Where's the rest of the story?

 - 
Tuesday, March 16, 2010

Just before we went to press with this issue, the Office of Inspector General (OIG) published a report stating Medicare pays about four times acquisition cost for standard power wheelchairs and about two times acquisition cost for complex power wheelchairs.

The report, "Power Wheelchairs in the Medicare Program: Acquisition Costs and Services," caught the eye of at least one lawmaker, Sen. Charles Grassley, R-Iowa, whose office wasted no time issuing a statement. The headline: "Grassley revved up over wasteful Medicare spending on power wheelchairs." (It was Grassley, you'll remember, who led a congressional hearing on power wheelchair fraud and abuse in 2004.)

Ouch.

As you can imagine, the industry issued its own statements. AAHomecare, NCART, NRRTS, The VGM Group's U.S. Rehab and the Power Mobility Coalition (PMC) all disputed the report's claims. They pointed out that reimbursement for power wheelchairs has been cut by more than 35% in the past few years, including a cut of 9.5% this year.

They also pointed out that the OIG didn't take into account the service costs and business expenses involved with providing power wheelchairs to Medicare beneficiaries. That's what really gets me.

The report states that, in the first half of 2007, Medicare and its beneficiaries paid suppliers, on average, $2,970 beyond acquisition cost for standard power wheelchairs to perform, on average, five services and cover general business costs. They paid suppliers $5,627 beyond acquisition cost for complex power wheelchairs to perform seven services and cover general business costs.

But what does it cost providers to perform these services? What does it cost them to cover business expenses like accreditation, a requirement for billing Medicare? How can the OIG (or anyone who reads its report, including Grassley) put that $2,970 and $5,627 in perspective without that information?

Since many of the industry's arguments for preserving power wheelchair reimbursement have to do with the service costs and business expenses involved with providing power wheelchairs to Medicare beneficiaries, that should be where the rubber meets the road.

When I interviewed Seth Johnson, vice president of government affairs for Pride Mobility Products, he summed up the report this way: "Where's the rest of the story, as Paul Harvey would say?"

The OIG report follows a CNN report in July that compared Medicare and Internet prices for power wheelchairs. (That's something the OIG investigated in 2007; it claimed Medicare pricing for power wheelchairs was, on average, 45% higher than median Internet pricing.)

It has been a tough summer for power wheelchair providers and the groups that represent them.

It could get worse.

At press time, provisions to eliminate the first-month purchase option for power wheelchairs (standard but not complex) were still alive and kicking in House and Senate healthcare reform plans.

Hang on tight.

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