WASHINGTON--According to the American Association for Homecare, an influential congressman lent credibility on Friday "to the inaccurate and misleading government study" that suggests Internet prices available to consumers should be the basis for Medicare reimbursement of power wheelchairs.
House Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., sent a "Dear Colleague" letter to fellow representatives about a Department of Health and Human Services Office of Inspector General report, released Oct. 30, that found Medicare payments for PWCs were 45 percent higher than median Internet prices for the equipment.
Called "A Comparison of Medicare Program and Consumer Internet Prices for Power Wheelchairs," the report said that for the first three months of 2007, the government could have saved nearly $40 million if its fees had been the same as those Internet prices, and beneficiaries could have saved $233 in copays for the products. (See HomeCare Monday, Nov. 5.)
"Based on this analysis, the OIG concludes that lower prices for wheelchairs--and savings--are available to consumers and the Medicare program," Stark wrote in his letter.
But because "this study and the flawed comparison of Medicare and Internet pricing will be used by some members of Congress [to] justify further cuts to power wheelchair reimbursement rates," according to AAHomecare President Tyler Wilson, the association is scheduling meetings with both Rep. Stark and Inspector General Daniel Levinson to rebut the OIG's "apples to oranges comparisons."
The association said it will make the following points to both OIG and Stark:
--The cost of acquiring power wheelchairs used by Medicare beneficiaries through the Internet does not in any way compare to the cost of providing these devices to Medicare beneficiaries adhering to the appropriate standards of care. The implied cost savings of Internet pricing is extremely misleading.
--In a previous OIG analysis of power wheelchair prices--"A Comparison of Prices for Power Wheelchairs in the Medicare Program"--from April 2004, the OIG acknowledged that "the estimates of potential program savings presented in the findings of the report would be lower if median prices had included any supplier administrative costs."
--In former Inspector General Janet Rehnquist's testimony before the U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services and Education on June 12, 2002, the OIG indicated that when CMS compared Medicare prices to those from the Department of Veterans Affairs they added a 67 percent markup to the VA prices.
--Internet pricing does not account for the specialty evaluations performed by certified medical professionals, training, repairs and other non-equipment costs that are required in furnishing power wheelchairs to Medicare beneficiaries. Under Medicare, durable medical equipment providers must bear the expense of evaluating the beneficiary's specific needs, assessing the home, assembling the wheelchair, delivering the equipment to the home, conducting customized onsite fitting to accommodate the individual's seating needs, performing onsite training, processing claims for payments to insurers and maintaining facilities to provide service and repair. Any accurate analysis of costs required to provide the expected Medicare standard of care must take into account these services and administrative costs, which are distinct from the costs of acquiring the equipment.
--Online power wheelchair merchants cannot comply with Medicare standards. They carry limited product inventories and offer little or no assistance with product set-up, beneficiary training or repairs.
--Internet prices for power wheelchairs are an inappropriate and inaccurate source of data for establishing Medicare fees for these devices. Use of such data would skew the median price downward because the data does not account for all of the required services and activities necessary to furnish power wheelchairs to Medicare beneficiaries in a manner that ensures the beneficiary's safety or complies with standards applicable to Medicare enrolled providers.