Editor’s Note

The War on Mobility

Why has CMS set its sights on power mobility providers and patients?

• By David Kopf
• Jan 01, 2012

Over the course of 2011, it has been hard not to watch with my jaw on the floor as the Centers for Medicare and Medicaid Services has relentlessly pursued mobility providers and, by association, their patients’ access to care. Apparently, CMS sees mobility as a major center of waste, fraud and abuse, even though most mobility patients don’t really have a choice about their need for a chair. So, CMS has engaged in what can best be described as a year-long war on mobility. Let’s review some of the key developments that have unfolded over the past 12 months:

Rental Upheaval

We started off the year with the complete removal of the first month purchase option for standard power mobility. Prior to the elimination, a patient with a permanent mobility condition could opt to purchase a power mobility device in the first month. But starting Jan. 1, 2011, that was no longer the case; providers had to rent that device to the patient over a 13-month rental period, and bill Medicare in monthly installments over that time.

Given that the majority of power mobility patients have lifelong conditions, and thusly providers built their business models around the notion that they would purchase the chair and have it funded in one month, the elimination completely threw mobility providers’ business models and cash fl ow into disarray.

In short order, those providers had to transition to a rental model, having to somehow fund the cost the of expensive medical equipment without reimbursement. Fortunately, there have been inventory financing offerings from manufacturers and other credit sources to help them handle this transition, but it’s fair to say it hasn’t been easy.

Data with an Agenda

Then, in July, the Office of Inspector General for the Department of Health and Human Services released a report that said 61 percent of power wheelchairs provided to Medicare beneficiaries in 2007 were either medically unnecessary or lacked sufficient documentation. That’s $95 million of the $189 million Medicare supplied for power chair funding that year.

The report, creatively titled “Most Power Wheelchairs in the Medicare Program Did not Meet Medical Necessity Guidelines,” went on to say that 52 percent had claims that were insufficiently documented to determine, and 9 percent of power wheelchairs were medically unnecessary. It added that of that 9 percent of claims, 2 percent should have received a less expensive mobility device (such as a scooter or a manual wheelchair), and 7 percent should have received a different type of power wheelchair. As you can imagine, the 61 percent figure got much larger news attention than the 9 percent, seven percent, or 2 percent, which was where the rubber actually met the road.

The Latest Salvo

Now, CMS has announced that starting Jan. 2 of this year it will start a demonstration program that would require pre-payment review for all Medicare claims for power wheelchairs in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. Yep, you read that right: pre-payment review for all power wheelchair claims in some very key states. According to AAHomecare, this will affect nearly half of all Medicare’s power mobility beneficiaries.

Naturally, this new assault on power mobility providers has caused a great deal of outcry from providers and various state and national associations, who are calling on Congress to stop the demonstration project before it hurts patients and providers alike. As if this industry wasn’t war weary enough, it seems there is yet one more battle to fight.

This article originally appeared in the January 2012 issue of HME Business.