Metzger explains Region C resignation
NEW BRAUNFELS, Texas - There’s nothing coincidental about Dr. Paul Metzger’s decision to leave his position as medical director of the Region C DMERC and the sweeping changes to the K0011 power wheelchair market now underway in Region C.
After the coverage guidelines for power wheelchairs tightened up and the denials started flying last year, Metzger, who’d never subscribed to the â€˜three steps and you’re out’ theory of claims denial for power wheelchairs, realized he could not abide an about-face on policy, especially when he realized it was not within his power to turn around the policy.
“I chose not to be a party to what was being done to legitimate suppliers of powered mobility, without my knowledge or consent,” Metzger wrote in an e-mail to HME News. “Resignation was my only honorable alternative.”
In the immediate aftermath of his decision to step down, he said he had planned to invest in an automobile transmission franchise and move to Georgia to be near a newborn grandchild. Then the Scooter Store approached him.
“I then realized how much anger and frustration I was feeling about what had happened to my career and the last 10 years of my professional life in medicine,” Metzger wrote. “I took TSS up on their offer a day before I left Palmetto because I could not just walk away from this unjust mess.”
In recent months, claims for power wheelchairs in Region C have spiked downward from 15,284 in April 2003 to 8,786 in October 2003, the most recent month for which a complete data set is available. The Wheeler Dealer scandal in Houston erupted in September 2003. Claims for K0011 power wheelchairs in the other DMERC regions have continued to rise gradually over the same time period. Today, Metzger still believes that CMS is trying to protect the Medicare trust fund, but also that they have abandoned the high road.
“Even suppliers who are not affected by this power grab must realize that the precedent has been set for absolutely arbitrary and capricious proclamations that could affect their bailiwick next,” Metzger wrote.