Properly Prescribed, Power Wheelchairs Prevent Falls and Keep Thousands of Seniors and People with Disabilities Safe and Independent at Home, Lowering Healthcare Costs for Taxpayers
A July 2011 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG) about power wheelchair usage in Medicare back in 2007 has resulted in misleading articles published in several media outlets, including USA Today.
The findings section at the front of the OIG report, “Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines,” begins with the statement, “Sixty-one percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity.”
This suggests that most power wheelchairs provided in 2007 were not medically necessary. But a reader would only have to finish the paragraph to discover that the OIG report found the wheelchairs were not medically necessary in only two percent of the cases, out of the 375 sample claims the OIG reviewed. In those two percent of claims, the OIG found that manual wheelchairs or scooters would have been more appropriate for the Medicare beneficiary. In seven percent of the claims, the OIG said “beneficiaries should have received a different type of power wheelchair than was provided.” And 52 percent of the claims were “insufficiently documented to determine whether the power wheelchairs were medically necessary.”
In other words, in most cases examined in the study, the OIG could not determine whether or not the wheelchairs were medically necessary – in their sample of four-year-old data, which does not reflect current regulations or reimbursement rates.
Yet, last month, USA Today published a July 13 news article about “medical scooter fraud” that stated, “Medicare’s inspector general also showed that 61% of the motorized wheelchairs provided to Medicare recipients in the first half of 2007 went to people who didn’t qualify for them….” An August 11 editorial in the South Florida Sun-Sentinel used the same OIG statistic to conclude that “about $100 million was wasted.” Neither statement is supported by the OIG report, which uncovered a number of cases where the beneficiary should have received “a more expensive power wheelchair.”
Tyler Wilson, president of the American Association for Homecare, said, “It’s disappointing but not surprising that the OIG report led to distorted news coverage. The American Association for Homecare has zero tolerance for waste and fraud, and we have lobbied for stronger anti-fraud measures for Medicare for years. But policymakers must not forget that properly prescribed, power wheelchairs help prevent falls and keep thousands of seniors and people with disabilities safe and independent at home, which lowers healthcare costs for taxpayers.”
“The OIG report ignores the real problem with Medicare’s system for reviewing claims which is the government’s failure to adopt an effective documentation process for determining a beneficiary’s medical necessity for a power wheelchair,” said Wilson. “Physicians, providers, clinicians, and consumer advocates have repeatedly warned Congress and the Centers for Medicare and Medicaid Services (CMS) that the current documentation process is confusing, inefficient and subjective.”
Home medical equipment providers are concerned that neither the media nor government investigators are focusing on the fact that 52 percent of the claims that the OIG reviewed had insufficient information for the investigators to determine whether or not a Medicare patient had a medical need for a power wheelchair.
“This is the statistic that puts the real problem in perspective,” said Georgie Blackburn, who is vice president at BLACKBURN’S, a home medical equipment provider in Tarentum, Pa. She added that the 2007 period reviewed by the OIG was just after CMS revised documentation rules, but failed to properly educate physicians and providers on the changes.
“The bottom line is that providers file extensive paperwork with their reimbursement claims so they can be repaid for the power wheelchairs that they have already purchased from manufacturers and delivered to Medicare beneficiaries,” she said. “We badly want to provide CMS with all the information they need to process claims so our businesses can stay open. If information is missing, it’s because their guidelines are confusing physicians and providers.”
One of the major problems is that providers have to depend on physicians to supply patient medical information. Blackburn said that CMS has failed to supply physicians with a tool or template to document the patient medical information that is now being required. When the information isn’t available to be reviewed, she said the claim falls into the insufficient information category and the providers are wrongly blamed.
“Physicians are used to documenting patient medical history for their purposes, not for what CMS is looking for to document medical necessity,” she said. “CMS needs to work with physicians and providers to develop a policy that works for all the stakeholders.”
The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community who serve the medical needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
CONTACTS: Michael Reinemer, 703-535-1881, firstname.lastname@example.org; Tilly Gambill, 703-535-1896, email@example.com