Q. Why does CMS feel the HME industry has exploited the powered mobility benefit?
A. The obvious reason is the increase in utilization from 1995 ($43 million) to 2003 ($1.2 billion). This was partially the result of an aging population with mobility impairments, pockets of clinician and supplier fraud and abuse, outdated coverage policies and direct-to-consumer advertising. The need for powered mobility will continue to grow given the demographics, so new policies were warranted, and fraud seems to now be under control. This leaves direct-to-consumer marketing. There is nothing illegal or wrong with direct-to-consumer advertising. However, in health care, consumers aren't always fully informed, and they're not necessarily spending "their" money. CMS's issue, here, is that the Medicare program, when created in 1965, was based on the traditional medical model and set up as a public "trust." Contemporary health care has evolved in the last 40-plus years. However, the concept of a public trust has not. Under the "trust," the practitioner prescribes what is reasonable and cost-effective, and charges appropriately for the intervention. Unfortunately, the standard of practice for powered mobility was unclear and certain providers exploited it, and, unfortunately, we are all guilty by association. From CMS's perspective, much of the advertising in our industry tends to exploit the benefit as an "entitlement" that is "free" or costs little. The industry contends it will work with your physician rather than consult your physician or therapist. In moving forward, I suggest that we be more united as practitioners, suppliers and manufacturers by adopting and policing a standard of practice and code of ethics, especially when it comes to how we present ourselves to the public. We can learn from the pharmaceutical industry, which was warned by CMS to tone down direct-to-consumer advertising. It now advises people to consult their physicians as to the appropriateness of a drug. hme
Mark Schmeler, Ph.D., OTR/L, ATP, is on the faculty of the Department of Rehabilitation Science & Technology at the University of Pittsburgh. Reach him at email@example.com