Manual chair market faces challenges

The manual wheelchair market is currently surrounded by a lot of regulatory activity and mobility manufacturers expect it to be included in the national competitive bidding program at some point. In response, equipment vendors are focusing their efforts on helping providers through the challenges that exist now and the potential difficulties that may arise down the line.

The manual market seems to be holding steady or growing modestly for both standard and complex wheelchairs. At Exeter, Pa.-based Pride's Quantum Rehab division, utilization has been steadily increasing, says Mike McCarthy, Quantum's national sales manager for manual wheelchairs and Synergy seating products.

At Kennewick, Wash.-based TiLite, more wheelchair users are opting for complex chairs, says Marty Ball, vice president of sales.

"The fact is that the more 'complex' chair considers the individual, rather than the cost only," Ball said. "Being able to construct a made-to-order individualized wheelchair offers the user independence at a low physical cost. More of the younger users are learning that they can maintain a relatively independent lifestyle by using today's technologies."

Coding conundrum

A major challenge at the moment is getting the proper reimbursement for K0005 codes because funding sources have a "lack of knowledge of advancing technologies," Ball said. "The result is, of course, an initial denial of the more complex product based entirely on price, rather than on the outcome or result of a chair that is more up to date. Can you imagine anyone using a 25-year-old computer or car, neither of which is as important as a wheelchair?"

Quantum's staff has made getting K0005 reimbursement a top priority, McCarthy said.

"We take a business consultation approach with providers to help them move it forward," he said. "We coach providers through the tough cases. The K0005 code set is difficult to get justified and reimbursed--that is where our product planning and reimbursement team can really help them with our educational component. We also help them by keeping an adequate amount of demonstration products in the field."

While new code classifications for manual chairs are badly needed, that probably won't happen anytime soon because of competitive bidding, said Cynthia Counts, director of homecare for Atlanta-based Graham-Field.

"Many are hesitant to make changes because of the heavy changes that they have to endure already with Medicare and competitive bidding," she said.

On top of that, Counts says it's only a matter of time before manual chairs are included in the bidding program.

"We absolutely believe that it will only be a matter of time before manual wheelchairs are included in competitive bidding," she said. "Unfortunately, it will be the end users and homecare providers who are most affected by this. When manual wheelchairs become a category for competitive bidding, it will force the hand of the provider to buy more on price vs. quality."

The market has already seen the pricing for wheelchairs decrease over the past several years, which has made it very difficult for manufacturers to offer quality wheelchairs at affordable levels, Counts said. "With competitive bidding, most manufacturers will lessen the quality on the wheelchairs to save on costs," she said.

Mary Nell Westbrook, chief marketing officer for Kansas City, Mo.-based Sizewise, agrees that competitive bidding will erode the quality of manual wheelchairs.

"All wheelchairs are not created equally--this is more evident now than ever from a manufacturing standpoint," she said. "Competitive bidding will continue to force off-shoring and there will be less and less domestically produced product. For the strength and technical integrity of a wheelchair to support a bariatric patient, for example, being designed and built in the U.S. affords a level of quality control that just isn't found offshore."

The 5% factor

One saving grace appears to be the 5% Medicare reimbursement hike for manual chairs that went into effect in 2009 while other durable medical equipment took a 9.5% hit. Judson Cummins, product manager for Elyria, Ohio-based Invacare, says this development should make manual wheelchairs "more attractive" to the provider community.

"Manual wheelchairs are attractive not only because of the additional 5% reimbursement, but also because they often provide a natural adjacent revenue stream that a provider might not be taking advantage of," he said. "For example, if a provider has traditionally focused on power wheelchairs, then the Group 2 first-month purchase option might be a hit to that revenue. While Invacare has solutions and programs to address this, perhaps that revenue stream can be supplemented with high-end custom manual wheelchairs or a rental business segment for standard wheelchairs."

McCarthy adds: "We viewed the cut and increase as a nice opportunity for our providers to balance the shortcomings of the original cut and many are doing it with success. Those that are good at it are ringing the register."