Rental power wheelchairs: 'It's a bad deal'

Sunday, July 29, 2007

WASHINGTON - The rehab industry last week pulled out all the stops to try and "knock out" a provision that would eliminate the first-month purchase option for power wheelchairs.

The Ways and Means Committee in the House of Representatives included the provision in a bill passed on Friday that would reauthorize the State Children's Health Insurance Program (SCHIP). Eliminating the purchase option for power wheelchairs and other changes would help pay for the House's plan to expand SCHIP and increase physician payments.

On Friday, the House Energy and Commerce Committee still worked to tweak its version of the bill. The Rules Committee will review and resolve any differences between the bills.

"We're doing everything we can," said Seth Johnson, vice chairman of AAHomecare's Rehab and Assistive Technology Committee (RATC) and vice president of government affairs for Pride Mobility Products, who worked Capitol Hill. "I'm confident that there are opportunities to knock out this provision."

In a bill also released this month, the Senate proposes paying for a $35-billion SCHIP expansion by increasing the tobacco tax by 61 cents. Its bill doesn't include provisions to eliminate the purchase option for power wheelchairs or reduce the oxygen cap. President Bush's 2008 budget, which proposes a $5-billion SCHIP expansion, includes both provisions.

The Congressional Budget Office (CBO) estimates that eliminating the purchase option for power wheelchairs would save CMS $600 million over five years.

After the House bill was released, groups like NCART and NRRTS e-mailed alerts to more than 1,000 providers and manufacturers, urging them to lobby their representatives to pressure the chairmen of the Ways and Means and Energy and Commerce departments to eliminate the provision.

"The same day we sent out the alert, I got back 20 responses from people who had jumped on it right away and contacted their representative," said Simon Margolis, executive director of NRRTS. "More people have to get off their butts. They have to believe that when industry leaders tell them to do something like this, they have to. We don't ask them unless there's good reason."

Here's what's at stake: If Congress eliminates the first-month purchase option, fewer providers will supply power wheelchairs, reducing beneficiary access, industry sources say.

"I know the providers who I've spoken to in South Dakota are not willing to rent power wheelchairs," said Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D., and chairman of RATC. "It would mean paying for wheelchairs up front and waiting longer to get paid. We're not getting paid adequately, anyway. We take no pleasure in the idea of no longer serving those clients, but it's a bad deal. The economics would no longer play out."

Additionally, based on information received from the SADMERC, the industry argues that nearly 100% of beneficiaries who need power wheelchairs purchase them upfront.

"People purchase complex power wheelchairs on day one because they know they'll need them for a long time," said Sharon Hildebrandt, executive director of NCART. "Also, the chairs can't be used by anyone else."

Even if eliminating the first-month purchase option for power wheelchairs remains in the House bill, the industry is confident that it has enough allies in the Senate to eliminate the provision in conference. Last year, a group of senators, including Sens. George Voinovich, R-Ohio, and Rick Santorum, R-Pa., successfully removed the provision from a Medicare spending package.

Some wonder, however, how much longer the rehab industry "can dodge the bullet." Attempts to implement the provision go back at least two years.

That's why Pederson spoke about the importance of protecting the first-month purchase option at a July 26 event in Rapid City celebrating the 17th anniversary of the Americans with Disabilities Act. Similar events took place nationwide.

"(Rep. Stephanie Herseth Sandlin, D-S.D.), our representative, can expect a lot of feedback after that event," he said.