Sloppy, Inaccurate Wheelchair Story in AARP Bulletin Is Rebutted by Paul Tobin of United Spinal Association

A sloppy, wildly inaccurate story about power wheelchairs by Jim Toedtman that appeared in the November 2009 issue of AARP Bulletin was rebutted in the December issue of the Bulletin by Paul Tobin of United Spinal Association.

Tobin writes in a letter to the editor, “‘The Case of the Expensive Wheelchair’ compares prices Medicare paid for wheelchairs versus the cost to suppliers and assumes the difference is due to fraud. We’re dead set against Medicare fraud, but this assumption fails to recognize that wheelchairs—like people—are not fungible. A person with permanent paralysis needs an individualized wheelchair. Someone 6 feet 4 inches tall, paralyzed from the neck down with little use of hands, who depends on a breathing tube, needs a power wheelchair with individualized electronic controls and room for oxygen supplies. Adapting wheelchairs to an individual is essential and requires professional consultation. That’s why they cost more than something bought off the shelf.”

Tobin was being polite. The AARP story was extraordinarily misleading.

AARP Bulletin incorrectly assumed that the only cost of providing a wheelchair in the home of a person with disabilities is the acquisition cost.

AARP Bulletin inaccurately claimed that “efforts to address the excess have been stymied,” citing campaign contributions from the “medical equipment lobby.” It failed to account for the numerous, deep reimbursement reductions for wheelchairs and other durable medical equipment over the past 10 years.

AARP Bulletin apparently bought the canard that the durable medical equipment sector killed the competitive bidding program and escaped scott free, again, a wildly inaccurate notion with no basis in reality.

AARP Bulletin failed to mention that a long list of disability groups in the US also advocated the delay in the bidding program, including American Association of People with Disabilities, the American Foundation for the Blind, the American Medical Rehabilitation Providers Association, the American Occupational Therapy Association, the America Physical Therapy Association, the Brain Injury Association of America, the Disability Rights Education and Defense Fund, Easter Seals, Lutheran Services in America, the National Association of Social Workers, the National Disability Rights Network, the National Multiple Sclerosis Society, the National Rehabilitation Association, the National Spinal Cord Injury Association, Paralyzed Veterans of America, United Cerebral Palsy, and the United Spinal Association, among others.

AARP Bulletin careered back and forth between the issue of rate setting by Medicare and criminal fraud, very effectively blurring the two distinct issues. The legitimate wheelchair providers in the HME sector suffer when policymakers and the media disparage them and conflate honest homecare operators with criminals engaged in fraud.

Finally, AARP Bulletin ignored the real story – that a robust home medical equipment sector that competes on the basis of speed and quality helps to move patients out of hospitals more quickly into quality post-acute care at home, reducing hospital length of stay and saving the healthcare system money. It’s also one of the reasons why Medicaid systems can successfully “rebalance” their beneficiary population out of institutions and into home and community-based settings.

Deep Flaws in Medicare Competitive Bidding Program for Durable Medical Equipment Were Not Fixed and Are Not Addressed by Recent GAO Study

The American Association for Homecare has worked with Congress and Medicare to address flaws in the competitive bidding program for durable medical equipment, some of which are discussed in a new Government Accountability Office (GAO) report. However, deep structural and design flaws still remain in this bidding program. Those flaws will reduce seniors’ access to quality care at home and will put thousands of competitive homecare providers out of business.

“The first round of Medicare’s competitive bidding program for wheelchairs and other forms of ‘durable medical equipment’ was poorly timed, was unclear about what had to be included in bids and failed to notify all suppliers that losing bids could be reviewed, according to a new Government Accountability Office study,” reports CQ Healthbeat News.

The report further details the lack of notification to providers about the post-bidding review process. The report recommends that CMS improve future rounds of bidding by notifying all suppliers if a disqualification review process is conducted, giving all suppliers an equal opportunity for such reviews; and contains a recommendation that CMS make it very clear how suppliers can request a review.

AAHomecare continues to say that there are underlying flaws with the bidding program that CMS has not addressed such as evaluating CMS’ methodology for determining bid rates and the fact that there was significant variation in bid rates for the exact same product billing codes across various bidding areas. Beneficiaries will be forced to go to multiple, unfamiliar providers for different items and services and will see reductions in service and quality of items based on artificially low winning bid amounts. Also, the bidding program, as currently structured, will force the majority of providers out of business.

“The fact remains that CMS has not fixed the fundamental problems in the design and structure,” said Tyler J. Wilson, president and CEO of the American Association for Homecare. ‘Those fundamental flaws in the structure of the program are dangerous because they will reduce seniors’ access to quality, cost-effective care at home, and the flaws will needlessly put thousands of competitive, hard-working medical equipment providers out of business.”

To learn more, visit associations/3208/files/AAHomecare Comments on GAO Study of Bid Program December 2009.pdf.

AARC Support for Meek Bill Underscores Clinical Concerns about Bid Program

The American Association for Respiratory Care’s (AARC) endorsement of Rep. Kendrick Meek’s bill to end the Medicare competitive bid program for durable medical equipment underscores the severe clinical implications of providing homecare to Medicare beneficiaries based on a lowest-cost bidding system that not only drives a race-to-the-bottom approach to serving seniors but also eliminates most of the competitors who currently compete on the basis of service and quality. Text of the November 20 letter of support from AARC to Rep. Meek follows:

“The American Association for Respiratory Care (AARC) a 49,000 member professional association for respiratory therapists offers its support of HR 3790, legislation that seeks to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner.

Respiratory therapists provide clinical care and services to pulmonary patients across the continuum of care. While the majority of respiratory therapists work in the hospital setting, an increasing number are employed in alternative care sites such as nursing homes, physician offices, rehabilitation facilities and home care companies.

The AARC and our members are very much aware of the struggles many of our pulmonary home care patients are having in receiving the full range of Medicare services for which they are eligible and which they desperately need. Constant changes in Medicare coverage policy for durable medical equipment, such as the 36 month cap on oxygen rental and the impending implementation of the competitive bid program have had a negative impact on the pulmonary patient’s ambulatory care.

HR 3790 will repeal the competitive bid program and include provisions that will assure the budget neutrality through other payment reductions.

The AARC believes your legislation is good for the patient, a sound Medicare policy and is fiscally responsible.”

To read the full letter, visit http://www.aahomecare.org/associations/3208/files/AARC_HR3790_Support_Nov09.pdf.