Didn't you hear? It's a done deal. Please act accordingly.


Now that the healthcare reform bill is the law of the land, we editors at HME News are dividing and conquering. Mike's working on a story about the provision that will levy a 2.3% tax on medical device manufacturers (it's the only HME provision that's part of this week's reconciliation process), Theresa's working on a story about the provisions that will expand and accelerate competitive bidding, and I'm working on a story about the provision that will eliminate the first-month purchase option for standard power wheelchairs.

I started calling wheelchair providers yesterday to ask them how eliminating the purchase option effective Jan. 1, 2011, would affect their businesses and their patients.

Before I could even spit the question out, the first provider I called said: "I listened to NPR on my way to work this morning and they were interviewing some Republican senator and he described the reconciliation process as—there's 20 hours of floor time and in that 20 hours, I guess any senator can propose any amendment to any part of the healthcare reform bill and then each amendment is voted up or down. If that's the real process, how do we really know if the first month purchase option provision is a done deal?"

This provider is good to HME News. He's smart and he always makes himself available. But like so many providers out there he's in denial. Do he and other providers really think that the same senators that proposed and passed the provision to eliminate the purchase option in the first place will introduce an amendment to preserve it and then pass it, sending it back to the House for approval?

I think not—and so do most industry watchers. The elimination of the first-month purchase option for standard power wheelchairs is inevitable.

As such, providers need to start looking at how they're going to pick their way through this rubble. From a cash flow perspective, how will they deal with getting their, say, $4,000 in reimbursement over the course of 13 months instead of the first month? From a product perspective, what will they do if a patient dies or changes insurers in the fourth month of his rental, leaving them with a used wheelchair and only $1,200 instead of $4,000 in their pockets? If they plan to put the wheelchair back out, do they have the the policies and procedures in place to refurbish it and do they know how to bill Medicare under those circumstances?

Some of these questions will be answered through rule making (a process through which CMS details how it plans to carry out Congress' wishes), but they're questions that providers need to be prepared to ask and answer.

Now, even though the provision to eliminate the purchase option is a done deal, it doesn't mean that new language/legislation couldn't be introduced that would amend the provision. That's the industry's next move and there are other healthcare-related bills that Congress will be working on the rest of this year that could serve as good vehicles for that language/legislation.

But right now, the provision to eliminate the purchase option is a done deal and providers should act accordingly.

Liz Beaulieu