Providers: “Blame the physicians, too”

Friday, October 31, 2003

YARMOUTH, Maine - While the wayward HME provider often is depicted as the poster child for wheelchair fraud, some providers and even CMS administrator Tom Scully recently have pointed to the primary care physicians and their role in boosting the numbers.

“It’s hard to believe, but you can currently, or until today, write a prescription for a wheelchair, and apparently some doctors in Houston have written thousands, without even seeing a patient,” Scully said. “That seems pretty wild to me that you can get a $5,500 piece of equipment without even seeing a doctor.”

Providers agree saying some doctors stray from the requirement that a patient be unable to walk to receive a power wheelchair.

“People are getting wheelchairs whether they need them or not,” said Tyrell Hunter, president of Majors Mobility in Topsham, Maine.

Hunter said when she encounters this problem she goes back to the doctor for further documentation of need or sends the patients elsewhere.

Problems with physicians signing off on inappropriate equipment will propagate as technology continues to advance as well.

“Physicians need to be in the loop and be part of the process, but I know that in many cases the physicians are not the most knowledgeable when it comes to the patient’s needs,” said Gary Gilberti, president of Chesapeake Rehab Equipment in Baltimore. “They don’t know the technology that is available and things like that.”

For this reason, Gilberti and other providers are in favor of what they call the “team approach,” which would require a physician to work with a physical or occupational therapist and a rehab technician before prescribing a piece of mobility equipment.

RATC submitted comments to CMS earlier this year requesting the organization require a PT or OT evaluation as part of the patient assessment process, according to Gilberti.

In a preliminary step, however, CMS’s initiative to curb power wheelchair abuse included a provision where CMS will work with physicians in clarifying their prescribing responsibilities.

While providers say education is important, many worry that pressure to sign off on equipment will continue, not only from unscrupulous providers, but from the patients themselves.

“If you go to your doctor and say, ‘Doc, I want to get this or try this,’ he might say no, but if you push him, he is going to sign,” said Gilberti.