PWC delay called 'double edged sword'

Sunday, November 6, 2005

YARMOUTH, Maine - A U.S. Senate amendment that would delay CMS's transition from CMNs to doctor's prescriptions for power mobility devices is taking heat from some within the rehab industry. The reason: Not only will the delay create a record keeping nightmare, critics say, but it's paid for with a 1.5% reimbursement cut for 2006.

"If this would have happened six or eight weeks ago, we would have run with it," said Simon Margolis, vice president of clinical and professional development for National Seating and Mobility. "But [the rule] has already been implemented, which means we are bound by it at this moment. We've figured out ways to do it. I don't want NSM to have to pay $150,000 in 2006 for the privilege of putting off something that we've already geared up to do."

The reimbursement cut has its roots in politics. The amendment, which is attached to the spending bill for the Department of Health and Human Services, needed to be budget neutral. Because CMS expects savings from the rule - more beneficiaries in scooters rather than wheelchairs, for instance - a cut was necessary to offset delaying the transition until April 1, 2006.

Nancy Lansing, director of marketing for Connecticut Rehab, agreed with Margolis, saying that rehab providers need to stop "spinning their wheels" and "move on" to other changes that will affect the industry, namely new codes for wheelchairs and scooters.
"Oct. 25 has come and gone," she said.

A few more months to prepare for what they believe are unavoidable changes to the way power mobility devices are provided isn't worth a 1.5% cut that will save CMS about $10 million, say Margolis and others.

Moreover, although the cut is slated for 2006 only, it might stick, Margolis said.

"I haven't know CMS ever to give us back anything," he said. "Once they've decreased the price, you very seldom see the price go up. My fear is that it will be a permanent reduction."

In addition to cost, going back to CMNs, only to return to prescriptions and medical records in the spring, would not only be costly but also an "administrative nightmare," Lansing said.

While he contends the amendment is a "double-edged sword," Jerry Keiderling, vice president of VGM's U.S. Rehab, said he still believes in holding up the rule so "everything is in line with each other": the rule, the new codes, the local coverage determination.

"All the ducks need to be in a row," he said. "The DMERCs need to have all their notification and education, the doctors need to have their education - everything - before any part of it should be implemented. What it will do is cause a little chaos. I think if people look at the whole picture, they'd be willing to have a little chaos to get it in a form and fashion that works for everybody."