Across the country, thousands of senior citizens and people living with physical disabilities are concerned about whether they can maneuver well enough in their homes to groom themselves, prepare meals and get to the bathroom.
These basic tasks are often difficult for those in need of mobility assistance, medical devices that can help them move around the house. For Medicare beneficiaries in need of mobility assistance, the lame-duck session of Congress will be critical in determining whether many can age gracefully in their homes or will need to be placed in nursing homes or other facilities because their physical limitations compromise their safety.
The Medicare mobility benefit allows beneficiaries to receive power wheelchairs to help perform the daily necessities of living in their homes, but that option is in jeopardy unless Congress acts quickly to delay implementation of a new policy that would eliminate a patient's right to have Medicare pay for a power wheelchair in the first month it is obtained.
On the surface, the change from a first-month purchase option to a 13-month rental may appear minor. But it will be a severe jolt to power wheelchair providers, especially those that are small businesses. Many home medical equipment providers say they will be forced to go out of business or to no longer offer power wheelchairs. Today's porous economic climate is partly to blame: banks and other lenders are largely refusing to provide loans and lines of credit to businesses so they can purchase power wheelchairs from manufacturers before they are specially fitted for each Medicare beneficiary.
In better economic times when credit is more readily available for businesses, the policy change might not be so devastating. But today, this change threatens not only to delay or prevent Medicare patients from receiving mobility assistance that their physicians have prescribed, but will terminate many jobs in communities where unemployment is already approaching 10 percent or more.
Just before the congressional recess, members of the House and Senate signed letters asking the chairs and ranking members of key committees to support a one-year delay in implementing the change. By delaying the implementation date from January 1, 2011 to January 1, 2012, it would give providers the time they need to adjust their business models to a sudden reduction in their cash-flow. The delay wouldn't increase Medicare spending because the cost would be offset by a one-percent reduction in reimbursement rates for standard power wheelchairs.
In their letter, which was signed by 44 of their House colleagues, Reps. Jim Langevin (D-R.I.) and Glenn Thompson (R-Pa.) reiterated that "providers unable to secure financing and prepare for this substantial change in reimbursement policy will be unable to continue to provide power wheelchairs, resulting in a loss of jobs, economic revenue, and beneficiary access to a physician-prescribed power wheelchair."
The bipartisan letter also underscored how power wheelchairs benefit Medicare patients, as well as the taxpayers.
"Furnishing power wheelchairs to Medicare beneficiaries saves the program millions of dollars a year by allowing vulnerable beneficiaries to remain safe and independent in their homes and communities," the lawmakers wrote. "Without access to power wheelchairs, thousands of beneficiaries would face additional hospitalizations, home health visits and other clinical services due to falls and other injuries that occur because of compromised mobility. In addition, power wheelchairs often postpone or alleviate the need to place an individual in a long term care facility."
In the Senate, Sen. Arlen Specter (D-Pa.) wrote a similar letter signed by six of his colleagues warning that "absent a delay in implementation, this change will create significant access and quality of care issues as providers either struggle to make the significant changes to their business model to adapt to the new payment model or simply go out of business."
The elimination of the first-month purchase option would add yet another financial burden on businesses that are already bracing for the economic fallout from the badly-flawed "competitive bidding" program that is also scheduled to begin January 1, 2011. Home medical equipment providers have also endured price cuts of more than 35 percent over the last five years, lengthy delays in reimbursement payments by the Medicare program and excessive audits by the government.
Providers, consumer advocates and Medicare beneficiaries are bewildered as to why the government so often targets the Medicare mobility benefit when power wheelchairs greatly benefit Medicare patients, while, as the lawmakers stated in their letters, actually saving government funds.
Clearly, the policy change will have a direct impact on beneficiaries. If, as expected, many providers no longer offer power wheelchairs or go out of business, Medicare patients will have a difficult time finding providers to fill their prescriptions for power mobility devices. This will most dramatically impact rural areas of the country, which are already experiencing some delays.
Moreover, patients who do receive power wheelchairs will likely have their prescriptions filled with used mobility devices that have been previously customized for other beneficiaries; thus these power wheelchairs may not function effectively for the new patient. In addition, the used power wheelchairs certainly won't have the lifespan of a new one. There are also serious concerns as to whether providers will be able to service the chairs or properly adjust them under a rental scenario that does not provide reimbursement for such services.
Consumer advocacy groups have joined providers in asking Congress to delay implementation of the new policy. Congress has received letters from groups such as the United Spinal Association, American Association of People with Disabilities, National Council on Independent Living, National Spinal Cord Injury Association and the Association of Programs for Rural Independent Living.
"This is an example of the wrong policy, at the wrong time," said Tyler Wilson, president of the American Association for Home-care. "Americans have strongly indicated that they want smart public policy that creates jobs and helps families and communities. Elimination of the first-month purchase option does just the opposite. It will cost jobs in communities, while depriving vulnerable Medicare patients of the mobility assistance they need. We urge Congress to delay implementation of this policy."
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. To learn more about the Medicare power mobility benefit, go to www.aahomecare.org/mobility. American Association for Home-care: 2011 Crystal Drive, Suite 725, Arlington, Virginia 22202. 703.836.6263