Past experience indicates bennies will pay the price
While the rehab industry cringes at the thought of life under new pricing for power mobility devices, they've already had a taste of what it's like for seating cushions.
CMS implemented new pricing for cushions July 1. Like with pricing for PMDs, the agency used gap filling, resulting in 10% to 30% reductions in reimbursement. As a result, some rehab providers have made several changes, including supplying more lower-end cushions.
"If there's a question about what cushion to provide, we now provide the lower-end cushion," said Scott Scobey, president of Low Country Mobility in Savannah, Ga. "We have to--we're not going to take the chance that we won't get paid. People say you should provide what patients need, but I run a business. I need to make some profit."
Some providers no longer supply cushions through certain payers. Other providers, like Chris Henry, CEO of The Medical Store in South Burlington, Vt., provide a smaller range of cushions.
"We've cut the number of seating cushions we carry in half," he said. "You want to fight to keep options available for beneficiaries, but you need to stay in business, too."
Tyrrell Hunter, president of Majors Mobility in Topsham, Maine, agreed that, while choice still exists, the process of selecting cushions isn't as "open-ended" anymore.
"Our referrals know the old days of the therapist saying, 'We'll try this cushion' are no longer," she said.
As a way to compensate for reduced reimbursement for cushions, some providers have also looked to strip costs from their service and delivery models, said Tom Borcherding, senior vice president of global sales for The Roho Group, which manufactures cushions.
Still "at the end of the day, if a certain cushion is needed by a certain client, it can still be provided," he said.