The iBot: Standing tall with CMS? scrutiny?

Friday, June 30, 2006

ENDICOTT, N.Y. - Independence Medical officials have their fingers crossed that CMS will create a new code for its stair-climbing wheelchair, the iBot, and attach that code to a hefty reimbursement.
"We feel very strongly that it should be covered by Medicare," said Elizabeth Patience, manager of reimbursement. "It's an amazing device."
Amazing or not, the early word from CMS does not look promising.
A CMS analysis of Independence's application for a new code proposes that Medicare cover only the iBot's mobility system and standard function--not its stair-climbing and balancing system. Given that most of the chair's cost--$26,100--resides in the balancing system, it appears unlikely that CMS will approve reimbursement that exceeds what Medicare now pays for a K0011, about $5,000, say industry watchers.
If that is the case, the iBot will be out of reach for 99% of Medicare beneficiaries, Patience said.
That's because beneficiaries would have to pay for the uncovered cost out-of-pocket, and most seniors on fixed incomes don't have that kind of money.
CMS's decision is important to Independence for another reason: If the agency decides to cover the iBot at or near the acquisition price, other insurers, who often follow Medicare's lead, would likely do the same, Patience said.
However, with Medicare in the mood to cut, not increase, its DME benefits, doling out more money for what is little more than a "souped-up" K0011 seems like a long-shot, said an HME reimbursement specialist.
"We all have patients who could benefit from something like the iBot," said Tim Pedersen, owner of WestMed Rehab in Rapid City, S.D. "What it comes down to is medical necessity, and a case hasn't been made compelling enough for the government to consider going from one floor to another medical necessity."
That attitude irks Patience.
"We've had consumers who have created a home for themselves in the laundry room because everything else is upstairs," she said. "It is inhumane."
Additionally, only a limited number of seniors would be eligible for the iBot, Patience said. Those seniors would have to be active, cognitively sharp and have a need to climb stairs. As such, the drain on Medicare's coffers would not be that great.