"Once I pay my bills I barely have enough left for food for the month. I can't pay to fix my wheelchair."
For years, William Welch, 58, was a truck driver, a free spirit traveling along the roads. But now Welch spends his days in a Brunswick, Md. apartment, barely able to move from a chair to the refrigerator because his Medicare-supplied power wheelchair is broken and he can't find anyone to fix it, says the American Association for Home-care (AAHomecare).
"I'm stuck in the house and I can't go anywhere," said Welch, who suffers from severe asthma and COPD. "When you lose your ability to move around, you're done. I can't see friends; I can't get groceries. I can't even get medicine for myself."
Medicare's inability to arrange repairs for beneficiaries' power wheelchairs is putting Welch's health at risk. Welch said he has fallen three times, and predicts, "I'll likely be heading to the emergency room after the next one."
Thousands of seniors and people living with disabilities face similar health risks.
Issues regarding repairs to Medicare-provided home medical equipment (HME) have persisted for years, but now they are more serious and more widespread. This dramatic escalation is the direct result of a national bidding program designed and implemented by the Centers for Medicare & Medicaid Services (CMS). The way CMS awarded contracts in the program has driven hundreds of companies out of business. Combined with perplexing rules for contract winners, the bidding program has proven itself to be a danger to the very people it is supposed to help.
For instance, Welch received his wheelchair from The SCOOTER Store several years ago. But when the company went bankrupt earlier this year, he had to call CMS for information on how to get his wheelchair repaired after it broke down in early June. He was given a list of suppliers who had won bids to provide power wheelchairs in his area.
"When I called companies on the list, they said they couldn't help me because their company didn't provide power wheelchairs," said Welch. "It turns out these companies won contracts to provide power wheelchairs, but they have no obligation to repair chairs that were provided by another company. I kept calling back Medicare, and they kept giving me the same numbers to call. It's a vicious cycle."
Welch said his only option is to pay for the repairs himself, something he can't afford. "I get a disability check because of my medical condition," he said. "Once I pay my bills I barely have enough left for food for the month. I can't pay to fix my wheelchair."
John J. Letizia, who is vice chairman of AAHomecare, explained that problems with repairs for power wheelchair provided to Medicare beneficiaries pre-date the bidding program that began two years ago in nine locations around the country.
In order to be reimbursed for repairing power wheelchairs, CMS requires companies to collect the documentation of medical necessity that was originally submitted when the beneficiary was approved to receive the equipment. That becomes a problem, Letizia said, when the supplier who provided the equipment is out of business and there is no access to the paperwork. "In those cases, CMS wants providers to go to the doctor and get the documentation from them. Good luck with that," said Letizia, who is also president of Laurel Medical Supplies, Inc. in Pennsylvania.
The bidding process adds new hurdles.
For instance, only the contracted supplier who provided the power wheelchair is obligated to repair it, and that obligation only lasts through the 13-month rental period. Other bid winners in the area can fix the chair, but they aren't required to, which is why, with The SCOOTER Store out of business, Welch can't find anyone to fix his chair.
Letizia and other industry representatives met with CMS in the spring to discuss repair issues after The SCOOTER Store, formerly the nation's largest supplier of power wheelchairs, closed its doors and left thousands of Medicare beneficiaries, such as Welch, without a place to turn for repairs when their equipment breaks down.
He said the group was dissatisfied with the response from CMS.
The group was told that repairs were not a problem because CMS was not auditing documentation paperwork on them. "But that could change at any time, so that wasn't a satisfactory answer," Letizia said. "Providers aren't going to start doing repairs without proper documentation, risk being audited later, and not get paid or be ordered to return payments."
So the repair situation remains unresolved, potentially leaving thousands of the most vulnerable Americans with extremely limited mobility and independence.
Major problems, like with wheelchair repairs, continue to plague the bidding program that procures HME, such as oxygen tanks, hospital beds, and diabetic testing supplies, for beneficiaries.
One of the most significant problems is that the program allows non-binding bids, which means that providers can submit unrealistically low bids that are then used to calculate the prices for products and services, but the bidders do not have to commit to signing contracts for the amounts of their bids. Yet, these bids are still used in the formula that sets prices.
Earlier this year, when CMS announced an average 45 percent price cut for most HME items and 72 percent for diabetic testing supplies, many providers were forced to lay off workers, close their businesses, or no longer service Medicare patients. In addition, Medicare beneficiaries report instances where new providers contracted under the initial stage of the bidding program were endangering their health by not providing either the equipment or the level of service they had received previously.
Lawmakers in Congress, as well as HME providers and consumer advocates, urged CMS to suspend the bidding program so that the agency could address mounting problems. Instead, CMS expanded it from nine to 91 metropolitan areas across the country on July 1.
AAHomecare has filed a federal lawsuit asking for expansion of the program to be stopped, saying it violated its own rules by allowing companies without proper state and local licenses to submit bids and later win contracts to provide goods and services to Medicare beneficiaries.
"It's clear that the bidding program is doing a disservice to Medicare beneficiaries," said Tyler Wilson, president of AAHomecare. "We urge Congress to take action and suspend the program until the problems are fixed. Maybe lawmakers will listen to their constituents, people like William Welch, who deserve to be treated with dignity and respect."
The American Association for Home-care represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit www.aahomecare.org