Rehab industry to CMS: Delay new allowables for cushions

Sunday, June 25, 2006

WASHINGTON - The rehab industry has staged a campaign to delay CMS's new allowables for seat cushions, which go into effect July 1. The allowables cut reimbursement by anywhere from $5.75 to $127.35, compromising the industry's ability to put patients in the most appropriate cushions, sources say.

"The current allowables for cushions are not much above our costs, so even a reduction of a few dollars is kind of scary," said Mike Seidel, president of NRRTS. "Are people going to get the right cushions under the new allowables, considering that quality can vary tremendously? I'm not sure."

Groups like NRRTS and NCART and seat cushion manufacturers like The Roho Group have all contacted CMS to voice their concerns over the new allowables. CMS is "seriously considering" their request, industry sources say.

The reason for the reimbursement cut: CMS's gap-filling methodology. To set prices for new codes, the agency deflates prices to 1987 levels--the base year of the DME fee schedule--then inflates prices by 4% per year.

Industry sources argue that CMS shouldn't set new allowables for seat cushions until it has revised its gap-filling methodology--something it plans to do as part of its competitive bidding program.

Without a delay, industry sources fear providers will have no choice but to supply patients with lower-end cushions, even when higher-end cushions may be more appropriate.

"The new allowables force providers to make decisions on what products to supply based on cost--not the benefit to the consumer," said Tom Borcherding, senior vice president of global sales for The Roho Group in Belleville, Ill. "Your higher-performance products--the products that really address the needs of the consumer--will become less utilized."

Tom Hafford, president of Mobility Dynamics in Cleburne, Texas, said that keeping higher-end cushions a viable option for providers is key to effective treatment.

"The cost of treating decubitus ulcers can be $10,000, $20,000 or $30,000," said Hafford, who is also president of the Greater Texas Rehab Providers' Council. "A cushion that can minimize the possibility of a patient forming those ulcers costs $300, $400 or $500."

The old and new allowables, respectively, for seat cushions:
E2601--$88.65 to $61.16
E2602--$161.88 to $119.40
E2603--$223.04 to $151.59
E2604--$315.76 to $188.41
E2605--$321.69 to $269.17
E2606--$436.07 to $419.93
E2607--$295.60 to $289.85
E2608--$354.00 to $348.09
E2609--Individual consideration
K0734--$330.81 to $331.47
K0735--$389.54 to $421.78
K0736--$378.68 to $334.19
K0737--$435.56 to $423.06