WASHINGTON, April 9, 2013 /PRNewswire-USNewswire/ -- Often lost in the debates over Medicare costs, policies, and regulations is what power wheelchairs mean to the people who need them says the American Association for Homecare (AAHomecare).
Across the country, thousands of senior citizens with physical disabilities, as well as younger people who have suffered accidents or debilitating illnesses, depend on power wheelchairs from Medicare to help them ambulate around their homes.
Anyone receiving a power wheelchair through Medicare obtained it after a physician documented that the equipment is a medical necessity. The device provides critical assistance to patients so that they can perform the daily necessities of life while staying in their homes; activities like getting to the bathroom, preparing food, and answering the front door.
But even that doesn't tell the whole story. Many recipients of power wheelchairs would lose their independence and be forced into nursing homes and other care facilities without a power wheelchair. "It is stunning that during these policy debates the well-being of the Medicare beneficiary seems to be a secondary priority for policymakers," said Tyler Wilson, president of the American Association for Homecare. "Equipment providers and consumer advocates constantly have to explain how policies and regulations affect beneficiaries."
The Medicare power mobility benefit has been accused of paying for power mobility devices, such as scooters, that are used for recreational purposes. But that is not the case. Government utilization data clearly confirms that scooters represent a mere two percent of the total Medicare expenditures for power mobility devices.
George Cannon, and his wife, Mary, are typical Medicare power wheelchair users. Each day, they navigate their power wheelchairs down the hallways at an assisted living facility in St. George, Utah, as they make their way to the facility's dining room for meals. Without their power wheelchairs, the elderly couple would likely be in a nursing home.
"I wouldn't make it without the power wheelchair," said George, 94. "A few years ago, it got to where I couldn't walk any distance with my walker…it seemed that it would make life easier to get around if I had a power wheelchair."
Ryan Wilson, of Louisville, Ky., is another Medicare power wheelchair user. He suffers from spina bifida and has been a paraplegic since birth. Throughout his life, he has confronted medical challenges that have affected his mobility. A few years ago, after Wilson developed a pressure ulcer his mobility became even more severely restricted.
"My body was just not the same as far as mobility," said Wilson, who is not related to AAHomecare's Tyler Wilson. "My shoulders have just about given out and the power chair has brought me back. Especially after the ulcer, I was basically bedridden and couldn't get around my own house. If I wanted to go out, someone would have to push me because my shoulders quit. With the power chair, the shoulders are not an issue. I can go until the battery quits."
Studies have shown that power wheelchairs reduce government health spending because Medicare patients with power wheelchairs have fewer falls and hospital emergency room visits. Power wheelchairs also delay placements in expensive nursing homes. Armed with this data, and studies showing that senior citizens would rather stay in their homes than be placed in care facilities, one would expect the government to encourage the use of power wheelchairs. Instead, however, over the past nine years the Centers for Medicare & Medicaid Services (CMS) has implemented a series of policies and regulations that have restricted the availability of power wheelchairs to Medicare beneficiaries. In fact, government officials have skewed their oversight findings to reflect negatively on durable medical equipment providers and Medicare beneficiaries.
Nearly two years ago, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a report trumpeting that 61 percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 "were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity." The same report said that 80 percent of claims for power wheelchairs supplied to beneficiaries in the first half of 2007 did not meet Medicare requirements.
But a less ballyhooed section of the report noted that medical necessity was actually questioned on just nine percent of the claims for power mobility devices that were reviewed. And of those nine percent, seven percent simply needed a different type of power wheelchair, while only two percent needed a less expensive piece of equipment. The issue that the OIG didn't report on is that CMS has a subjective documentation process that allows for claims to be denied for frivolous reasons involving documentation that have absolutely nothing to do with the medical needs of the patient.
That power wheelchairs are often not medically necessary would come as a huge surprise to people like Ryan Wilson and the Cannons.
They depend on the Medicare power mobility benefit every day. Their quality of life is linked to being able to use the power chair that Medicare provided. Thousands of people who receive power wheelchairs from Medicare are exactly like them—immobile without a power wheelchair. Their power wheelchair is critical to their ability to fix food and get to the bathroom; it allows them to stay in their homes rather than living in nursing homes and care facilities.
Medicare beneficiaries that qualify for power wheelchairs are, on average, about 71 years old and usually suffer from a combination of COPD, diabetes, arthritis, and heart disease.
"Clearly, there has to be a better understanding of the Medicare power wheelchair user," said Tyler Wilson. "They are people who rely on Medicare to provide their mobility."
The American Association for Homecare represents durable medical equipment providers and manufacturers who serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility devices, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Please visit www.aahomecare.org.
SOURCE American Association for Homecare