Industry grimaces at seating prices

Monday, July 31, 2006

WASHINGTON - Despite CMS's decision to stand by its new allowables for seating cushions, the rehab industry has no plans to keep quiet. NCART formed a taskforce in mid-July to share with CMS the access issues that have followed implementation of the allowables on July 1.
The allowables cut reimbursement by anywhere from $5.75 to $127.35, compromising the industry's ability to put patients in the most appropriate cushions, sources say.
"The current allowables for cushions are not much above our costs, so even a reduction of a few dollars is kind of scary," said Mike Seidel, president of NRRTS. "Are people going to get the right cushions under the new allowables, considering that quality can vary tremendously? I'm not sure."
NCART, NRRTS and seating manufacturer The Roho Group requested that CMS rescind the new allowables, but the agency denied their request.
Under the new allowables, providers will have no choice but to supply patients with lower-end cushions, even when higher-end cushions may be more appropriate, industry sources fear.
"The new allowables force providers to make decisions on what products to supply based on cost--not the benefit to the consumer," said Tom Borcherding, senior vice president of global sales for The Roho Group.
Tom Hafford, president of Mobility Dynamics in Cleburne, Texas, said that keeping higher-end cushions a viable option for providers is key to effective treatment.
"The cost of treating decubitus ulcers can be $10,000, $20,000 or $30,000," said Hafford, who is also president of the Greater Texas Rehab Providers' Council. "A cushion that can minimize the possibility of a patient forming those ulcers costs $300, $400 or $500."
The reason for the reimbursement cut: CMS's gap-filling methodology. To set prices for new codes, the agency deflates prices to 1987 levels--the base year of the DME fee schedule--then inflates prices by 4% per year.
The industry argued to CMS that it shouldn't set new allowables for seat cushions until it has revised its gap-filling methodology--something it plans to do as part of its competitive bidding program.