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Medicare’s Planned DME Changes ‘Mobilize’ Activists

By Michael Reynolds

The federal Medicare program has introduced a number of changes that will have a direct effect on people with significant physical disabilities.

The first, which affects individuals who regularly use urinary catheters, states that the procedure of reusing intermittent catheters by boiling them, otherwise known as “clean intermittent catheterization,” is now unacceptable. The second, a 10-city experiment to allow competitive bidding on durable medical equipment (DME), along with a restricted reimbursement rate on powered mobility equipment (including what are considered “rehab” power wheelchairs), is proposed to take effect in July.

The competitive bidding proposal could negatively affect a large population of wheelchair users, including those not receiving Medicare. Consumer activists have worked tirelessly on both rule changes.

The impetus for these changes in urological supplies comes from a couple of different sources. The Bush administration recently instituted a policy whereby Medicare will not pay for surgery if it occurred because of preventable hospital errors. For example, Medicare won’t pay for a second surgery to remove a sponge left inside a patient during the first Medicare-paid surgery.

The policy change, which took effect April 1st, states that individuals who

reuse catheters or use the clean intermittent catheterization technique should be allowed to use a new, sterile catheter each time, along with a suitable lubricant.

Previously, persons were required to have a certain number of urinary tract infections (UTIs) within a set time before being approved for a sterile catheter each time they needed to empty their bladders. The change in policy is being lauded by urological suppliers and consumers.

Steve Winter, a paraplegic from Mesa, Ariz., received some press coverage in late 2006 by pressuring his representative for a rule change. The Arizona Republic article that profiled the issue noted that the old regulations violated Food and Drug Administration (FDA) standards because a UTI can cause severe pain and lead to infections in the kidneys. The article also noted that untreated or multiple UTIs can cause dangerous and potentially life-threatening complications. This rule change will inevitably save lives, given that the Medicare changes will spur state Medicaid and private insurance to provide better coverage.

The current proposal to open the Medicare DME process to competitive bidding in 10 metropolitan areas in the U.S. could have a devastating impact on individuals who need complex rehab wheelchairs, chairs that may need specialization such as a reclining seat to prevent decubitus sores, or those that require a modified headrest to work with a communication device.

Currently, those who use complex rehab wheelchairs have a maximum reimbursement rate of $4,730.40 for their chairs, a decrease of more than $3,000 from the rate of about $8,000 per power chair in late 2006. The change took place in January 2007, when all power wheelchair payments made by Medicare were reduced by 27%.

In July, power chair reimbursements will be reduced again, this time by 19%. This additional payment cut by the Centers for Medicare & Medicaid Services (CMS) is through the Medicare National Competitive Bidding (NCB) program.

Medicare reimbursement rates are used by private insurance companies to set levels of reimbursement. It is not uncommon for private insurance to cover only a percentage of the Medicare reimbursement. When Medicare conducted pilot programs in two different areas in the U.S. more than a decade ago, complex rehabilitation wheelchairs were not part of the study.

The NCB program is expected to have major consequences throughout the country. For example, with the new rules in effect in the Miami metropolitan area, the number of authorized DME providers to Medicare is expected to drop from 397 to no more than four. That means only four providers in metro Miami will be able to sell powered mobility devices, and those providers are not required to have an accredited rehabilitation specialist on their payroll for fitting or adaptation needs.

Medicare has stated it will not be forced to perform repairs even on its own equipment. Currently, the metropolitan Miami market has more than 300 places where a consumer can buy a wheelchair. At each wheelchair dealer, repairs are usually a given, as is a trained staff that can spend time fitting a wheelchair to an individual. Currently, it is common for a customer to get a trial wheelchair while a custom-fitted chair is being sent. That may change.

Critics of the changes say it is next to impossible for such a limited number of providers to service the needs of clients who were previously handled by hundreds of companies. For example, the process of being fitted for a wheelchair is not a trivial matter to someone who spends a majority of his time sitting in one. Getting timely repairs performed, too, is a critical matter to a wheelchair user.

Besides wheelchairs, other adaptive and durable medical equipment, from walkers to bathroom safety equipment, will only be available through a limited number of distributors.

To Marilyn Hamilton, National Competitive Bidding is going to be a “lose-lose” situation for consumers and dealers alike.

Hamilton, inventor of Quickie wheelchairs and former CEO of Sunrise Medical,

knows of the need for reliable mobility options. She said that NCB and Medicare will wreak havoc on the needs of their consumers and she has been spearheading a grassroots campaign to inform suppliers of mobility equipment about the situation. She also is working with a number of national disability rights groups to give consumers the information needed to effectively advocate for complex rehabilitation wheelchairs to be taken out of the NCB pool.

In late May, thousands of consumer activists called the Capitol phone lines in Washington to voice their opinions. Since then, the House has been working on a measure to delay the implementation of the Medicare changes. H.R. 2231 proposes to exempt complex rehab and assistive technology from the national competitive bidding program.

More information can be found online at http://marketing.sunrisemedical.com/Funding/Competitive _ Bidding.htm

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Michael Reynolds is a freelance writer and short movies producer.

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