LOS ANGELES, Feb. 28, 2012 /PRNewswire-USNewswire/ -- Karen Miner, an advocate for people living with disabilities, is concerned that many Medicare beneficiaries in California may lose access to power mobility devices that allow them to remain independent in their homes rather than confined to nursing homes and care facilities. Across the country in Pittsburgh, PA, Georgie Blackburn, a home medical equipment provider, fears that Medicare regulations, as well as some new ones poised to be enacted, will decimate the provider community. Soon, she says, because of government policies, there may not be enough providers still standing to answer the mobility needs of senior citizens and people living with disabilities.
That is the dismal state of the Medicare mobility benefit today.
In recent years, the Centers for Medicare and Medicaid Services (CMS) has implemented a series of policy changes that include reimbursement cuts, a controversial bidding procurement system, elimination of the first-month purchase option, unwarranted audits, and excessive denial of reimbursement claims. These policies have taken a toll on Medicare patients, their families and caregivers, and the durable medical equipment (DME) providers serving them.
Whereas physicians could once rely on the Medicare mobility benefit to improve the mobility of their patients who were unable to ambulate in their homes, today doubt seeps into the minds of not only the doctors writing the prescriptions, but also their patients. At the root of this transformation are government policy and regulatory changes that are swiftly dismantling the network of service providers and recklessly driving down utilization of power wheelchairs.
Miner and Blackburn are concerned about whether Medicare beneficiaries will continue to have access to mobility equipment.
Pittsburgh and Riverside, California are two of the nine metropolitan areas subjected to the first round of the new bidding procurement program for Medicare DME. All nine areas have seen steep drops in reimbursement claims. There were similar declines in the other seven areas where the bidding procurement process was instituted in 2011.
Moreover, it is clear that the severely flawed bidding program, which encourages irresponsible low-bids and creates unsustainable prices, prevents many dependable providers from serving Medicare beneficiaries. In the Riverside, California metropolitan area, for instance, the number of providers eligible to provide standard power wheelchairs to new patients in Medicare dropped from 375 in 2010 to just 37 in 2011. In Pittsburgh, the decline was from 125 to just 18, according to government data.
"We are very concerned about the impact of the bidding procurement program on some of the most vulnerable people in our society," said Miner, co-founder of two advocacy organizations, Research for Cure and Californians for Cures. "If providers go out of business or no longer serve Medicare patients, seniors and people with limited mobility must wait longer for the medical equipment prescribed by their physicians. This will cause pain and suffering. For someone with limited mobility, a power wheelchair can mean the difference between living independently in their home or being confined to a care facility or nursing home."
Miner, a quadriplegic, said it's "very unfortunate" that CMS is implementing policies that are restricting access to power wheelchairs for Medicare patients. "These results are so disturbing," she said. "We all know friends and relatives, who are going to need a power wheelchair in the near future. But now we have to worry about whether Medicare will provide it. This is shameful. I'm very disappointed in the people at CMS responsible for this."
Blackburn said the government regulations are making it impossible for many home medical equipment providers to continue servicing Medicare beneficiaries. She noted that in the nine locations where the bidding program was implemented – Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, Calif. – providers and consumer advocacy groups are concerned about whether Medicare patients are receiving the home medical equipment that they need.
"What's clear is that the rate of Medicare beneficiaries receiving mobility equipment seems to be sharply declining at a time when the demand is increasing," Blackburn said. "This is an unwise policy for CMS. It means that more seniors and people living with disabilities will require expensive hospital care.
"CMS is playing a shell game – the power mobility procurement goes down, but other Medicare categories increase. Low-cost home medical equipment is being switched for high-cost hospitalization and care. That wastes taxpayer dollars, while preventing some of the most vulnerable people in our society from maintaining their mobility and independence at home."
In June, CMS plans to implement a prior authorization program for the mobility benefit, requiring the government to approve mobility prescriptions before Medicare patients receive power wheelchairs. Stakeholders are pleased with several adjustments to the program, such as allowing providers to submit the authorization requests to CMS on behalf of physicians. But the impact of this program on Medicare beneficiaries in still uncertain.
"Medicare beneficiaries, power wheelchair providers, and equipment manufacturers all want an efficient procurement system that allows Medicare patients to receive the medical equipment that is prescribed by their physicians," said Tyler Wilson, president of the American Association for Homecare. "We are pleased that CMS listened to these stakeholders and made significant changes to the prior authorization program. Stakeholders must be included in discussions on how to shape the mobility benefit. This needs to be a permanent transformation. We are willing to work with CMS for the kind of mobility benefit that Americans deserve."
Mobility Matters is published periodically by the American Association for Homecare to inform Congress, the administration, policymakers, consumers, 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. The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Visit www.aahomecare.org/athome. 2011 Crystal Drive, Suite 725, Arlington, Virginia 22202. 703-836-6263
SOURCE American Association for Homecare