K0011 leaves mixed legacy

Tuesday, July 31, 2007

BALTIMORE - It's gone now, the most famous and infamous HCPCS code in the history of the durable medical equipment fee schedule: the K0011.
Hatched in 1993, embraced by the industry in 1996 and besmirched by wheeler-dealers throughout the late 1990s and the early 2000s, the K0011 changed the way seniors maneuvered through their golden years and the way the nation thought of HME suppliers.
A faint blip on the radar screens of most Americans before the Wheeler Dealer scandal broke in September 2003, the K0011 cast all HMEs in a murky light at a time when the industry was gearing up to offset antagonistic policies like competitive bidding.
Unfortunately, among the wider population, the K0011's most durable legacy is likely to be as a symbol for the unethical behavior. But not necessarily for seniors.
"We have hundreds of customers who have been able to stay in their homes when they wouldn't have been able to otherwise," said Tyrrell Hunter, president of Majors Mobility in Topsham, Maine. "We have helped many many people stay independent."
That was the idea back in 1993 when the K11 emerged as a successor to E codes that previously served the power mobility market. In 1996, Pride Mobility Products introduced the Jazzy, a mid-wheel drive power chair with a stylish platform and a cushy captain's chair. Seniors who might have shunned the institutional chairs leapt into these drivers' seats.
"There were power chairs before, but they were rear-wheel drive," said Dan Meuser, president of Pride. "They operated well for high-end users but for tight indoor use, the previous chairs didn't do the trick."
The Jazzy, and the imitators that burst from workshops all over the industry, did just the trick. Seniors loved them, and so did suppliers. Unlike high-end rehab, it didn't take a highly credentialed professional to fit a power chair. All it took was a doctor's prescription and some otherwise routine paperwork. And for that, there was in excess of $5,000 in reimbursement.
Buying in high volume, the national's largest suppliers were able to procure power chairs for less than $1,000 each. They poured untold dollars in television advertising, and the escalation of the K11 was on. And so were the wheeler dealers.
"It became the era of the long-distance marketers," said Hunter.
Manufacturers concede as much, but they're quick to draw distinctions, as well.
"You have to separate the wheeler dealers from those who were creating awareness of a product that improves a person's life and that I, as a taxpayer, have a right to under Medicare," said Lou Slangen, senior vice president of worldwide market development at Invacare.
"The fraud was not K11 fraud, it was electronic billing fraud," said Meuser. "The reason we say that is because the criminals in Texas weren't buying power chairs. They were billing for them. But those guys weren't delivering the chairs."
Unfortunately for the HME industry, the public at large didn't make such distinctions. Nor did Congress whose sympathies for the HME industry had to be taxed by the tawdry press coming out of Texas, and other locations across the country.
But that doesn't necessarily mean that competitive bidding, or the shattering of the K-codes, are a consequence of wheeler dealers. Far from it.
"This break up of the K11 probably would have happened anyway," said Mark Sullivan, vice president of rehab at Invacare. "They did the same thing with S&P, where there was never even a hint of fraud and abuse. They had to break up the K-codes for competitive bidding."