ATLANTA--Dr. Doran Edwards hopes the third time's the charm for Medicare's new power mobility codes.
Less than a week after CMS announced it would delay implementation of the codes--originally issued in February and revised in mid-September--the SADMERC medical director announced that he will now devote his full attention to reworking the codes once more and will lead an advisory panel to do so.
"I have suspended all of my other SADMERC duties for this one project. Whatever it takes, I'm willing to put in the time to do," he said Wednesday at a Medtrade session presented by the National Coalition for Assistive and Rehab Technology.
"This is the third formal attempt to come to a consensus that you agree with, CMS agrees with and the DMERCs agree with," Edwards told the audience. "This will impact the future of power mobility. We must get this right."
On Oct. 14, CMS announced it would delay implementation of the codes, which had been scheduled to take effect Jan. 1, 2006 (see HomeCare Monday, Oct. 17). Just a month earlier, the agency added 13 codes to the 49 it had issued in February and modified testing requirements.
But speaking again at an early-morning Thursday session sponsored by Sunrise Medical, Edwards explained that CMS recognized additional codes were needed to accommodate lightweight travel vehicles, which had not been recognized in the first round of codes in February; hence the addition of more codes last month. Beyond that, he said, there were also concerns with some safety issues surrounding the codes, and that testing labs might not be consistent in the way they performed tests for the new codes.
To remedy the situation, Edwards said CMS will empanel a 12-member technical committee to give input on the codes. The agency is quickly soliciting participants for the group, which he hopes will include manufacturers, providers, engineers, technicians and clinicians--"all of those who have stakeholder status with respect to power wheelchairs," Edwards said. Medicaid has also expressed an interest in participating on the panel, Edwards told HomeCare Monday.
With an as-yet-unnamed CMS contractor as facilitator, the panel will be seated within the next 30 days, he said, although details about when and where it will meet have not yet been decided.
Nominees for panel seats should have "broad experience, and perhaps [have] worked with more than one company or over a large segment of the population. If it's a clinician ... I want someone who's not fresh out of school but has several years in the trenches dealing with this, who is familiar with Medicare, familiar with coding and has some grasp of the history of what's going on ... and also has a very good grasp on what the range of the population to be served by these chairs might be," said Edwards, who will work with CMS to select panel members.
While "the best of the best will be chosen to be on this committee," Edwards said, he will consider all nominees as "a talent pool" from which the panel may draw for particular expertise on specific questions.
With the second round of codes, Edwards explained, the emphasis was on performance and durability, but clinical functionality was a missing piece. "This is where we need people with broad-based experience to [tell us] 'What does this chair serve? Who are we targeting for this?'" he said.
He continued that determining categories of chairs, not specific codes, will be the initial matter at hand for the panel. "The first question that will be tackled is, 'Do we now have an adequate breakout of categories of chairs? ... What are your performance levels? What are your durability levels? What are your functionality levels? And how does that apply to a clinical application?' Once that is defined," Edwards said, "then we can worry about the codes ... they're nuts-and-bolts details."
Pressure to 'Get This Mess Straightened Out' While the advisory panel has an "undefined length of time to complete this revision," Edwards cautioned, "it's not an indefinite time.
"There is still a great deal of pressure from Congress, from Medicare, from Medicaid, from all the third-party payers to get this mess straightened out ... it's got to be fixed."
Thus, Edwards said, "We need people who can dedicate their lives over the next three or four months to nothing but solving this problem."
He pointed out that since "HIPAA has required a universal code set for all third-party payers, we may be creating codes that will be invalid for Medicare ... but perfectly valid for Medicaid or private insurers. This is going to have a very broad-reaching and thus long-term effect.
"Our goal is to get to the heart of the matter and settle this once and for all so that the codes can remain in effect for a number of years without having to be tweaked." That means, Edwards continued, "your lives are going to depend on what we do in the next few months ... so that's why we want your input."
But, Edwards emphasized, "If we pull this off successfully, it may be the template for how all standards are applied to DME in the future for competitive bidding. This is as open and transparent a mechanism as I have ever seen from CMS."
Edwards encouraged all of those interested in participating on the panel to contact CMS by e-mailing Joel Kaiser, jkaiser@cms.hhs.gov, or Carol Blackford, carol.blackford@cms.hhs.gov.
