Bush sets sights on PWC cap

Friday, March 31, 2006

WASHINGTON - When President Bush presented his FY2007 budget to Congress Feb. 1, it was deja vu for the rehab industry. The budget includes language that threatens to eliminate first-month purchases for power wheelchairs.
The industry escaped a similar fate late last year. A Medicare/Medicaid spending package originally included comparable language, setting off a flurry of lobbying activity. Spurred by the industry, six senators crafted an amendment to drop the language from the bill.
Now the industry finds itself right back where it started, worrying about cash-flow problems for providers and reduced access to power wheelchairs for beneficiaries.
"This was taken care of--or we thought so," said Cara Bachenheimer, vice president of government relations for Invacare.
Bush's budget estimates that eliminating first-month purchases for power wheelchairs would save $50 million in 2007 and $470 million from 2007 to 2011. Nancy Lansing, vice president of compliance and marketing for ATG Rehab, doesn't buy it: "What they save in wheelchairs, they'll pay out in nursing home and hospital stays due to complications," she said.
But those who hold the purse strings refuse to let the proposal die, sources said.
"The (Office of Management and Budget) sees dollar signs," said Simon Margolis, National Seating and Mobility's vice president for clinical and professional development.
The industry sees trouble. It estimates more than 95% of beneficiaries choose to purchase power wheelchairs in the first month, largely because they suffer from long-term conditions.
If Congress picks up the proposal for legislation, power wheelchairs would become a capped rental item: Reimbursement would be spread out over 13 months and title of the equipment would transfer to the beneficiary at that time.
"It's a cost shift to the providers," said Sharon Hildebrandt, executive director of the National Coalition of Assistive and Rehab Technology (NCART). "Providers aren't like banks, particularly rehab providers. They don't have the cash to order a base and all the various component parts and then dribble and drab payments back to manufacturers."
The proposal also raises questions about service and maintenance, as well as what will happen when wheelchair parts like bases are rented but other parts like seating systems are owned.
The industry is crossing its fingers that the proposal never sees the light of day. "I've heard from many interested parties in Washington--both Republicans and Democrats--who are concerned about issuing or developing legislation that further cuts the Medicare benefit after the Deficit Reduction Act," said Seth Johnson, vice president of government affairs for Pride Mobility Products.
The language in Bush's budget reads: "The budget proposes to reimburse for short-term power wheelchair usage based on actual time used versus paying up front at the full purchase price."



In a March 3 letter to the Senate's Budget Committee, Sens. Mike DeWine and George Voinovich, both Republicans from Ohio, argued against President Bush's proposal:
"Initial purchase eliminates hardship for suppliers, who must pay the manufacturer for the product and evaluate and fit the client with the appropriate product up front. Increasing the fiscal burden on suppliers may cause them to discontinue carrying power wheelchairs, ultimately putting beneficiaries' access to power mobility devices and the ability to independently function in their homes at risk."