Wheelchair access 'Denied'

The more Mark Sullivan read media reports that characterized the HME industry as a bunch of crooks, the angrier he got. Finally, Sullivan, Invacare's vice president of rehab, couldn't take it any more. The result is “Denied.” The 34-page book includes photos of real people using complex rehab equipment; text that explains the market challenges; and an introduction by Quickie wheelchair co-founder and consumer advocate Marilyn Hamilton. Sullivan, who took all of the photos but one, “doesn't make a nickel off the book.” His goal in writing “Denied” is simple: To help stave off further reimbursement cuts to complex rehab by showing lawmakers and bureaucrats what it is all about. “I hope every RTS or company buys one and gives it to their state Medicaid office or their local congress person or their senators. Hopefully, the MAC medical directors will get a copy. That is all we are really looking for—that people buy one and give it away.”

HME: One of your goals with this book is to help convince lawmakers that Medicare's in-the-home rule should be abolished. Why is that?

Sullivan: Think about all the struggle that went on to create the ADA to ensure accessibility and access to the community—access to parks, access to public buildings. Now here is this other branch of the government telling you, 'We don't care about that.'''

HME: Yes. The ADA is supposed to increase community access, but the in-the-home rule denies it.

Sullivan: Exactly. What CMS will tell you is, “We are not saying you can't take your chair out of the home, but we are only going to pay for features or performance that helps you in the home.” Clearly, if you follow their guidelines what will happen is that people will develop less featured chairs that meet the declining reimbursement. I think that is the wrong way to go. And the states are not supposed to abide by that policy but they do because they follow Medicare.

HME: Do lawmakers understand complex rehab?

Sullivan: I think they re getting there, but it is still not quite visual enough for them.

HME: This book should help. It demonstrates the old adage, “A picture is worth 1,000 words.”

Sullivan: Yes. You can't make it up. People have very short attention spans. You can do all the videos and DVDs you want, but people won't sit and watch them. I wanted something that was short enough and visual enough that people would read it. There are a couple of pages in there that talk about the problem and a couple of pages on what we think the solution is. There's a page that talks about what the providers have to go through to get something paid. And then just a lot of good visuals.

HME: Another focus of the book is the difference between complex rehab and consumer power chairs.

Sullivan: Yes. You are talking about something completely different. The term wheelchair is a problem in itself. I gave it another title, “individually tailored mobility system items.” I used that to try and differentiate. Complex rehab wheelchairs are more like custom orthotics and prosthetics than they are wheelchairs.

HME: How did you come up with the title of the book?

Sullivan: The original name was freedom, but that sounded almost like too much of cliché. We asked a few people what they thought, and someone came back with “Freedom Denied.” I said I liked the word denied by itself. It's a term our industry uses. CMS says: Your claim has been denied.