Business Solutions

Power Mobility Finding Its Identity

The power mobility industry continues to evolve alongside a growing aging population.

• By Joseph Duffy
• Nov 01, 2014

Power mobility and complex rehab providers have seen some significant changes and positive developments over the past few years. A growing customer base of aging seniors has fueled much of its growth and cautiously paints a bright outlook. At the same time, however, many policy and reimbursement changes have created a fair number of challenges. But it’s this growing foundation of customers that will most likely help power mobility and complex rehab to create the identity needed to successfully deal with payers and policymakers.

The good, the bad and the ugly

While many significant challenges plague the power mobility industry, such as competitive bidding and audits, the Prior Authorization demonstration project, which was just expanded to 12 additional states October 1, has been an industry bright spot, according to Seth Johnson, vice president of government affairs for Pride Mobility/Quantum Rehab.

“Competitive bidding remains an issue for the industry as a whole and with the Round Two re-compete expected to move forward next year, that will continue to be a significant focus,” Johnson says. “Within the Competitive Bidding proposed rule released this summer, CMS proposed a very limited 12 area pilot program that would bundle certain products within a category, including standard power and manual wheelchairs, which would also include all maintenance and repair costs. While the industry pushed back extensively, raising concerns with the impact such a program would have on beneficiaries and providers, Medicare seems intent on trying the concept in a limited manner.”

A final ruling with more details is expected in late October.

Johnson also points out that the CMS e-clinical template that had been a source of cautious optimism in the industry for over a year is continuing to move forward and a demonstration is expected in the coming year. This, he says, should lead to a more standardized format for documentation, which would assist PMD providers, physicians, clinicians and CMS in determining whether the coverage criterion for an item has been met.

“One of the main challenges for power mobility providers is administrative (technical) error denials that have nothing to do with the medical necessity for the item,” says Dan Fedor, reimbursement specialist for the U.S. Rehab division of VGM Group Inc. “Many claims are denied for administrative errors, such as format of date stamp, sequence of signatures, and content format. Even when the patient meets the coverage criteria for the item ordered, providers have to dedicate resources to fight this through the appeals process. Unfortunately most of these denials are automatically affirmed in redetermination and reconsideration and the money is recouped while the provider has to wait for approximately two years to have a hearing with the ALJ. Ironically most denials are overturned at ALJ and the provider gets the money back; however, for some mid to small providers, it is too late.”

Julie Jackson, director of Invacare’s Rehab Business Unit, adds that complex rehab continues to be an area of innovation and development to bring to market clinically, functionally and aesthetically superior products that assist a consumer’s ability to gain full access to their environment. But standard power mobility is challenging, due to the increased number of audits, capped rental and national competitive bidding. She says she doesn’t see this changing.

“It is difficult,” explains Greg Packer, president of U.S. Rehab. “Prior Authorization helps because providers know they are distributing something that they are going to get paid for. That doesn’t mean they won’t get audited. And with competitive bidding rates, it’s harder to give patients what they need in competitive bidding areas, where often it’s not costeffective to provide equipment. It’s alarming that we can’t have a system that is better suited to patients and providers, who have to be able to pay their staff. As prices are driven to the bottom, we won’t be able to provide the same level of service as before.”

Power mobility and the retail market

Power mobility’s retail potential grows along with its customer base, especially as the baby boomer generation ages. It’s a strategy every provider should consider to help alleviate the burden brought by cuts, caps and competitive bidding.

“CMS’ current in-the-home restriction for PMDs means that a large number of consumers who only need a PMD for outside the home will look to purchase those products for cash,” Johnson says. “Providers who have stayed ahead of the curve have always sought to keep themselves as diversified as possible when it comes to funding sources, and retail should be explored as an additional source of revenue. A diverse product mix and a variety of cash-only products cannot only be a source of revenue, but can also complement items that are covered by insurance. Providers that have a retail presence should know the rules of the road when it comes to what they can and cannot do and how to properly utilize ABNs when appropriate.” Patricia O’Brien, director of marketing and merchandising for Golden Technologies, notes that the retail market for power mobility is wide open.

“Manufacturers like Golden Technologies are developing more cash retail products for both scooters and power chairs and teaching dealers how to sell these products successfully and profitably for cash,” she says. “Golden has been offering a retail mobility program for the last couple of years that has helped our dealers learn how to sell mobility products for cash and helped them to grow their cash retail sales.”

One provider who has done very well with retail power mobility is Northeast Med-Equip/Northeast Accessibility. The secret? Pre-owned product.

“The key is picking up good used equipment at a reasonable price,” explains George Turturiello, ATP, CRTS, of Northeast Med-Equip/Northeast Accessibility. “Stick to the major manufacturers for ease of parts acquisition. Have someone who knows the mechanical and electronics of most manufacturers. This will let you sell CPO [certified pre-owned] wheelchairs. I warranty them for one year except batteries, which are six months. None of the wear items are covered, such as tires and arm pads.”

Turturiello says you can also do retail rehab if you have high-end chairs and can reconfigure them to suit new clients.

“I can take three high-end chairs and create a new custom seating system with power options for a fraction of the cost of a new chair,” Turturiello explains. “This requires at a minimum an ATP and high-rehab knowledge. What also helps is age. You must be able to remember the days when you had to piece a chair together from four or five different manufacturers and make them work. Now it is one-stop shopping.”

Jackson points out that some providers have done very well in the retail segment. She says having a showroom with product and promotional material is key and also many providers have done very well selling on the web.

Power renting

Standard power providers had no choice but to transition their Medicare business to a rental model if they wanted to remain in that market, according to Johnson. A number of companies did exit the market due to rental challenges, including repair and replacement requirements.

“However, most providers found success by identifying the right rental products that are both economical and high quality, which has allowed them to reap the benefits recurring rental payments provide,” he says. “The more user friendly a product is, and the less time a provider spends repairing an item, the more viable the product is not only in a capped rental market, but also retail.”

For Georgie Blackburn, vice president of government relations and legislative affairs for BLACKBURN’S, whether you can say mobility providers have successfully made the transition to rental models depends upon what is meant by “success.”

“Providers have done what we’ve had to do but that doesn’t necessarily spell success for the patient, the supplier or the manufacturer,” she says. “The driving factor in Medicare’s decision to rent was based in their belief that many do not use their chairs ongoing or die before converting to purchase. I hope Medicare’s thinking reverses in the future, substantiated by fact.”

Jackson adds capped rental is the reality in the standard mobility segment, and believes that providers have adapted to the new environment. Having access to parts and kits to easily change out components is a necessity, such as armpads, seats and shrouds.

Protecting complex rehab

According to Packer, the best providers in the industry, the seasoned veterans who understand the system and are used to taking care of patients, are frustrated by CMS and misguided media reports. That’s why he says a separate benefit for complex rehab is so important.

“U.S. Rehab is working with providers and the University of Pittsburgh to develop objective and subjective outcomes to provide the proof that ATPs play a critical role in complex rehab,” Packer explains. “Pilot projects and studies will develop programs and protocols to make sure patients’ lives are improved and extended to their fullest abilities. A complex rehab patient who is properly positioned can carry on a productive life, which returns revenue to the system. Complex rehab is a true science, and it reduces hospital visits and complications of disease.”

So how can providers protect the complex rehab benefit?

“This is an easy question,” Blackburn says. “We need to pass legislation that protects CRT, specifically H.R. 942 and S. 948. We have bi-partisan support and already 160 representatives on H.R. 942. BLACKBURN’S is very proud that all of our House representatives in our service area understand its importance and are on the bill. Ensuring Access to CRT is necessary moving forward to protect the benefit for the small population of individuals who require complex rehab technology, to insure suppliers of CRT have additional credentialing protecting outcomes, to insure CRT is considered medically necessary outside as well as inside the home, and to allow for a plan of care that includes provision of CRT at point of discharge when one is transitioning from a skilled facility to a community or home environment.”

Johnson notes that while complex rehab is largely exempt from competitive bidding and is only partially included in the Prior Authorization demonstration, it has been negatively impacted by the CMS change for certain items from routinely purchased to the capped rental payment category and also Medicaid changes.

“The Separate Benefit legislation remains the industry’s top legislative focus on the federal level and in a handful of states in order to provide an increased level of protection for consumers and providers of complex rehab technology items and services,” Johnson says. “Complex rehab products are unique and individualized to address the specific medical needs of the patient and should be separated from standard DME in order to insure appropriate access.”

Joining NCART and supporting the carve-out of complex rehab via the Separate Benefit Package are critical, Jackson notes.

“We must all align together to help support preservation of this category and ultimately continue delivering the best products available to the consumer,” she says.

“Providing the right power mobility product will change a life for the better,” Blackburn adds. “Those of us who provide CRT and other levels of PMDs must be committed to improving lives whether it’s through employing highly trained staff, fighting for improved healthcare policy at the congressional level or providing only the best of mobility products. It’s a long-term responsibility that BLACKBURN’S takes seriously.”

This article originally appeared in the November 2014 issue of HME Business.