Despite the current coding uncertainty, the need for power mobility will surge and the cash-heavy scooter niche may be the most attractive market.

Though hampered by competitive bidding, increased regulations, narrowing margins, and ill-informed coding decision from CMS, DME providers will continue to see increased business in the power mobility sector. In the power pantheon, scooters could be the biggest market. “Demographics are destiny to a certain degree,” says Eric Sokol, director of the Power Mobility Coalition (PMC), Washington, DC. “This is a demographic that wants to be mobile and to keep going.” The PMC is a national coalition of suppliers and manufacturers dedicated to providing power mobility equipment and services to elderly, seriously ill, and disabled Americans.

But with this inevitable demographic upside, there could be some headaches. Baby Boomers, as the generation born between 1946 and 1965 are called, are a demanding group. They do not want devices that are unreliable or difficult to use. It is these sorts of demands that are driving innovation. “[In the future], we will continue to see advances in electronics and an increase in performance and serviceability,” says Cy Corgan, national sales director (retail) for Pride Mobility Products, Exeter, Pa.

While Sokol’s group does not provide scooters, the director of the PMC does have his own hopes and predictions for the future of scooter technology. “[Companies] will make them lighter, stronger, and easier to break down so seniors can put them in their cars on their own,” he says. “Hopefully, the price point will also drop as well, making them more affordable.”

The biggest headache regarding innovation is probably coding. In many cases, innovators may be their own worst enemies if they do not take into account how new technology—which does not have a code—affects the ability of providers to be reimbursed for it. “CMS is often reactionary [in providing new codes] as are all government agencies,” says Sokol.

Over at The Scooter Store, a national chain, cautious optimism is the watchword when discussing the hurdles of government policy. “Nationwide competitive bidding will not affect the cash scooter market. However, it might have a dramatic effect on the reimbursement market,” says Mark B. Leita, director of public affairs at The Scooter Store, New Braunfels, Tex. “Today, a large number of suppliers provide a wide array of scooters satisfying Medicare requirements for a power operated vehicle (POV) in most markets. This provides beneficiaries with choice for both product and service. Competitive bidding will, by default, limit the number of suppliers, but also will result in both product and service being minimized to meet growing pressure to lower prices. It is hard to imagine the beneficiary getting better product or better service.”

Corgan says that Pride tries to address coding limitations while developing the technology—being proactive where the government simply reacts. He adds that for scooters, in particular, coding is less of an issue because it is a cash-heavy market niche. “Scooters are looked upon as a retail [not a medical] device,” he says.

Scooter Criteria
There are a number of criteria to consider when determining which scooters to carry, including quality, trained service and sales staff, good manufacturer distribution, and the ability to get parts quickly. The key to providing a good scooter is good service. Corgan says that the end user needs to be supported by the dealer and the dealer needs support from the manufacturer.

DME providers need to be aware of the existence of what Corgan calls “fringe” manufacturers who are looking to make a fast buck and whose scooters are of low quality and are completely unsupported. Though these scooters may look attractive from a price-point perspective, they may cause headaches for both providers and end users because they cannot be adequately maintained.

Of course, fringe manufacturers are not the only problem facing the power mobility industry. As the Wheeler Dealer incident illustrates, fraudulent practices can undermine the credibility of the entire industry. However, there may be a way to keep this incident from being repeated.

Accreditation
Accreditation is a buzzword that has been floating around the industry for some time, and it is the means by which the industry can keep what Sokol and the PMC’s counsel Stephen Azia calls “bad actors” from entering the picture. “The large majority of companies [out there] are playing by the rules. It is the bad actors that are giving the [industry] a black eye,” says Azia.

Sokol notes that it was the keen eyes of providers—not government regulators—that caught the unusual spike in reimbursement claims that led to the uncovering of the fraud. Though Sokol and Azia see providers as generally honest, they do support the congressional mandate following the Wheeler Dealer incident requiring accreditation. “It sets in place standards for accountability and safeguards to make sure the providers have training, are providing quality devices, and are serving the beneficiary,” Sokol says.

Not surprisingly, Pride is also a supporter of industry-wide accreditation. “We stand behind accreditation and we are advocating for the government to implement accreditation as soon as possible,” says Seth Johnson, Pride’s vice president of government affairs. “Accreditation is a mechanism that CMS will be using to enforce the new quality standards.”

But Sokol and Azia say that CMS is dragging its feet on the kind of accreditation that Congress mandated, instead issuing a set of rules as part of the Medicare Modernization Act that could cause more harm than good. The problem, explains Sokol, is that “the Interim Final Rule is very arbitrary, punishes good actors, is burdensome, and—in one sense—does not create meaningful barriers to bar [bad actors]. It hassles [the good providers in] the community and physicians. It seems to me to be a misplaced priority.”

The lack of a comprehensive implementation of accreditation may have other long-term implications as well, particularly in terms of the proposed rules covering competitive bidding of power mobility devices. In a June 30 press release, PMC called the new rules “too complex, overly restrictive, and needlessly anticompetitive.” The group is also critical of CMS for not mandating that those providers taking part in the competitive bidding program first be accredited. “This is one of our biggest concerns,” says Sokol, whose official comments to CMS listed the need for accreditation first on its list. “It’s really putting the cart before the horse.”

Among the group’s other comments was that the proposed quality standards be subject to comment and nonwinning suppliers should have expedited appeal rights. Additionally, CMS should clarify the basis upon which it fixes prices, competitive bidding should not impact cash sales to those who do not qualify for Medicare, product categories should not be narrowly defined, and provider financial information should be clearly stated and evaluated prior to bid submission.

Pride also submitted comments to CMS. Running about 11 pages, the comments focused on potential rulings for inclusion of power wheelchairs, the category that also includes scooters. “Our comments touched on two main reasons for such an exemption,” says Johnson. “First, the fact that these are not an ‘off the shelf’ type of items, rather they are very service and instructionally intensive products. Power wheelchairs designed for ‘regular use’ are measured, fitted, adapted, and programmed in consideration of the patient’s body size, disability, period of need, and intended use based on the instructions provided by the physician. In addition, due to the current CMS power mobility devices initiatives pertaining to new codes, local coverage criteria, and fee schedules, CMS is not going to have claims data to show that under the new system—to be in place prior to implementation of competitive bidding—additional savings could be achieved by including these products in the competitive bidding program.”

However, even though scooters fall under the same criteria as power wheelchairs, it is too early to tell how significantly impacted the market will be. Johnson predicts that because it is a niche market and only a small number of scooters get reimbursed, it should not have much of an impact on this segment of the market. For Sokol, the future of the scooter market is clearly not tied to Medicare.

Independence on the Go
Sokol suggests that providers lessen their dependence on government money. Instead, he advises that those who want to provide scooters enter into contracts with private third-party payors, provide lower price-point devices—which will allow more cash sales—and enter into contracts to provide scooters to malls and local high-foot-traffic attractions.

Azia agrees with his colleague that the market is designed for more out of pocket transactions. This is simply an acknowledgement of the type of patient that will be using the device. “You’ll see more people using scooters for convenience reasons. It’s more for people who don’t fit the Medicare model/profile,” he says.

Corgan also sees the future as an out-of-pocket, cash-heavy one reflecting the desires of the always independent Boomer. “Boomers want to see their families and maintain their independence,” says Corgan. “The market will continue to grow and stay predominantly a cash-based one. The products must continue to be portable and maneuverable.”

C.A. Wolski is a contributing writer for Dealer/Provider.