Mobility Report

For the past several months, Congress has been discussing a proposal that would deliver a major blow to Medicare coverage of power wheelchairs, which yearly help thousands of senior citizens and people living with disabilities regain their mobility and independence. Previous congressional and regulatory changes have chipped away at this valued benefit, but this time people on Medicare and the manufacturers and suppliers who strive to serve them may face their biggest legislative challenge yet.

While debating the State Children’s Health Insurance Program, known as the CHAMP Act, some members of the House of Representatives decided to help pay for expanded healthcare benefits for lower-income children — a very worthy cause — by significantly changing Medicare’s power mobility benefit. The House sought to eliminate doctors’ ability to prescribe power wheelchairs for long periods to Medicare beneficiaries, even if they are permanently disabled. Instead, the House established a 13-month rental period for all beneficiaries, regardless of their physical condition.

It may seem like a mere accounting change, but the real-life impact on suppliers, manufacturers and, most of all, beneficiaries, would be devastating. Fortunately, the Senate version of the legislation paid for expanding children’s health insurance by increasing the federal tax on cigarettes. Since cigarette smoking adds countless costs to government health spending, the Senate felt justified in making the industry contribute towards improving healthcare for children. According to the Centers for Disease Control (CDC), the recent lost productivity estimate when combined with smoking-related health-care costs exceeds $167 billion per year in the United States.

In the Conference Committee, the final legislation dropped the language eliminating the purchasing of power wheelchairs, but like most revenue- enhancing maneuvers, this one is likely to resurface again as Congress seeks money to pay for other initiatives. It seems, however, that some lawmakers don’t understand that this is merely a budget gimmick: Renting equipment would allow the government to claim an immediate budget savings, but the government would actually pay more over the 13-month rental period than it would if the power wheelchair were purchased.

Moreover, a shift from purchase to rental would leave unanswered questions, such as the process for allowing patients to have the mobility equipment longer than 13 months. In addition, the change would have a devastating impact on the power mobility industry.

The government would essentially be asking suppliers to pay the upfront costs, such as obtaining a power wheelchair from the manufacturer, fitting a beneficiary to the chair, and complying with the voluminous government documentation requirements. But during the rental period, suppliers would receive monthly payments spread out over more than a year. Many suppliers say they would not be able to survive this financial burden, especially after absorbing huge cuts in reimbursement for power wheelchairs and the implementation of competitive bidding. Many suppliers, particularly smaller ones, would no longer be able to provide power wheelchairs and scooters.

The big loser, once again, will be Medicare beneficiaries, some of the most vulnerable people in our society. Already, thousands of seniors and people living with disabilities are not getting the appropriate power mobility equipment that could vastly improve their quality of life. What happens is that when suppliers go out of business or no longer provide the products, it becomes very difficult for beneficiaries to find other places to fill their prescriptions. This is especially true in rural communities, where small suppliers cover large geographic areas. But these same small providers are the ones hardest hit by the government’s ill-conceived policies.

Previously, the Centers for Medicare & Medicaid Services (CMS) had estimated that 17,800 Medicare beneficiaries a month would need power wheelchairs in 2007. But the government’s own data show that since the reimbursement cuts last November, use of the power wheelchair benefit has plummeted. For instance, in February 2007, only 8,599 beneficiaries utilized the benefit, a steep drop from the 14,287 beneficiaries who obtained power wheelchairs or scooters in the same month a year earlier.

The major reason for the decline is that there are fewer suppliers providing power wheelchairs and scooters because the government has made it too difficult for the businesses to survive. Clearly, lawmakers and regulators alike don’t fully understand the role that the power mobility benefit plays in lowering healthcare costs. There is a huge misconception that Medicare beneficiaries obtain power wheelchairs and scooters, and then die shortly after receiving them. To the contrary, a study on the life-cycle of people with power wheelchairs shows that, on average, seniors and people with disabilities far outlive the 13- month rental period that the House tried to establish. Specifically, the data shows that beneficiaries live, on average, 9.5 years after receiving mobility equipment. The data strongly contradicts the reasoning behind the rental proposal, which is that the government won’t have to make all the monthly payments because patients will die before the rental period concludes.

Furthermore, data shows that the government saves substantial sums because seniors and people with disabilities who use power mobility equipment don’t have as many falls that require hospital care and are less likely to be placed in nursing homes because they retain more mobility and independence.

The best outcome would be for lawmakers and regulators to gain a better understanding of the Medicare mobility benefit so it can continue to help improve the quality of life for our senior citizens and people with disabilities. They must begin to realize that the mobility benefit is a friend to beneficiaries and government; it shouldn’t be a target.

One of the nation’s largest disabilities groups, American Disabled for Attendant Programs Today or ADAPT, held a live demonstration yesterday in Chicago. According to WGN News, the protest was held in front of the headquarters of the American Medical Association (AMA).

ADAPT is known throughout the country for their demonstrations, but is also recognized for their legislative policy advocacy, grassroots education and mobilization efforts. This was very similar to the demonstration held in Washington, DC a while back that I had the privilege to witness. This particular protest however was held in part to demand better patient healthcare rights. The WGN news clip would suggest that physicians prematurely institutionalize seniors and people with disabilities rather than finding ways for people to live independently at home.

Watching this video clip though, brings me to a few relevant points of interest. Keeping people living at home independently not only enhances their quality of life, but also provides significant financial savings back to insurance and/or federal programs. Why?

• Changes in power wheelchair technology have made it possible for people with mobility impairments to pass through most doorways in their own home unassisted. The results of these changes give seniors and people living with disabilities the ability to rely less on a caregiver and the freedom to carry out their own activities of daily living;
• According to a report issued by the Alliance for Aging Research and Dr. Jack Guralnik with the National Institutes of Health, the total average annual costs of care for a person who remains independent for the year is $4,800. The total average cost of a person who lost independence during the year and needed help with daily activities is $36,000. The additional costs of medical and long term care each year due to lost independence is $26 Billion.
• National Center for Health Statistics reports that the average length of stay in a nursing home/institutional setting is 568 days.
• RRC, a renowned economics group conducted an outcome study of Medicare data which shows that by providing mobility equipment to senior citizens, Medicare actually saves enough to cover the cost of the equipment plus an average $10,887 over a two-year period. These benefits do not even include non-Medicare costs such as nursing home expenses.

Hats off to every organization fighting for disability rights across the country. The vitally active role we all play in educating the public today the better off our society will be tomorrow.

While the demonstration project in South Florida and Los Angeles should indeed help to reduce fraud and abuse, there are ways to make it even more effective.

CMS has publicly announced that its crackdown will unfold over a 30-90 day period, but wouldn’t that give the scam artists a window to accelerate electronic billing on the supplier numbers they already have?? Moreover, will it also give them time to relocate to other areas that are NOT part of the demonstration project? The program would be more effective if it was enacted immediately without giving these scam artists time to adjust. For example, CMS should consider making immediate site visits, and taking a more aggressive step of canceling supplier numbers suspected of being associated with shaky suppliers. Those businesses should be forced to prove they are legitimate.

Many company executives, including myself, have strongly advocated for years that mandatory accreditation for all suppliers would curtail fraud within the Medicare program. Our own reviews (which for the record are not nearly as sophisticated as the government investigations) have found "companies" billing the Medicare system for power mobility equipment while operating from addresses that were dry cleaners, vacant buildings, and garages. Congress has weighed in and has called for action. Last month, the Washington Post reported the third conviction from HHS’ special task force unit.

In most cases, senior citizens and people living with disabilities have been victims of these scams because they never received the products or services. Should the time ever come, most will not be able to receive a power wheelchair or scooter because government records show that they have already received one.

To be sure, if the fight against fraud is to be successful, the government must revise the system so that scam artists no longer have easy access to NSC billing numbers that open the door to Medicare reimbursements. CMS is now requiring accreditation in connection with the competitive bidding program, but that’s a process that will take years to be fully implemented.

What’s needed is mandatory accreditation for all suppliers before they can bill the Medicare program. This would force all suppliers to face a level of scrutiny that would weed out many of the fraudulent dealers and eliminate the longstanding pay and chase approach the government has used for years. Another benefit is that it would improve the credibility of the power wheelchair industry, and help ensure that Medicare beneficiaries receive quality service, as well as quality products. The days of criminals who pay doctors to write hundreds, if not thousands of phony power wheelchair prescriptions are numbered!

For almost five years now, I have been educating Congress on a number of ways to fight real fraud in the Medicare system. Some of those initiatives include mandatory third party accreditation, increased quality standards and increased, unannounced site visits. I am convinced that there was someone finally listening when I asked the question: how can a dry cleaner or empty building be billing the Medicare program? Can it really be that easy? Shouldn’t we be doing as much as we possibly can to a) protect our most frail population from these scam artists, b) protect the Medicare trust, and c) finally save the integrity of legitimate suppliers who are 100% committed to providing quality healthcare to Medicare beneficiaries?

The power mobility industry has been pushing for true, fraud measures for quite some time. It seems that for every step we take forward in gaining much deserved credibility, another scam artist makes the front page. Quite frankly…it’s time to put an end to this practice. In fact, the American Association for Homecare wrote an open letter to Congress entitled Greater Efforts Needed by Medicare to Combat Fraud applauding the recent efforts by CMS, but that more needed to be done.

Now, The Centers for Medicare and Medicaid Services (CMS) appears to be getting serious about fighting Medicare fraud associated with the power mobility benefit. The agency has recently shifted their focus from measures that restrict access to power wheelchairs and scooters to actually tracking down fraudulent suppliers and putting an end to costly scams that are costing the government millions of dollars.

In a July 2 press conference, Health and Human Services Secretary, Michael Leavitt announced an expansion of the Medicare Fraud Strike Force, a two-year effort designed to further protect Medicare beneficiaries from fraudulent suppliers. The power mobility industry applauds this new direction. Suppliers, manufacturers and Medicare beneficiaries still suffer from the series of regulatory changes — reimbursement cuts, new coding, competitive bidding and others — that were touted by CMS as tough action against fraud. But in most instances, the victims of these policies were legitimate suppliers and beneficiaries, not the scammers.

At least now, CMS has its sights on the right target: the fraudulent dealers. The demonstration project is aimed at South Florida and Los Angeles. Under the initiative, suppliers (about 2,700 in South Florida and 5,000 in LA) must reapply for their National Supplier Clearinghouse (NSC) supplier numbers; these numbers are required to bill the Medicare system. And, suppliers will need to be accredited and CMS will also conduct unannounced site visits.

This is attacking the problem at the source!

I’ll have Part II next time.