American Association for Homecare: CMS inexcusably releases flawed Utilization Data

November 21, 2011 -- The federal government's tracking system for power wheelchairs provided to Medicare beneficiaries hasn't been adjusted to account for a new procurement policy implemented last January. Thus, the utilization numbers erroneously show a far higher number of power wheelchairs provided than were actually delivered to Medicare patients.

Major providers and manufacturers report declines of 30 percent or more in their power wheelchair sales to Medicare beneficiaries, yet the government data show significant increases.  Stakeholders, including providers, manufacturers and consumer groups, are concerned that the flawed data may mislead lawmakers on Capitol Hill, who are contemplating cuts to the Medicare program that could negatively impact the Medicare mobility benefit.

"The utilization data is supposed to provide an accurate picture of how the Medicare mobility benefit is being used," said Tyler Wilson, President of the American Association for Homecare (AAHomecare).   "When the data is wrong, it defeats that purpose. As Congress and the administration consider changes to the Medicare program, it is essential that their decisions are based on correct information that reflects reality."

Wilson said future changes to Medicare may determine whether some of the most vulnerable people in our society - senior citizens and people living with disabilities - can obtain mobility assistance allowing them to remain independent in their homes rather than be confined to care facilities. "The government owes Medicare beneficiaries at least the obligation to base their decisions on accurate information," Wilson said.  "It's clear that the government must update the way it calculates utilization numbers for mobility assistance."

The problem results from a new policy that eliminated a Medicare beneficiary's option to purchase their power wheelchair in the first month it was delivered.  Under the old system, a physician prescribed a power wheelchair, a provider delivered it and when the Medicare patient indicated that she/he wanted to own the chair, the government reimbursed the provider.  Now, however, under the new system providers are reimbursed in 13 monthly rental payments.   In compiling utilization data, the government now counts each monthly rental payment as if it were a new Medicare beneficiary obtaining a power wheelchair.  

In September, HME News reported that the data indicated that standard power wheelchair utilization has "skyrocketed." For example, HME News reported that in one of the four Medicare regions the number of beneficiaries increased from 5,411 (February) to 9,498 (March) to 12,525 (April).  Explaining the increases, HME News said the data indicates the "same beneficiary is counted each month, instead of, when there was a first-month purchase option, only once at the time of purchase."

Across the country, providers are frustrated and stunned by the erroneous data:  in reality, the new system has created severe financial and operation problems for providers.  Some are going out of business or no longer providing power wheelchairs to Medicare beneficiaries.  

Take Serina Breen. She worked for a home medical equipment company before starting her own business in 2009.  As an employee for the company, she provided more than 400 power wheelchairs to Medicare beneficiaries from 2006 to 2009. Once she started her business in Rodeo, CA, she said the audit risks, charge backs and excessive paperwork caused her to "purposely" limit sales to Medicare patients. The problems she experienced mirror the challenges faced by other providers.

Since 2009, she has provided only a few power wheelchairs to San Francisco Bay area Medicare beneficiaries - people living with disabilities who need mobility assistance to continue living independently in their homes.  And since January, when new Medicare regulations were implemented, her business with Medicare beneficiaries declined even further - she has provided only two power chairs to Medicare beneficiaries in 2011.

"It's really sad," said Breen, who operates Freedom Mobility Center, LLC. "The government has made it incredibly difficult to provide power wheelchairs to Medicare patients.  They are cutting Medicare costs by depriving vulnerable people of their mobility."    

The rental policy, she said, has made it unfeasible for many businesses to continue providing power wheelchairs to Medicare patients, while cutting their access to mobility assistance.   "The government just doesn't get it," Breen said, noting that a recent study found that mobility assistance saves Medicare$10.73 for every $1 invested in mobility equipment.    

"Medicare patients who are bariatric and those who require extensive medical attention or are seriously ill have trouble finding power wheelchairs," she said. "A provider's cost to purchase a bariatric power wheelchair, one with a weight capacity of over 450 pounds, is too high in comparison to the reimbursement from the government and there is too much risk involved with the rental policy."

Under the rental policy established by the Centers for Medicare & Medicaid Services (CMS), if a Medicare patient is hospitalized for a lengthy period, placed in a care facility or dies, the rental payments stop and the provider must attempt to re-rent the used power wheelchair.  Breen said that it's "very unfortunate" the government has established such a flawed system – one that is bad for Medicare beneficiaries and providers.  

"To stay in business, providers must be able to collect all of the rental payments from the government after delivering power wheelchairs to Medicare beneficiaries," Breen said. "We have to ensure that most power wheelchairs get capped out or can be easily and quickly transferred to a new beneficiary.  Unfortunately because providers are forced to think this way in order to remain viable, it results in less access for those Medicare beneficiaries who are bariatric, require extensive medical attention or have terminal illnesses."

What does Breen think about the utilization numbers showing increases in power wheelchairs delivered to Medicare patients?

"That is definitely false!" she said.  "CMS is counting the same power wheelchairs multiple times. This is comparing apples to oranges and of course the utilization numbers are going to look like they are increasing if they are calculated that way. Like the other policies, it makes no sense."

Mobility Matters is published periodically by the American Association for Homecare to inform Congress, the administration, policymakers, consumer organizations and the media about Medicare's power mobility benefit, and the need to sustain it. AAHomecare is committed to helping seniors and people living with disabilities regain their freedom and independence. To learn more about the Medicare power mobility benefit, go to www.aahomecare.org/mobility . American Association for Homecare - 2011 Crystal Drive, Suite 725, Arlington, Virginia 22202 -703.836.6263