Mobility Matters Bulletin from the American Association for Homecare
LOUISVILLE, Ky., Aug. 9, 2012 /PRNewswire-USNewswire/ -- Like many others with spina bifida, Ryan Wilson has lived much of his life with medical challenges that have affected his mobility. Five years ago, after Wilson developed a decubitus ulcer his mobility became severely restricted.
"My body was just not the same as far as mobility," said Wilson, 35. "I was a walking person who became a wheelchair person." After nearly five years with a manual wheelchair, Wilson said his body was worn down, his shoulder too weak to maneuver the chair. He had to move in with his mother.
But Wilson said the downward spiral spun upward in February when Medicare approved him for a power wheelchair, a medical device that lifted his spirits and changed his life.
"My shoulders have just about given out and the power chair has brought me back into society," Wilson said. "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."
Once Wilson developed the ulcer, he stopped working. His doctor said he could have died from an infection. Now, however, Wilson said the power wheelchair has returned some of the independence that he had missed, including grooming, preparing food, and getting to the bathroom. "And being able to leave my house, go up and down the street on the sidewalk, walk the dog, and go outside and spit in the yard," Wilson said. "Just simple things that I would need help with, now I don't."
Wilson is like thousands of Medicare patients across the country: they depend on power wheelchairs to allow them to live safely and independently at their homes. For many people living with disabilities, the power wheelchair is what prevents them from being confined to a nursing home or other care facility. Studies show that power wheelchairs actually reduce government health spending because Medicare patients have fewer falls and hospital emergency room visits with power wheelchairs. The mobility devices also delay placement in costly care facilities.
Yet, over the last nine years, the Centers for Medicare & Medicaid Services (CMS) has repeatedly implemented a series of policy and regulation changes making it more difficult for Medicare beneficiaries to receive power wheelchairs prescribed by their physicians. At the same time, home medical equipment providers have faced devastating cuts in reimbursements for power wheelchairs, excessive audits, and other policies that jeopardize their ability to continue providing the medical devices.
"Senior citizens and people living with physical disabilities clearly benefit from power wheelchairs, but CMS and Congress repeatedly adopt policies that restrict use of the Medicare power mobility benefit," said Tyler Wilson, (no relation to Ryan), who is president and CEO of the American Association for Homecare. "This increases government spending by driving Medicare patients into expensive nursing homes and other care facilities. The government has to get smarter about health care policy."
The latest threat to the benefit comes from CMS' plan to implement a demonstration program that will subject all claims for power mobility to a prior authorization process for a period of three years in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. Medicare patients in these states receive nearly 50 percent of the power mobility prescribed annually to beneficiaries.
While stakeholders, such as physicians, providers and disability advocates, generally support the prior authorization program, most steadfastly insist that it include a clinical template that physicians can use to precisely provide the information that CMS seeks to document patients' medical need for power wheelchairs. The current documentation guidelines are so subjective and flawed that CMS contractors routinely deny claims for power wheelchairs that were prescribed by physicians. Many denied claims are overturned after lengthy and costly appeals, but under the prior authorization program Medicare patients would not obtain a power wheelchair until after the denials are resolved and some beneficiaries may never be approved for the equipment.
This has prompted sharp criticism from consumer advocates, such as the Association of Programs for Rural Independent Living (APRIL). "We remain concerned that the program CMS has designed…has the potential to eliminate the Medicare benefit for power mobility devices for individuals who reside in one of the seven States where the program will be implemented," Billy Altom, the APRIL executive director, warned in a recent letter to CMS.
Meanwhile, Ryan Wilson doesn't understand why CMS and Congress are adopting policies that restrict utilization of the Medicare power mobility benefit.
"My power wheelchair means so much to me," said Wilson. "Although it is not feasible, I would love for some lawmakers and bureaucrats to spend time in wheelchairs to help them realize just how hard it is…that's the type of experience that would help them understand why people need them and why advocates for people who are disabled fight so hard that we can have access to them."
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/athome.
SOURCE American Association for Homecare