Policy change should drive scooter access

Sunday, July 31, 2005

WASHINGTON -- In a major policy change that should increase beneficiary access to scooters -- and possibly reduce power wheelchair utilization -- CMS has eliminated the restrictive requirement that scooters be prescribed only by a specialist in physical medicine, orthopedic surgery, neurology or rheumatology.
The policy change is effective for claims with dates of service on or after May 5.
By broadening the pool of doctors who can prescribe a scooter, CMS changed a regulation that goes back many years and initially was likely intended to control scooter utilization. As times changed, however, it became easier for doctors to prescribe a $5,000 PWC than a $2,000 scooter. As a result, Medicare beneficiaries often ended up with a PWC when a less expensive scooter would have adequately served their mobility needs.
"It did contribute to power wheelchair utilization," said a DMERC official who asked to remain anonymous. "From a common sense point of view, if you can get item A for $3 with no fuss and item B for $1 with a lot of fuss, human nature tells you what will happen."
"This is a good thing," added provider Bernie Hamann, co-owner of Lakeside Mobility in Rochester, N.H. "It was my experience that if a person didn't qualify for a scooter because the doctor wasn't qualified to prescribe one, that doctor would qualify him for a power wheelchair."
The change in who can prescribe a scooter or power operated vehicle (POV) falls in line with CMS's new "algorithmic approach." This strategy is intended to insure that Medicare meets a beneficiary's mobility needs with the least costly equipment. For example, if a scooter serves a patient best, CMS does not want a doctor to prescribe a more expensive PWC. Similarly, if a walker will suffice, CMS doesn't want the patient to receive a manual wheelchair.
By removing the specialist requirement, CMS eliminates a hoop that beneficiaries had to jump through to get a scooter. However, CMS's pending face-to-face regulation should offset any potential spike in scooter utilization, said Pride Mobility's director of government affairs, Seth Johnson.
(As a way to reduce utilization, the MMA requires CMS to develop a program that requires a doctor to see a beneficiary before prescribing a PWC.)
"From an industry standpoint, we are in line with CMS saying it wants proper controls in place to the right people get the right equipment," Johnson said. "Face-to-face will provide some reasonable physician involvement."