Costs and Savings in Medicare Change on Wheelchairs

[Guest guest]

Costs and Savings in Medicare Change on Wheelchairs

By MICHAEL JANOFSKY

WASHINGTON, Jan. 29 - For a few months after severe

arthritis in her knees forced Sister Scholastica Rzepka

into a manual wheelchair, her arms still had the strength

to propel her around the Sisters of the Holy Spirit convent

near Pittsburgh, her home for the last 77 years. By last

fall, with arthritis crippling her shoulders, her doctor

prescribed a power wheelchair.

Not long ago, Medicare would have reimbursed the company

that provided the chair - with almost no questions asked -

covering the usual 80 percent of the $5,200 cost. But after

a soaring demand for power wheelchairs and dozens of highly

publicized cases of fraud and abuse in recent years,

Medicare administrators late last fall began to take a

closer look at reimbursement requests, an effort now saving

the government millions of dollars.

Medicare officials say they are merely doing their jobs

better. But companies that make and provide the wheelchairs

contend that the government has, in effect, tightened the

eligibility requirements, which they say is hurting both

them and their customers.

Tarpey, the owner of Med-Care Supply, a small

company in , N.Y., that sent Sister Scholastica,

88, her new chair, said Medicare had denied initial claims

for nearly 20 of her customers. In the nun's case, Ms.

Tarpey said, the agency ruled the chair was not medically

necessary despite assurances from Sister Scholastica's

doctor that the arthritis in her knees prevented her from

taking even a single step.

Ms. Tarpey has appealed the denials for each customer and

is awaiting hearing dates. If a first appeal is denied, she

has the right to a second. But she said she feared the

worst: denials that would force her to choose between going

out of business or going to court to sue her customers for

the cost of the chairs. She has already cut her staff in

half, to just two part-time workers.

" I'm just a small-business owner, " she said. " I've already

spoken to a bankruptcy attorney and used most of my savings

to keep going. Now, it's down to pretty much just me, but I

don't know how long I can hold on. "

Big companies are suffering as well. The Scooter Store, a

Texas company that is the largest supplier of power

wheelchairs and scooters in the country, selling 50,000 a

year, recently dismissed 200 of its 1,500 employees and

blamed the government for the layoffs.

" It's just nuts, " Doug on, the company president,

said. " They talk about fraud and abuse. To me, it's abuse

in the home of the beneficiaries. They now have a choice to

crawl around or go to a nursing home. That's abuse, and

it's absurd. "

The controversy over payments for power wheelchairs has

been growing as the demand for them has increased. In

recent years, Medicare reimbursements have nearly tripled,

to more than $845 million in 2002 from just over $289

million in 1999, an increase that reflects a rise in the

number of Medicare payments for power wheelchairs, to

159,000 in 2002 from 55,000 in 1999.

For the same period, overall Medicare spending rose by 22

percent as the population of Medicare increased by just 1

percent a year.

Much of the new demand was driven by shady companies that

took advantage of the relatively loose Medicare approval

process. Ben St. , a spokesman for the inspector

general of the Department of Health and Human Services,

said federal prosecutors have already won convictions in

more than a dozen cases and are trying more than 50 other

cases in 20 states, the District of Columbia and Puerto

Rico.

In County, Tex., Medicare paid for more than 3,000

power wheelchairs in 2001. A year later, it paid for

31,000, reflecting what federal officials said was $84

million in fraudulent claims.

As federal officials around the country began prosecuting

cases, officials at the Centers for Medicare and Medicaid

Services, the agency that runs Medicare, initiated a

program to crack down on abuses. As part of a 10-point

program, the agency said it would begin " a more detailed

screening process " for new suppliers and require stricter

overall monitoring.

To educate the public, Medicare instructed the four private

insurance companies that handle Medicare claims for power

wheelchairs to adopt standards that reflect " the clinical

conditions for which mobility products are reasonable and

necessary. " That led to a " policy clarification " for

suppliers, which outlines who is eligible for a power

wheelchair and what medical records are required to support

the claim.

Tim Hill, the center's chief financial officer, described

the effort as not so much new policy as " new scrutiny " by

officials who had grown lax in monitoring regulations in

place since 1997.

" We had seen a spike in power wheelchair spending, " Mr.

Hill said. " It was the prudent thing to do. "

Makers and suppliers of power wheelchairs say the change is

more than a restatement of old policy. They say it narrows

the eligibility requirement by eliminating people like

Sister Scholastica who can stand without help but have

limited arm strength. In addition, suppliers say they are

facing new demands for paperwork, like a physician's

contemporaneous notes of a patient's deterioration, that

they were never before asked to submit.

" They've thrown the baby out with the bath water, " said A.

Malachi Mixon III, chairman and chief executive of Invacare

of Elyria, Ohio, the nation's largest manufacturer of power

wheelchairs with sales of $1 billion a year. " They're

trying to stop the fraud, but instead, they've decided to

kill the program. "

A. Scully, who stepped down last month as

administrator for the Center for Medicare and Medicaid

Services, said he had asked his staff to develop a new

strategy in the face of the rising number of fraudulent

claims.

If no further changes are made, health experts say

pressures will grow on health care providers to help people

who, with a power wheelchair, can do many things for

themselves. Annette Kasper, a nurse at the convent where

Sister Scholastica lives, said that if the nun loses her

power wheelchair, convent staff members will have to tend

to her constantly or she will have to be moved to a

facility better equipped to help her.

" It's all just starting to sink in with the disabled

community, " said Imparato, president and chief

executive of the American Association of People with

Disabilities. " If they're concerned about fraud, there are

ways to crack down on bad actors that don't require a

one-size-fits-all approach to ways to pay for power

wheelchairs. They are going to force people to impoverish

themselves in institutional settings. People who have not

committed fraud are penalized, and the punishment doesn't

fit the crime. "

http://www.nytimes.com/2004/01/30/politics/30CHAI.html?ex=1076453087 & ei=1 & en

=8f83cdd483ef72af

[Guest guest]

From: Laxity

Subject: Costs and Savings in Medicare Change on Wheelchairs

~~

With this being the case I wonder if I ever will get a power wheel chair....I

certainly can't use the manual-my shoulders will dislocate.

CindyH

Wisc.

[Guest guest]

From: Laxity

Subject: Costs and Savings in Medicare Change on Wheelchairs

~~

With this being the case I wonder if I ever will get a power wheel chair....I

certainly can't use the manual-my shoulders will dislocate.

CindyH

Wisc.