Bundling 'problematic' for power wheelchairs

Wednesday, November 26, 2014

WASHINGTON – HME stakeholders are deeply concerned about CMS’s plan to bundle payments for power wheelchairs and the impact that will have on patients and providers’ bottom lines. 

In a final rule issued Oct. 31, CMS stated that it would implement a demo project in 12 competitive bid areas, in which providers would submit a single bid for furnishing standard power wheelchairs, related accessories and services needed on a monthly basis. 

Bundling is not an unreasonable concept, but CMS’ application of it could be, says Don Clayback.

“Bundling could probably work in certain situations, but when you look at products that have a wide variety of configurations and a wide variety of situations that you’re trying to meet, such as with power wheelchairs, I think it just becomes extremely problematic,” said Clayback, executive director of NCART.

Due to the “variety of configurations,” stakeholders are wondering exactly what HCPCS codes CMS plans to include in the bundling. 

“It’s like going to the hospital and saying, ‘You have all these different surgeries and it’s really hard to sort them out, so we’re just going to create one code for all these surgical procedures and then we’re going to ask you to give us one price,’” said Clayback.

The inclusion of repairs in bundling adds another layer of complexity. It’s almost impossible for providers to estimate the average cost for potential repairs because patients and their needs change over time, says Peter Rankin, manager of government affairs for AAHomecare. One year you could have a beneficiary who is still getting used to their chair and staying home and the next year, they’re all over town. 

“You have a significant cost difference if that patient changes drastically,” said Rankin.

In addition to bundling, the final rule includes an expansion of competitive bid pricing to non-bid areas in 2016. The new pricing will be phased-in over the course of six months. In rural areas, the payment amount will be based on 110% of the average of regional prices.

“I think it’s going to create unfairness in the pricing because you’re using pricing for a populated area and you’re applying that to pricing for an unpopulated area and they’re not the same animal,” said Clayback. 

Jackie Semrad is the owner of Reliable Medical in Brooklyn Park, Minn. and chair of the AAHomecare Complex Rehab and Mobility Council. As a provider, she’s worried about how the application of bid rates in rural areas will affect beneficiaries. 

“They already have a difficult time getting serviced,” said Semrad. “If you have to drive 80 miles one way, if you’re losing money just by driving out there, you’re not going to be driving out as often.”