Mobility Report

CMS (Centers for Medicare & Medicaid Services) should be applauded for recently implementing mandatory accreditation that will provide closer inspection of suppliers who will be allowed to bid for contracts under the new competitive bidding process being implemented. While suppliers and manufacturers have various concerns about whether competitive bidding for power wheelchairs and scooters is going to be an effective and efficient process for delivering mobility equipment to Medicare beneficiaries, there is resounding support within the industry for mandatory accreditation. In fact, the industry has called for swifter implementation of this important safeguard than the government’s own timeline.

The industry, however, is concerned that the highly public CMS campaign to fight fraud is overshadowing a developing crisis for Medicare beneficiaries.

In 2007, a CMS forecast said that 243,000 Medicare beneficiaries would medically require a power wheelchair or scooter. But the Medicare power mobility benefit was utilized by only 170,000 beneficiaries, leaving more than 70,000 people who did not get the power wheelchairs or scooters they need to improve their mobility and quality of life.

We fear that new policies and regulations from reimbursement cuts to coverage policy and coding changes have caused many suppliers to go out of business or stop providing power mobility equipment. The result is that it becomes more difficult for Medicare beneficiaries to find suppliers to fill their prescriptions.

Competitive bidding is adding another new wrinkle, with an uncertain impact on suppliers. The industry supports CMS efforts to eliminate Medicare fraud, including new regulations that help achieve that goal. But we also need for the agency to stay aware of the impact and burdens that its policies can place on legitimate, law-abiding suppliers, and more importantly, Medicare beneficiaries. The most vulnerable people in our society deserve a Medicare process that works, and improves their quality of life.

At a recent congressional briefing, the Centers for Medicare & Medicaid Services (CMS), sharply criticized the Durable Medical Equipment industry, decrying that rampant fraud costs the Medicare system millions of dollars each year. While Medicare fraud certainly must be stopped, the context in which CMS discusses it and the root causes of the fraud need to be addressed.

For years now, CMS has repeatedly pointed the finger at “the industry,” particularly when discussing fraud related to power wheelchairs and scooters.

Let’s take a closer look. The power mobility industry is comprised of the manufacturers of power mobility equipment and the suppliers, businesses ranging from mom and pop operations to large companies. These suppliers navigate CMS’ ever-changing regulations and policies to deliver power wheelchairs and scooters to Medicare beneficiaries living with disabilities. The fraudulent operators are NOT part of the legitimate power mobility industry. They list their addresses as vacant buildings or storefronts, and move from place to place. They are not real businesses; they are crooks.

Consider this: When scam artists bilk investors in land scams, are they referred to as part of the legitimate real estate industry? No. If a car thief steals automobiles, strips the vehicles and is caught reselling the auto parts, is he referred to as part of the auto parts industry? Again the answer is a resounding, no. It shouldn’t be any different in the durable medical equipment business.

Unfortunately, by talking about fraudulent dealers as if they were part of the power mobility industry, CMS has cast a shadow of doubt on dedicated and hard working suppliers. It has unfairly caused the industry to lose valuable credibility with our regulators, Congress and even Medicare beneficiaries. The industry shares with CMS a strong desire to stop Medicare fraud, and we are encouraged that the agency has made fighting fraud a top priority. But every one would be better served if CMS didn’t refer to the scam artists as part of the legitimate power mobility industry.

It is equally frustrating that the industry receives the blunt of the criticism for the fraud when it has been lax supervision of the Medicare system that has resulted in the wasting of taxpayer dollars. It certainly seems hypocritical that the industry gets the blame when CMS allowed the Medicare scams to flourish. How do fraudulent dealers operate in the first place? They receive supplier numbers from CMS that allow them to bill the Medicare system for equipment that doesn’t get delivered to beneficiaries. Clearly, the key to stopping fraud is a system that better scrutinizes which companies receive supplier numbers to bill the Medicare system. The responsibility for doing so falls on CMS.

I’ll have Part 2 next time.

Earlier this month, I had the privilege of attending one of the greatest veteran’s gatherings you will ever see in Washington, DC. This gathering was held at the National World War II Memorial. The organization that made it all happen; Honor Flight.

According to the Veteran’s Administration, an estimated 1,000 Americans who fought in World War II die everyday. Most veterans of this war are in their late 70’s and early 80’s. Of the 16 million veterans who served in this war, only 3 million are alive today.

In an attempt to honor the remaining Veterans across the country, Honor Flight, founded by Earl Morse provides America’s war veterans an opportunity to visit the WWII Memorial and other memorials in Washington. Morse, a Retired Air Force Captain, transports veterans several times a month from their hometowns to Washington for an opportunity to visit the memorials. This all expenses paid trip allows for each veteran to see a Memorial that has been dedicated to them for their sacrifices.

I have great deal of respect and admiration for Earl and his organization. His passion and drive is what makes the Honor Flight Network so successful. Since the first Honor Flight in May 2005, with six small planes and 12 World War II veterans, the program has expanded significantly. MSNBC was one of the initial national media outlets to cover one of the early flights from Dayton, Ohio.

By 2006, the program moved to commercial airline carriers to accommodate the maximum number of veterans possible. Moreover, it has partnered with similar programs, such as HonorAir in Hendersonville, North Carolina and Hero Flight in Provo, Utah. Together, with Honor Flight, they have formed the “Honor Flight Network,” and are aggressively expanding their programs across the nation. To date, over 5,000 veterans have been flown in to see their memorial.

Two weeks ago, Jerry Newberry on the VFW’s radio show, “The National Defense” interviewed Jim McLaughlin, Vice President of the Honor Flight Network. During the interview, McLaughlin discussed the organization’s early years, its current success, and the current waiting list.

Morse told me that the program is so popular that there are more than 3,500 people on the waiting lists for flights.

Organizations who have helped this great cause include Dow Chemical, The SCOOTER Store, and the Virginia American Legion.

The SCOOTER Store was honored to have provided power wheelchairs and scooters to the veterans who attended in 2007. I look forward to the partnership in 2008 and beyond.

I would encourage all members of Congress to attend one of these great events. You will be truly amazed at the appreciation these WWII veterans have when members of Congress attend. For more information about next year’s schedule, send me an email.

For the past several months, Congress has been discussing a proposal that would deliver a major blow to Medicare coverage of power wheelchairs, which yearly help thousands of senior citizens and people living with disabilities regain their mobility and independence. Previous congressional and regulatory changes have chipped away at this valued benefit, but this time people on Medicare and the manufacturers and suppliers who strive to serve them may face their biggest legislative challenge yet.

While debating the State Children’s Health Insurance Program, known as the CHAMP Act, some members of the House of Representatives decided to help pay for expanded healthcare benefits for lower-income children — a very worthy cause — by significantly changing Medicare’s power mobility benefit. The House sought to eliminate doctors’ ability to prescribe power wheelchairs for long periods to Medicare beneficiaries, even if they are permanently disabled. Instead, the House established a 13-month rental period for all beneficiaries, regardless of their physical condition.

It may seem like a mere accounting change, but the real-life impact on suppliers, manufacturers and, most of all, beneficiaries, would be devastating. Fortunately, the Senate version of the legislation paid for expanding children’s health insurance by increasing the federal tax on cigarettes. Since cigarette smoking adds countless costs to government health spending, the Senate felt justified in making the industry contribute towards improving healthcare for children. According to the Centers for Disease Control (CDC), the recent lost productivity estimate when combined with smoking-related health-care costs exceeds $167 billion per year in the United States.

In the Conference Committee, the final legislation dropped the language eliminating the purchasing of power wheelchairs, but like most revenue- enhancing maneuvers, this one is likely to resurface again as Congress seeks money to pay for other initiatives. It seems, however, that some lawmakers don’t understand that this is merely a budget gimmick: Renting equipment would allow the government to claim an immediate budget savings, but the government would actually pay more over the 13-month rental period than it would if the power wheelchair were purchased.

Moreover, a shift from purchase to rental would leave unanswered questions, such as the process for allowing patients to have the mobility equipment longer than 13 months. In addition, the change would have a devastating impact on the power mobility industry.

The government would essentially be asking suppliers to pay the upfront costs, such as obtaining a power wheelchair from the manufacturer, fitting a beneficiary to the chair, and complying with the voluminous government documentation requirements. But during the rental period, suppliers would receive monthly payments spread out over more than a year. Many suppliers say they would not be able to survive this financial burden, especially after absorbing huge cuts in reimbursement for power wheelchairs and the implementation of competitive bidding. Many suppliers, particularly smaller ones, would no longer be able to provide power wheelchairs and scooters.

The big loser, once again, will be Medicare beneficiaries, some of the most vulnerable people in our society. Already, thousands of seniors and people living with disabilities are not getting the appropriate power mobility equipment that could vastly improve their quality of life. What happens is that when suppliers go out of business or no longer provide the products, it becomes very difficult for beneficiaries to find other places to fill their prescriptions. This is especially true in rural communities, where small suppliers cover large geographic areas. But these same small providers are the ones hardest hit by the government’s ill-conceived policies.

Previously, the Centers for Medicare & Medicaid Services (CMS) had estimated that 17,800 Medicare beneficiaries a month would need power wheelchairs in 2007. But the government’s own data show that since the reimbursement cuts last November, use of the power wheelchair benefit has plummeted. For instance, in February 2007, only 8,599 beneficiaries utilized the benefit, a steep drop from the 14,287 beneficiaries who obtained power wheelchairs or scooters in the same month a year earlier.

The major reason for the decline is that there are fewer suppliers providing power wheelchairs and scooters because the government has made it too difficult for the businesses to survive. Clearly, lawmakers and regulators alike don’t fully understand the role that the power mobility benefit plays in lowering healthcare costs. There is a huge misconception that Medicare beneficiaries obtain power wheelchairs and scooters, and then die shortly after receiving them. To the contrary, a study on the life-cycle of people with power wheelchairs shows that, on average, seniors and people with disabilities far outlive the 13- month rental period that the House tried to establish. Specifically, the data shows that beneficiaries live, on average, 9.5 years after receiving mobility equipment. The data strongly contradicts the reasoning behind the rental proposal, which is that the government won’t have to make all the monthly payments because patients will die before the rental period concludes.

Furthermore, data shows that the government saves substantial sums because seniors and people with disabilities who use power mobility equipment don’t have as many falls that require hospital care and are less likely to be placed in nursing homes because they retain more mobility and independence.

The best outcome would be for lawmakers and regulators to gain a better understanding of the Medicare mobility benefit so it can continue to help improve the quality of life for our senior citizens and people with disabilities. They must begin to realize that the mobility benefit is a friend to beneficiaries and government; it shouldn’t be a target.

One of the nation’s largest disabilities groups, American Disabled for Attendant Programs Today or ADAPT, held a live demonstration yesterday in Chicago. According to WGN News, the protest was held in front of the headquarters of the American Medical Association (AMA).

ADAPT is known throughout the country for their demonstrations, but is also recognized for their legislative policy advocacy, grassroots education and mobilization efforts. This was very similar to the demonstration held in Washington, DC a while back that I had the privilege to witness. This particular protest however was held in part to demand better patient healthcare rights. The WGN news clip would suggest that physicians prematurely institutionalize seniors and people with disabilities rather than finding ways for people to live independently at home.

Watching this video clip though, brings me to a few relevant points of interest. Keeping people living at home independently not only enhances their quality of life, but also provides significant financial savings back to insurance and/or federal programs. Why?

• Changes in power wheelchair technology have made it possible for people with mobility impairments to pass through most doorways in their own home unassisted. The results of these changes give seniors and people living with disabilities the ability to rely less on a caregiver and the freedom to carry out their own activities of daily living;
• According to a report issued by the Alliance for Aging Research and Dr. Jack Guralnik with the National Institutes of Health, the total average annual costs of care for a person who remains independent for the year is $4,800. The total average cost of a person who lost independence during the year and needed help with daily activities is $36,000. The additional costs of medical and long term care each year due to lost independence is $26 Billion.
• National Center for Health Statistics reports that the average length of stay in a nursing home/institutional setting is 568 days.
• RRC, a renowned economics group conducted an outcome study of Medicare data which shows that by providing mobility equipment to senior citizens, Medicare actually saves enough to cover the cost of the equipment plus an average $10,887 over a two-year period. These benefits do not even include non-Medicare costs such as nursing home expenses.

Hats off to every organization fighting for disability rights across the country. The vitally active role we all play in educating the public today the better off our society will be tomorrow.