Complex rehab fights 9.5% cut with hard data

Sunday, February 22, 2009

WASHINGTON - The 9.5% reimbursement cut that took effect Jan. 1, 2009, will reduce Medicare payments to complex rehab providers by $7.5 million this year, according to an analysis of CMS data completed recently by Pride Mobility Products, AAHomecare and NCART.

For a Medicare program that spends almost $450 billion a year, that's budget dust. But for the complex rehab providers who have struggled through numerous cuts over the past few years, it will likely limit patient access to quality products and services, industry stakeholders say.

With this hard data in hand, the industry now hopes to persuade lawmakers that complex rehab should be exempted from the 9.5% cut. During AAHomecare's fly-in Feb. 11, congressional staffers seemed sympathetic.

"They looked at you like: 'Is that all it is?'" said Julie Piriano, Pride's director of rehab industry affairs.

"That ($7.5 million) figure puts things into perspective," added Sharon Hildebrandt, NCART's executive director. "It is a good selling point whenever you can keep your costs as low as possible."

The analysis revealed that CMS paid $40,680,782 for Group 3 wheelchair bases and $38,656,339 for Group 3 accessories. The 2007 data is the most current available.

Rescinding the cut, if it happens at all, will take time. That's because it must be done legislatively, and at the moment, with lawmakers focused on reviving the economy, it's not clear how or when that could happen, Hildebrandt said.

Lawmakers removed complex rehab from the competitive bidding program last summer. They did not, however, exempt it from the 9.5% cut. Congress imposed that cut on all products in Round 1 of competitive bidding in exchange for delaying the program.

Another fear: That other insurers will follow Medicare's lead and cut reimbursement for complex rehab equipment by 9.5%. Washington state did that recently.

"This 9.5% cut impacts 10,000 Medicare beneficiaries," said Paul Bergantino, an NCART board member and president of ATG Rehab in Newington, Conn. "But that's deceiving. As Medicaid adopts the cut, many more will be affected."