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.