Medicare Policy Change Threatens Rural Access to Power Wheelchairs
Author: American Association for Home-care
Published: 2010/12/04 - Updated: 2025/03/12
Publication Type: Informative
Topic: U.S. Medicare System - Publications List
Page Content: Synopsis - Introduction - Main - Insights, Updates
Synopsis: Medicare's elimination of the first-month purchase option for power wheelchairs may restrict access to mobility aids in rural areas due to provider cash flow issues.
Why it matters: This report discusses concerns about a Medicare policy change eliminating the first-month purchase option for power wheelchairs, set to take effect on January 1, 2011. Gerald Sloan, owner of Progressive Medical Equipment, LLC, expresses that this shift could hinder access to prescribed mobility aids, particularly in rural areas, due to cash flow challenges for providers. The policy's impact on small businesses and the administrative burdens associated with supplying medical equipment are highlighted. - Disabled World (DW).
Introduction
For 12 years, Gerald Sloan, owner of Progressive Medical Equipment, LLC, has provided home medical equipment to Medicare patients from his retail outlets near Kansas City and St. Louis, and he is also vice president of the Midwest Association for Medical Equipment Services (MAMES).
Today, Sloan is concerned that the elimination of the first month purchase option for Medicare beneficiaries requiring power wheelchairs will prevent patients in rural areas from receiving the mobility assistance that has been prescribed by their physicians. This change is scheduled to be implemented on January 1, 2011, but Sloan has joined the chorus of voices from across the nation urging Congress to delay implementation of this policy change for one year so that businesses can adjust to the abrupt change that will impact their cash flow and their ability to continue providing power wheelchairs to Medicare beneficiaries.
Mobility Matters recently talked with Sloan about the impact of the policy change, and the affect on providers in the Midwest.
Main Item
MM: How has your company performed in recent years?
SLOAN: I started off as the owner running the company alone; we peaked at 13 employees about two years ago and then with competitive bidding over the past two years we have dropped to eight employees. So we had a nice curve upwards during the good times and now we're forced to adapt in the bad times.
MM: Why is the elimination of the first month purchase option so impactive on your business, and on other providers?
SLOAN: Well it simply comes down to cash flow for everybody. There's a lot of preparatory work that goes into providing power wheelchairs for Medicare beneficiaries. Things like making sure there is proper documentation for the government, and home assessments. There's a considerable investment beyond the price of the wheelchair. It goes into every wheelchair delivery, so it creates a serious cash flow problem for many small providers when their payments from the government will be spread out over a 13-month time period.
MM: Do feel that the Centers for Medicare & Medicaid Services (CMS) and policymakers in Washington have failed to understand the resources and work it takes to provide a power wheelchair to Medicare beneficiaries?
SLOAN: Yeah, for sure. They have absolutely no clue what goes into the process for delivering any kind of medical equipment. Under the current situation, something as simple as a walker all the way up to power wheelchairs, you're asking for a lot of administrative overhead that goes into the process before you ever even consider ordering or delivering that piece of equipment.
MM: CMS is always looking to cut Medicare costs. Do you believe that tax dollars could be saved if the Medicare program adopted a more efficient administrative process?
SLOAN: Well that's an interesting question. I have spoken to Sen. Pat Robert's office about the need for a better documentation process. They're creating tighter and tighter standards to the point where it's almost impossible to meet them. Everything requires more documentation, and that means more time and resources that providers have to spend on paper work.
MM: So if CMS improved the administrative process, would it also help Medicare beneficiaries?
SLOAN: Well absolutely! One of the big arguments for CMS about their so-called competitive bidding program is that it would save Medicare beneficiaries on their co-pays and reduce the overall expenditures on medical equipment. Well, better oversight of the Medicare program and more efficient administration would save consumers money and not put a strain on providers.
MM: How are you and other providers dealing with the problems that will arise if the first month purchase option for power wheelchairs is eliminated in January?
SLOAN: We're a mid-sized company. Our revenues are above small providers and below large providers. Fortunately for us, we carry the credit capacity to handle the situation. The greater concern for me geographically speaking and also as Vice President of MAMES is that large providers aren't servicing rural areas, so patients in those areas are dependent on small providers. These are the businesses that provide two to three power wheelchairs a month. These are the providers that will be hard pressed to overcome the financial burden of providing power wheelchairs for Medicare beneficiaries if the first month purchase option is eliminated. They just won't be able to do it.
MM: What are other concerns for these smaller providers?
SLOAN: The way that the program is set up, if a patient dies or goes into a nursing home during the 13-month rental period, the power wheelchair is returned to the provider and rental payments from the government stop. Well, if a small provider is hit hard with returns one month, they may not have enough cash flow to carry that weight and their business would likely fold. Some providers won't take that risk and will go out of business or not carry power wheelchairs anymore. This is what I'm hearing from small providers in MAMES, which covers Missouri, Kansas, Iowa, Nebraska, Minnesota, South Dakota and North Dakota. All of those states have rural areas, where Medicare beneficiaries may have difficulty obtaining power wheelchairs in the future.
MM: Sounds like the elimination of the first month purchase option will be a disaster for Medicare beneficiaries in rural areas?
SLOAN: Yes, there are not many providers in rural areas where the population is less than in cities. Smaller providers right now cover those areas, but as smaller providers opt out of the Medicare program, beneficiaries will be lacking for service.
MM: Is it disappointing that CMS and other Washington policymakers don't understand the consequences of this policy change?
SLOAN: Yes, there very clearly is a disconnect with Washington. And, unfortunately, it looks like Medicare beneficiaries will be the victims.
Mobility Matters is published periodically by the American Association for Home-care (AAHomecare) to inform Congress, the administration, policymakers, consumer organizations and the media about Medicare's power mobility benefit, and the need to sustain it. AAHomecare is committed to helping seniors and people living with disabilities regain their freedom and independence.
Insights, Analysis, and Developments
Editorial Note: The anticipated Medicare policy change underscores the delicate balance between cost-containment measures and ensuring essential healthcare access, especially for vulnerable populations in rural communities. Policymakers must consider the practical implications of such reforms on both service providers and beneficiaries to prevent unintended barriers to necessary medical equipment. Here's the bottom line: Medicare's wheelchair policies are a mixed bag-lifesaving for some, a headache for others. The rules make sense on paper, ensuring equipment goes to those who truly need it, but the hoops you have to jump through can feel like a cruel test of endurance. State-by-state differences and the pre-approval dance only add to the frustration. Still, it's hard to argue with a system that, when it works, keeps people moving and independent. Maybe it's time we streamline this process so it's less of a battle and more of a support for those already fighting enough. - Disabled World (DW).Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by American Association for Home-care and published on 2010/12/04, this content may have been edited for style, clarity, or brevity. For further details or clarifications, American Association for Home-care can be contacted at aahomecare.org NOTE: Disabled World does not provide any warranties or endorsements related to this article.