Will access be limited?

Wednesday, January 31, 2007

Wheelchair suppliers are divided over whether CMS should require ATP evaluations for Medicare beneficiaries in need of certain power wheelchairs. According to the January HME NewsPoll (313 respondents), those who oppose the initiative (55%) said the requirement will present access problems, disqualify too many capable veteran suppliers and ramp up costs in a sector already hard hit by reimbursement reductions. Those in favor (43%) say the initiative is the right thing to do for patients, solves crippling credibility issues among suppliers and may rectify slow payment.
Unless CMS amends its coverage criteria, due to go into effect April 1, beneficiaries in rural America are likely to get a rude wake-up call when they try to move from a prescription to a power wheelchair, say many suppliers.
"There are only two ATPs in the whole state of Alaska," wrote Carol Sycks, president of Procare Home Medical in Anchorage. "All the training occurs out of state and is cost prohibitive."
Alaska may be an outlying state, but the access challenges are not, say suppliers.
"I know of only one ATP in this area, which is the second largest metropolitan area in the state outside of Atlanta," said Jeff Baumgardner, rehab department manager for DurMed Medical Services in Augusta, Ga. "She works for a rehab hospital here and does not do 'outside' evals."
The access problem is further exacerbated by the urban-rural split with regard to managed Medicare (Medicare Advantage plans) and fee-for-service beneficiaries.
"The majority of the fee-for-service Medicare is in the rural areas and there is not enough volume to support a RESNA-certified dealer," said David Daniel, CEO of Medi-Serv.
Boosters of the ATP requirement say these access challenges will not fall on deaf ears--that the medical directors are listening and that there's likely to be some redress.
However problematic the access issue, many suppliers welcome the initiative as a salve to the brutal beating rehab suppliers have taken in the past several years as wheeler-dealers turned up sales volumes on consumer mobility.
"Until the real crooks get rooted out of this business, CMS will continue to view all of us as crooks," said Ed Nosal, director of homecare acquisitions for Walgreens Home Care in Deerfield, Ill.
With the intercession of an ATP, there's a pervasive feeling that fraud and abuse will be dampened and that the industry's reputation will get a boost.
"Allowing ATPs and ATSs that specialize in seating and mobility only adds credibility to an industry that is sorely lacking in such professionalism," said Anthony Whitehead, an ATS with Quantum Rehab/ Pride Mobility.
But many uncredentialed, veteran suppliers, sounding like troops in the trenches, wonder whether ATP certification is all it's cracked up to be and perhaps not a substitute for on-the-job training.
"Just because you have a certified person does not mean they know what they're doing," said Lori Tilton, rehab manager for Vital Medical in Santa Ana Heights, Calif.
Many cringe at the thought of all that valuable experience counting for nothing under the new coverage criteria.
"Although classroom knowledge is not to be devalued, the act of actually doing the job should in fact have greater weight than it often times does," said Wendy J. Russell, owner of Kern Valley Medical Supply in Lake Isabella, Calif.