Medicare Legislation Will Hurt Wheelchair Users

Patricia Meier, a 63-year-old quadriplegic and Medicare recipient, needs to replace the wheelchair she has used for five years. Normally, Meier could simply use her Medicare benefits to replace the power wheelchair, which adjusts her position to prevent sores at WestMed Rehab Inc., a medical supplier near her home in Box Elder, S.D. But WestMed, along with several other suppliers across the country, says it will no longer provide power wheelchairs to most Medicare recipients after Nov. 15, when cuts in Medicare reimbursements go into effect.

WestMed, based in Rapid City, S.D., is the only major wheelchair supplier within 300 miles of Meier's home. Concerned about the prospect of companies ceasing to offer wheelchair supplies, South Dakota's Congressional delegation are pressing federal health officials to reconsider legislation intended to eliminate widespread fraud identified by the Health and Human Services Department (HHS), which oversees the program.

If Meier were to replace her chair without using Medicare, it could cost her between $17,000 and $20,000. With Medicare, she would pay only 20 percent of that.

"When I was able-bodied I bought cars cheaper than that," said Meier, who was injured in a car accident 20 years ago. "I don't know how I would be able to afford it."

With other suppliers saying they, too, won't be able to provide mobility equipment to many of their customers, those living with multiple sclerosis, spinal cord injuries and other conditions could be without the wheelchairs they need to get around.

Many wheelchair users "are going to have to pay out of pocket," said Tim Pederson, CEO of WestMed Rehab.

A 2004 study conducted by the HHS Inspector General showed that Medicare reimbursements for certain power wheelchairs were far higher than the prices paid by consumers and suppliers. According to the Centers for Medicare and Medicaid Services, which administers both health care programs, expenditures for power wheelchairs increased by 2,705 percent between 1995 and 2003, from $43 million to $1.2 billion in just over eight years.

Agency spokesman Jeff Nelligan said the increase is a "direct result of the excessive prices Medicare pays for these products."

Most suppliers have supported overhauling the system, to prevent companies from abusing it, but they say the government has gone too far.

The changes "do eliminate the fraud and abuse, but it also eliminates the benefit," said Pederson. "They are painting the entire industry in that broad brush, and they look at all of us as crooks."

Cara Bachenheimer, vice president of government relations for Invacare, said suppliers across the country have informed the company that they will be purchasing less equipment because of the reduced Medicare reimbursements.

Carol Gilligan, owner of Health Aid of Ohio Inc., said she will have to stop selling power wheelchairs altogether.

"There's just no way you can make a living," she said of the new reimbursements. "We have to change our business model."

Andrew Imparato, president of the American Association of People with Disabilities, said Medicare is not asking what is in the best interest of the patient.

"People are either going to have to figure out a way to finance them outside of Medicare, pay it out of pocket or just use their current chair until it breaks down," he said.

Several members of Congress have written to the agency in the weeks since the announcement. The entire South Dakota delegation sent a letter to HHS asking for more information. Pennsylvania Senators Arlen Specter (R-Pa.) and Rick Santorum (R-Pa.), wrote the department last week asking for a delay in implementation of the new fees.

The Pennsylvania senators expressed concern about the payment formula used to calculate the reimbursements (gap-filling), noting that the formula does not always take current market prices into account.

This article originally appeared in the October 2006 issue of HME Business.


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