Rehab:‘We can’t eat cut’

Friday, October 31, 2008

WASHINGTON--The complex rehab industry continues to build its case for a carve out from the 9.5% nationwide cut, even though its prospects appear slim, at least this year.

In late September, NCART released the results of a survey that found 95% of 184 responding complex rehab providers will reduce or eliminate product choice due to the Jan. 1, 2009, cut; 87% will reduce or eliminate off-site assessments and evaluations; and 88% will reduce or eliminate the availability of demo equipment.

Additionally, 91% of respondents say the cut will have an impact on their ability to perform repairs, especially in a patient’s home.

“The purpose of the survey is to show consumers, clinicians and policymakers that we can’t eat this cut,” said Sharon Hildebrandt, NCART’s executive director. “Something’s going to happen. Product choice and services are going to change.”

The survey is the latest attempt by the industry to defend itself against reimbursement cuts. Earlier this year, it released a report, conducted by the University of Rochester’s Simon Graduate School of Business, that found providers of high-end wheelchairs make, on average, a 5% profit.

The industry also plans to release initial results of a broader study by Georgia Tech University and the University of Buffalo in 2009.

It’s unlikely that members of Congress will move to carve out complex rehab this year, because they’ve already carved out the product category from national competitive bidding, industry sources said. They also have a growing financial crisis and a Nov. 4 election to worry about.

But the industry must continue collecting data and building its case, industry sources said.

“We need to be ready for current and future discussions,” said Don Clayback, vice president of government relations for The MED Group and part of NCART’s executive leadership.

In the meantime, the industry will monitor the real-time impact of the cut. It expected the first impact to be felt as early as October, when providers, working on a 60- to 90-day cycle, began placing orders for early next year.

Approaching Jan. 1, providers will have tougher and tougher decisions to make, industry sources said.

“They’ll be able to survive if they’re willing to tell consumers, ‘No,’” said Simon Margolis, executive director of NRRTS and a liaison to NCART’s board of directors. “They’re going to have to learn to say, ‘It’s not that you don’t deserve that chair, but Medicare won’t pay for it.’ We have to share the impact with consumers. If we don’t, they’ll never understand and neither will Congress.”

The industry’s concerns have been heard by at least one consumer group, according to Seth Johnson, vice president of government relations for Pride Mobility Products and vice-chair of AAHomecare’s Rehab and Assistive Technology Council. On Sept. 19, the American Association of People with Disabilities sent a letter to Sen. Max Baucus, D-Mont., chairman of the powerful Finance Committee, urging him to carve out complex rehab from the cut.

“It is essential that Medicare maintain the current payment rate for these specialized wheelchairs and parts to avoid exacerbating the disability condition and limiting independence for users,” the letter states.