PMD pricing: Rehab industry responds to 'curve ball'

Sunday, November 18, 2007

WASHINGTON - The rehab industry responded fast and furious to an Office of Inspector General (OIG) report claiming Medicare would save big bucks if it used Internet prices to set reimbursement for power mobility devices (PMDs).

The industry didn't think the Oct. 31 report had legs, but a Nov. 9 "dear colleague" letter from Rep. Pete Stark, D-Calif., changed all that, sources say. In his letter, Stark, who chairs the Health Subcommittee of the Ways and Means Committee, emphasized that Medicare would have saved $39 million in the first quarter of 2007 if it had used median Internet prices for Group 2 power wheelchairs.

In the days following Stark's letter, the industry, including AAHomecare, NCART and Invacare, churned out numerous rebuttals, calling the report "fatally flawed." The industry also got a boost from Reps. Tom Allen, D-Maine, and Ron Lewis, R-Ky., who countered Stark with their own "dear colleague" letter on the report.

Industry representatives planned to meet with Stark and/or his health aides as early as this week to educate them on providing power wheelchairs to Medicare beneficiaries.

"To get Reps. Allen and Lewis correcting the record--that's not something the industry has been successful in doing in the past when they've been thrown a curve ball like this," said Seth Johnson, vice president of government affairs for Pride Mobility Products.

In their letter, Allen and Lewis, sponsors of H.R. 2231, a bill that would carve out complex rehab from national competitive bidding, stated: "While we do not argue that lower prices may be available to individuals who can pay cash and require little or no servicing, we find it inappropriate and misleading to compare those prices to the service delivery model for power wheelchairs under the Medicare program."

Unlike Internet retailers, Medicare providers must adhere to numerous standards, the industry and Allen and Lewis argue: They must be accredited, they must conduct in-home visits, they must collect and maintain extensive documentation, and the list goes on and on.

"What concerns me the most is the basic misunderstanding or complete disregard on the part of the OIG and certain members of Congress about what it takes to provide rehab equipment to patients," said Tim Pederson, who chairs AAHomecare's Rehab and Assistive Technology Council (RATC). "It's incredible."

While the industry's response to the OIG report has been impressive, sources say, it has diverted groups like NCART from its full-court press to raise awareness about H.R. 2231, which, as of last week, still had no companion bill in the Senate.

"It has been very much a distraction," said Sharon Hildebrandt, NCART's executive director. "We've been on damage control."