New Medicare rules took effect Wednesday that lessen the amount of assistance recipients will receive to cover the cost of power wheelchairs.
By MARK ANDERSEN | Lincoln Journal Star
Truck dispatcher Mitch Miller sits on a $10,000 to $15,000 chair. Those $5,200 entry-level power wheelchairs can’t withstand years of hard use, says the Lincoln man who was injured 25 years ago.
“We use them like tennis shoes, all day, every day,” he said. “That’s our legs.”
Medicare rules that took effect Wednesday will put high-end chairs like his out of reach for many severely disabled people, he fears.
Those with MS or ALS often require advanced features: tilting backrests to prevent bed sores, mouth-controlled guidance systems, 24-volt vs. 12-volt systems to last the day.
After an outcry from others like Miller, the Centers for Medicare and Medicaid Services last week backed off slightly from the 21 percent to 41 percent rate cuts it had planned. The federal agency says lower rates are needed to counter runaway costs.
But The Associated Press reports that even under the modified rates, Medicare’s share for one chair dropped 28 percent, from $7,137 to $5,173.
And industry spokeswoman Sharon Hildebrandt of the National Coalition for Assistive and Rehab Technology said many still would struggle to get the chairs they need.
The Centers for Medicare and Medicaid Services began working toward its new rates after years of runaway costs and rampant fraud, especially around Houston.
According to the agency, Medicare expenditures for power wheelchairs increased 2,705 percent between 1995 and 2003 — from $43 million in 1995 to $1.2 billion in 2003.
Agency spokesman Jeff Nelligan called the increase a “direct result of the excessive prices Medicare pays for these products.”
But a November 2004 report from the Government Accountability Office blames much of that increase on poor Medicare oversight, despite warnings dating to 1997.
In few cases, the report said, did anyone verify whether a power chair was medically necessary, whether the person could not use a manual chair.
In reviewing 230 medical records from 2001, it said the Office of the Inspector General found 13 percent met Medicare’s criteria.
In 2002, federal agencies uncovered widespread wheelchair billing fraud in Texas. Suppliers had falsified records, substituting cheaper chairs for those they billed.
Of Medicare’s four power chair oversight regions, problems were concentrated in the South, where chair reimbursement grew from just under $100 million in 1997 to about $700 million in 2003.
For the region that extends from Iowa to California and includes Nebraska, meanwhile, it grew from about $20 million to $200 million.
In 2002, the GAO said, 14 percent of Medicare spending on power wheelchairs was going to Harris County in Texas (Houston), where just 1 percent of beneficiaries lived.
Lehn Straub, owner of two Jim’s Home Health Supplies stores in Lincoln, said Texas gave the whole industry a black eye, but contends changes the Centers for Medicare and Medicaid Services made in 2003 resolved the problem.
Medicaid stiffened its oversight. It tightened the rules of who qualifies to receive a power chair.
And in 2004, it cut what it paid for chairs.
In 2003, Medicare paid for 228,676 power chairs; that fell to 162,507 in 2004, a 29 percent drop, according to federal data.
For 2005, it climbed 8 percent to 175,140.
The Centers for Medicare and Medicaid Services announced it would overhaul its rates in September 2003. The new schedule was announced Oct. 2, touching off an outcry.
The new schedule goes too far, Straub said, and will hurt patients and suppliers alike.
The debate involves mostly power chairs, not manual chairs, which cost closer to $600.
Manual chairs meet the needs of about 85 percent of those who need a wheelchair, Straub said. Low-end power chairs meet the needs of about 70 percent of the remainder.
It’s that other 30 percent — those with ALS, multiple sclerosis, strokes, paralysis of the upper spine — who will be most affected, he said.
According to the wheelchair industry, some growth is attributable to improving technology, an aging public and greater awareness of handicaps. The advent of a tighter turning radius, for instance, made power chairs viable inside homes.
And while the cost seems high, Straub said, it typically takes his employees about 15 hours to assess, fit and document a patient’s needs for a chair. And 24-hour on-call repair service is included in the cost.
Nelligan of the Centers for Medicare and Medicaid Services said the new Medicare rates were developed “consistent with CMS' established practice” for durable medical equipment.
When Medicare pays too much, he said, so do individuals and co-insurers, responsible for 20 percent of the total cost.
“We’re carefully reviewing the concerns and comments submitted by industry, and we’re prepared to make changes, if necessary,” he said.
Miller, the Lincoln dispatcher, said the Centers for Medicare and Medicaid Services needs to find a different way to save money.
He’ll need a new chair in about four years. When the time comes, he’ll probably be able to foot the extra costs, because he works.
Others aren’t so lucky, he said.
“You’ve got people on a fixed $500 Social Security who can’t make payments.”
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.
