has caused providers to be very wary in providing standard
PWCs, she said. "Some companies are hanging back a little, not
wanting to have too much risk and liability," Piriano said. "Some
have indicated that they can't make the transition at this time, at
least in the short term, until they see what the lay of the land is
economically."
Medical directors for the four DME MACs are aware of the
problems, she said, and are working to come up with some solutions.
"But the need for guidance is pretty immediate," she said.
Meanwhile, there is the beneficiary access issue.
"It is pretty early, but some things are becoming evident," said
Tim Pederson, ATS, president and CEO of WestMed Rehab in Rapid
City, S.D. "We are taking a hard look at who we are providing
service to and under what circumstances. And we are looking at the
type of equipment we are providing. If it is a high-risk situation
and is going to come back in pieces, we're probably not going to
provide it.
"I see us being very selective under a rental [program]," he
said. "I think the mindset is different from when we provided a
power wheelchair that people own at the outset."
Pederson said he has heard of some companies getting out of the
Medicare standard power wheelchair business altogether. "And that
is always a possibility for us, as well," he said. "We are
concentrating on the complex side and less on the noncomplex."
Greatorex said he, too, must limit his standard power wheelchair
business. "We are not probably going to be able to help people with
their bariatric products," he said. "You're looking at a client
whose health stability is probably not very good. Usually, the wear
and tear on those products is pretty high. We are really seriously
having to look at every one of those and we are not taking them
all."
Darren Tarleton, president and CEO of Mobility Warehouse in
Stockbridge, Ga., said he has pared down his Medicare business so
it comprises only about 20 percent of his revenue. So the
elimination of the first-month purchase option is not affecting his
business too much.
Still, he is not in favor of the policy and he doesn't believe
it will achieve what CMS is projecting: cost savings for
Medicare.
"I really don't see it saving money in the long run," he said.
"The average person is going to live longer than 13 months. There
are much bigger problems in the system and I think [CMS is]
focusing on something that in the short term looks like it
will save money."
Stakeholders said they weren't holding out a lot of hope that
the policy would be repealed. "It's a terrible policy, but I
wouldn't be surprised if we're stuck with this," Greatorex
said.
That could happen, said Seth Johnson, vice president, government
affairs, for Pride. "Legislative options to delay [elimination of
the] purchase option at this point are very remote," he said,
adding, "We are continuing to work with CMS and its contractors to
secure additional guidance and clarification to assist providers in
transitioning to the [new program]."
