GAO emphasizes smallness of accessories market

‘The report is really the best we could have hoped for,’ Bachenheimer says
Friday, June 3, 2016

WASHINGTON – Mobility stakeholders say they now have backup from the Government Accountability Office.

Stakeholders were pleased last week when the GAO released a highly anticipated report that found Medicare utilization and spending for accessories for complex power wheelchairs are relatively low—about 312,000 and $159 million, respectively, in 2014.

“In the scheme of DME spending and healthcare spending overall, that’s a small number,” said Don Clayback, executive director of NCART. “Part of our message all along has been that this is a small group of specialized equipment used by people with high-level disabilities.”

The GAO was required to look at utilization and spending for accessories for complex power wheelchairs as part of a bill passed in December that delayed the application of competitive bidding pricing to these accessories for one year, until Jan. 1, 2017. Due to CMS’s inability to change its claims processing system fast enough, however, the agency has applied bid pricing, anyway, until July 1.

The GAO was also required to look at the impact of this new pricing. It found that among the 10 accessories with the highest estimated expenditures, eight had pricing adjusted by competitive bidding. This resulted in reductions ranging from 4% (expandable controller, E2377) to 17% (mounting hardware for joystick, control interface, or positioning accessory, E1028).

“Overall, we’re looking at reductions as high as 34%” when Medicare implements a second round of reimbursement cuts in non-bid areas on July 1, Clayback said.

The GAO did make a point to say that, while spending for accessories for complex power wheelchairs is relatively small, it does account for 51% of total spending for accessories. That’s because it’s the accessories that make complex power wheelchairs complex.

“The accessories are what make it customized and highly individualized to address the unique medical needs of beneficiaries in need of this technology to remain active and independent in their homes and communities,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products.

With the report in hand, stakeholders are now working with their champions in Congress on a more permanent fix to prevent the reductions. There are limited opportunities in this election year, but last year’s delay and the GAO report give them a “jump start.”

“The GAO report is really the best we could have hoped for—it provides an objective detailed data analysis of CRT accessories versus standard ones,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Our congressional champions have been waiting for this, and it solidifies what we’ve been saying: that CRT accessories are different and need to be permanently excluded from bid pricing. We can now move to the next step of working with Congress to address this issue legislatively.”