Changes in Medicare policies may hamper supply of power wheelchairs

Will power wheelchairs continue to be available to Nevada's Medicare patients following a series of federal regulatory and policy changes?

There are grave concerns among consumer groups, Medicare beneficiaries and homecare equipment providers in Nevada that the changes in Medicare policies may severely hamper the ability of providers to supply quality products and services to beneficiaries.

One of the biggest threats is a new law establishing that the Medicare program will pay rental payments over a 13 month period to homecare equipment providers after they supply power wheelchairs to Medicare beneficiaries. The change will create significant cash flow problems for providers, who will be forced to purchase the equipment from manufacturers, and then receive reimbursement payments stretching over 13 months.  Previously, Medicare beneficiaries could request that the government purchase the equipment for them in the first month of use.

In addition, the Medicare program is expanding the flawed "competitive" bidding system. The program restricts the number of providers who can supply home medical equipment in selected geographical areas around the country, severely jeopardizing access to power wheelchairs for seniors and those living with physical disabilities.

"We fear that the Medicare mobility benefit won't be available for the people who need it because there won't be providers around to fill the power wheelchair prescriptions once doctors order them for their patients," said Corrie Herrera, rural director for the Northern Nevada Center for Independent Living in Elko, Nevada. "Our organization, as well as others across the state who represent people living with disabilities, feel that the Washington policymakers don't understand how much a power wheelchair means to the people who need them. We must ensure that Medicare patients continue to have access to this equipment."

Herrera said physicians prescribe power wheelchairs to patients needing assistance with critical daily activities, such as grooming, getting to the bathroom and preparing food. By continuing to perform these tasks in their homes with power wheelchairs, Herrera said it often delays the necessity of placing beneficiaries in expensive nursing homes.  Mobility assistance also reduces emergency room visits for Medicare patients, who are less likely to suffer injuries from falls.

Jason Turner, 43, of Las Vegas, said his power wheelchair has made a dramatic difference in his life. Turner, who has multiple sclerosis, said he has used a power chair for a dozen years.  "It is like getting my legs back," said Turner. "I can help my daughters with their homework; and I have the freedom and independence to go wherever I need to go."

Moreover, Turner said that he is relieved not to be a "burden" on anyone because he can do so many things for himself.  "I hope that power wheelchairs remain available for other Medicare beneficiaries," he said.  "Being mobile changes your life."

Madonna Long, formerly of Reno and Battle Mountain, recalled that her mother, Ruth Crosthwaite, began using a power wheelchair before she passed away.  "My mother had severe arthritis and could not push a manual wheelchair," said Long, who has been in a wheelchair herself since suffering injuries in a school bus accident as a teenager. "My wheelchair, and my mother's wheelchair, allowed us to live our lives, and continue to do the things that we love. It's important that other Medicare beneficiaries can also enjoy freedom and independence."

But in recent years, changes in Medicare policies have significantly impacted providers, hampering their ability to supply quality home medical equipment and services to Medicare beneficiaries. Over the last five years, the Medicare program has cut reimbursements for power wheelchairs by more than 35 percent. At the same time, the providers are experiencing excessive government audits and extended delays in reimbursement payments.

The new rental reimbursement policy will slash providers' cash-on-hand by 40 percent in the first year. Because of the struggling economy, providers are unable to obtain loans or credit lines that would allow them to purchase power wheelchairs from manufacturers and do the necessary servicing so that Medicare beneficiaries have properly-adjusted equipment.  Many Medicare patients would receive chairs stored in warehouses that haven't been specially fitted to address the individual needs of the patients.

Consumer groups, providers, and Medicare patients are asking Congress to delay implementation of the new policy from January 1, 2011 to January 1, 2012.  The extra year would allow providers time to adjust their business models. The delay wouldn't increase Medicare spending because providers would agree to a one-percent reduction in reimbursement rates for standard power wheelchairs.

Meanwhile, the bidding program for home medical equipment and services is scheduled to take effect in nine metropolitan areas in January 2011. An additional 91 areas will start preparing for the bidding program later in 2011, including locations in Nevada.

Yet, in September 166 bidding system experts and economists, including two Nobel laureates, sent a letter to Congress warning about major problems with the bidding system.  The experts concluded that the system will fail, citing the fact that the bids are non-binding, the rules encourage unsustainable low-ball bids, the design distorts bids and the program lacks transparency.  H.R. 3790, the bill in the House of Representatives with broad bipartisan support, would replace the bidding program with other types of cost savings but preserve patient access to mobility equipment.  Organizations that favor elimination of this bidding program include the ALS Association, American Association of People with Disabilities, Muscular Dystrophy Association, National Council on Independent Living, National Spinal Cord Injury Association, and United Spinal Association, among others.