Many Businesses Cite Access Problems for Medicare Beneficiaries
WASHINGTON, April 11, 2011 /PRNewswire-USNewswire/ -- A survey of home medical equipment companies released today found that many businesses providing power wheelchairs to Medicare beneficiaries have made abrupt changes in their operations to comply with new federal policies. But the regulatory changes have made it difficult for some businesses to provide quality products and service to Medicare patients.
The American Association for Homecare (AAHomecare) said more than 125 businesses across the country were contacted for the survey, providing the most extensive research to date on how companies are adjusting to the federal mandates. These include the controversial competitive bidding process for most home medical equipment, replacing a first-month purchase option with a 13-month rental program for power wheelchairs, as well as other factors, such as extensive government audits and confusing guidelines for documenting medical necessity for mobility assistance.
Many providers reported negative consequences ranging from planning lay-offs, no longer offering power wheelchairs and going out of business to the need to find additional warehouse space for used equipment and struggles to perform repairs for some patients.
Specifically, the survey found that:
- 65 percent said their ability to service Medicare beneficiaries has been compromised
- 48 percent said their repair policy has changed
- 45 percent said the area in which they service patients has changed
- 28 percent said their level of staffing has been impacted.
"These companies are frustrated by government policies that are creating obstacles to providing mobility assistance to Medicare beneficiaries," said Tyler Wilson, CEO and president of AAHomecare. "Yet, many companies are making adjustments in their business operations so that Medicare beneficiaries can continue to receive power wheelchairs."
Wilson said the business owners provided valuable insight into how the actions taken by lawmakers and bureaucrats are impacting providers and Medicare beneficiaries. Furthermore, Wilson asserted that the government polices are yielding many unintended consequences that must be addressed, including forcing providers to "cherry-pick" the Medicare beneficiaries they can afford to assist, while others may go without mobility assistance. These new burdens, he said, are taking a toll on home medical equipment providers, whose frustrations are evidenced in the survey responses.
Mark Nice, of Central Medical Equipment Company, in Harrisburg, Pa., said that while government reimbursements for power wheelchairs have declined, administrative costs are increasing.
"We now need more inventory and have to wait to recoup our expenses," he said. "I now need to have a person call every rental each month and check on status…This will possibly lead to hiring another billing clerk and an additional service tech at a time when reimbursement has been severely impacted."
Moreover, Nice said the policy changes will hamper Medicare patients. "Patients will now be given the minimum equipment," he said, adding that adjustments for leg length, arm height and seat to floor height likely won't be made because the priority will be on issuing wheelchairs that are already in a company's inventory. Nice also noted that the cheaper equipment that will now be provided to Medicare customers will be lower quality than was previously available, will likely need more repairs and may not even last the five year period before beneficiaries are allowed to replace it.
The 13-month rental policy, which was shrouded with controversy, was implemented because the government contended Medicare beneficiaries might die shortly after receiving mobility assistance. The change was made despite studies by the largest providers showing that between 86 percent and 94 percent of Medicare patients lived longer than 13 months after receiving a power wheelchair. Now, because of the policy, many businesses are in the unfair position of rationing medical equipment that has been prescribed for Medicare patients by their physicians. Small businesses, in particular, are impacted because many only provide a few power wheelchairs a year.
"Unfortunately, I have to consider the longevity of the patient prior to a power chair order," said Glenn Steinke, of Air-Way Medical, in Bishop, CA. "If the patient may not live through the rental cap, I will have to take back a very used chair. What will I do with it then?"
Other providers acknowledged that they have to carefully select customers who are less likely to need extensive repairs on their chairs. "I have reduced the amount of chairs I will provide…" said one business owner, who asked not to be identified. "I have to say 'no' to certain patients that I know will be heavy users of the products that can cost me a lot in repairs."
Nancy Oyen, of Finley Hartig Homecare, in Dubuque, IA., added: "Several of our competitors are no longer doing electric wheelchairs. We only do basic power wheelchairs - no rehab. We find out patient history before accepting a patient, trying to determine where they will be living in 12 months and overall medical condition to determine if they will be alive throughout 12 months."
But a provider in the Charlotte, N.C. area, who asked not to be identified, said she is leaving the business altogether. Over the past three years, she said her company has suffered through a 30% decrease in earnings due to Medicare cuts and the sluggish economy.
"We are no longer offering Medicare power chairs at all," she said. "We simply can't afford to buy high quality, new equipment and put it out under the current rental arrangement. Medicare beneficiaries want new equipment and we have no way of certifying how rental power equipment has been maintained and cared for while in the hands of any beneficiary."
Since the beginning of the year, when the mandatory rental policy replaced a Medicare patient's option to purchase a power wheelchair, she said, "We have already turned patients away. I don't even know where to send them. We are not physically in a competitive bidding area, but most (companies) around us stopped doing them last year due to the significant documentation requirements. I guess they saw the writing on the wall. One lady I spoke with had already called 4 companies and was still searching. Let's hope that she can find a reputable company before she falls and requires a hospital stay."
Janet Round, of AWCS Medical, Inc., in Porterville, CA., said she has also stopped offering standard power wheelchairs.
"We will no longer be able to provide the standard power wheelchair to our patient population," she said, noting that problems have arisen with other medical equipment on rental programs. "The initial cost of the chair prohibits using it as a rental. We have found too many patients think they own DME (Durable Medical) equipment such as hospital beds…even when we have not received the 13 months of rental. They move out of state with our equipment or their family sells the equipment when the patient expires and there is no way for a provider to recoup the loss. I can't take the chance of them taking off with the power chair when we would have so much invested in the chair."
Others providers are also concerned.
"Providing power mobility now has the word 'RISK' written all over it," said Serina Breen, of Freedom Mobility Center, LLC , in Rodeo CA. "The rigorous and time-consuming documentation requirements required for power mobility along with the high risk of charge back already make providing power mobility equipment expensive and risky. Now with the elimination of the first month purchase option, this adds even more expense and risk to providers as we must purchase expensive equipment upfront and risk not being able to recoup the cost of our investment. As a result, we will provide less power mobility equipment to Medicare, and look to build our business with other product categories and insurers instead."
Matthew Boyd, of Hattiesburg Medical Supply, in Hattiesburg, MS, said, "We will be keeping less inventory and have changed which models we carry. We are carrying less expensive models due to the changes. Our service to our customers will be the same; however these policies affect the quality of power chairs available. We used to offer higher end chairs, but this is impossible now."
Another provider, Donald Jones, of Southern Medical Equipment Corp., in Cullman, AL., maintained that the government policies are inconsistent with the needs of the Medicare beneficiaries, who are prescribed power mobility to help them ambulate in their homes.
"Consumer power chairs, in order to meet the Medicare requirements, are only for patients that cannot walk due to a long term disability," he said. "The beneficiaries in this category are rough on the equipment. There is no way that a dealer can afford to finance the power chair and be expected to provide repairs on this type of equipment for five years."
Jones noted that if the rental chair is returned to the provider prior to the end of the 13-month rental period, the provider will have to pay to "completely refurbish the chair" before it could even be rented to a new Medicare patient.
Wilson, of AAHomecare, said the survey comments unfortunately reflect the current state of mobility providers across the country.
"These business owners are committed to helping people living with disabilities improve their quality of life," Wilson said. "But oftentimes government policies are obstacles. It's very unfortunate that Medicare beneficiaries are becoming the victims of bad public policy."
The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/competitivebidding.
SOURCE American Association for Homecare