CMS ready to roll with wheelchair demo
WASHINGTON — It appears CMS will finally be ready to roll this summer with the consumer-directed DME (CD-DME) demonstration, which carries the lofty goal of streamlining the rigmarole involved in buying a wheelchair.
A year and a half after announcing plans for the demonstration, CMS recently named Cigna Medicare, the Boise, Idaho-based Region D DMERC, as claims processor for the three-year CD-DME. Now, all systems are go for the demonstration to take off July 1.
Per the demonstration, four designated Centers for Independent Living (CILs) will school beneficiaries on how to choose a wheelchair, as well as negotiate its price. The CILs, which have been given $150,000 grants, will also provide beneficiaries with a voucher for an amount within the Medicare fee schedule to purchase a wheelchair (The demonstration doesn't apply to capped rentals).
That's where Cigna comes in. It'll authorize the vouchers and pay claims from the four CILs (located in Portland, Maine; Worcester, Mass; Tulsa, Okla.; and Pittsburgh). That'll streamline the process of acquiring a wheelchair, proponents say. Beneficiaries won't have to bill their local DMERC, and providers can treat the purchases as cash sales.
Dennis Fitzgibbons, director of operations for the Portland, Maine-based Alpha One CIL, said his program hopes to school 25 beneficiaries with various disabilities in its first year. He said his program would also work with physicians to make prescriptions for wheelchairs more specific. When beneficiaries walk into a HME store with a vague prescription, they can get an inappropriate chair and billing can take longer than usual, he said.
"The biggest pro here is streamlining," Fitzgibbons said.
Upon leaving the CILs, CMS envisions beneficiaries entering HME stores and using their knowledge of wheelchairs and the allure of a cash sale to not only talk a provider down in price but to get more bang for their buck by upping the Medicare-allowed warranty or maintenance agreement.
"We're not doing anything to expand reimbursement," said Paul Mendelsohn, the demonstration's project officer. "We're just giving beneficiaries more flexibility. They'll no longer be at the mercy of the ethics or knowledge of the supplier."
If beneficiaries can't strike a deal on their first at bat, the demonstration's encouraging them to look elsewhere, including the Internet, which Mendelsohn said will be less "risky" for educated beneficiaries. When beneficiaries' negotiations succeed, excess funds, which will be kept in beneficiary-specific accounts, can be used to purchase accessories such as cushions.
"We really don't know if it's going to work," Mendelsohn said. "That's our experiment."
Jim Greatorex, co-owner of the Portland, Maine-based Black Bear Medical, said if he can forgo the expenses and headaches associated with billing, he'd be willing to lower the price of his wheelchairs. As far as more specific prescriptions go, and beneficiaries being "at the mercy of the ethics or knowledge of the supplier," though, he said that's not the case, at least at his company.
"For any wheelchair above a K0004, it doesn't get here unless a specialist, like a therapist, is involved," Greatorex said. "Just for compliance reasons and because it's the right thing to do. Companies that are worth anything, that are growing, operate that way."
Tyrrell Hunter, president of the Topsham, Maine-based Majors Mobility, said she'd lower the price of her wheelchairs, too. But, she's concerned about Medicare encouraging beneficiaries to order high-end wheelchairs over the Internet.
"If too many people did that, we'd be out of business," she said. "That's the long and short of it. We can't provide what we provide, including services, with Internet pricing. Medicare better be careful. What if these beneficiaries need service? We won't work on a chair we haven't provided." HME