Initial Shock Gives Way to Flurry of Dialogue

Responding to PMD reimbursement cuts of almost 40%, HME providers and advocacy groups met with members of Congress, penned letters to CMS, and enlisted consumer groups in an all-out effort to restore rates to workable levels. A month later, the question remains: will it make a difference? “When you get to a critical mass, I think it can make a difference,” says Ann Howard, director of federal policy for AAHomecare, Alexandria, Va. “Some pretty powerful members of the Senate are weighing in—through letters or personal calls to Mike Leavitt [Secretary of Health and Human Services]—and at some point you are going to reach a tipping point.”

The outcry against the cuts is notable for its many-pronged attack. No longer limited to just the trade press, several newspapers ran largely industry-friendly coverage. An October 11, 2006, Washington Times article by Gregory Lopes declared “Medicare Cuts Hurt Disabled.” The article quoted industry expert Cara Bachenheimer, JD, VP of government relations for Invacare Corp (and Dealer/Provider columnist) along with provider Jim Greatorex of Black Bear Medical, Portland, Me.

In yet another response to industry pressure, six Ohio House Democrats—Tim Ryan, Ted Strickland, Dennis Kucinich, Sherrod Brown, Marcy Kaptur, and Stephanie Tubbs Jones—asked HHS to postpone the proposed cuts set to go into effect November 15. In an October 13 letter to Secretary Leavitt, lawmakers echoed industry concerns saying the reductions would decrease reimbursement rates for power wheelchairs by approximately 35% to 41%, and the cuts would hurt “patient access for those most in need, as well as dramatically impacting small businesses in our communities and across the country.”

In justifying the cuts, CMS spokeswoman Ellen Griffith-Cohen has said the payment changes will more closely reflect wheelchair manufacturers’ retail prices. She also noted that payment changes will reduce beneficiaries’ copayments because beneficiaries pay 20% of the price CMS pays.

Meanwhile, a report in the Congressional Quarterly confirmed that Ohio mobility equipment suppliers (including Jim Ravas of Active Mobility of Ohio, and Bob Hamilton of Hamilton’s Health Aid Service) asked House members Deborah Pryce (R-Ohio) and majority leader John A. Boehner (R-Ohio) to halt the payment changes. “If allowed to go forward, the new power wheelchair payments will cause lay-offs, close businesses, and make it difficult for senior citizens and people with disabilities to get power wheelchairs,” the suppliers said in a news release.

On the Senate side, Senators Arlen Specter (R-Pa) and Rick Santorum (R-Pa) sent a letter to Secretary Leavitt that said, “In late September, we communicated our concerns to the Center for Medicare Management that PMD reimbursement reductions in excess of 12% may not provide beneficiaries access to medically appropriate medical equipment. We are concerned that the published payment rates include reductions from 26% to 43%, which are significantly higher than that amount….We urge you to postpone implementation of the fee schedule in order to provide adequate time for CMS to work with industry on an alternative payment methodology.”

AAHomecare has hit 60 Senate offices and counting, with largely good response. “We have had numerous meetings on a collection of home health, oxygen, and HME issues, and every office we've met with on the Senate side is interested in this issue, and we have not gotten any negative pushback,” says Howard. “A lot of them don’t quite know what to do about it, but they are concerned. And we are going to help them with ideas on what they can do. Our intent is to hit every single Senate office between now and a couple of days after the election.…It’s going to have an impact if the pressure keeps up.”

Despite the good progress, some providers are hunkering down and preparing for the worst while hoping for the best. “I’m concerned with the new codes, but I think there is still a little room to work with,” says Larry Rice, chief operating officer for In Home Products Inc, Dallas. “A really clever wheelchair and rehab provider may be able to survive, and rehab providers are going to have to really look at their business again. I’m asking where can we save money? Where can we build in efficiencies and still provide this equipment? I’m going to look at all the reliable manufacturers and see if I can find the equipment that really meets my customers’ needs at a reasonable cost. I don’t want to give up on these end users even with these cuts.”

Adding a crucial voice against the cuts were clinicians and advocates representing seniors and people living with disabilities who charged CMS with “dismantling” the Medicare benefit for power mobility equipment. “The Medicare mobility benefit as we knew it is gone,” asserted Andrew Imparato, president and CEO of the American Association of People with Disabilities. “CMS has chipped away at the benefit over the last 3 years, and this latest step ensures that people living with disabilities will get little help from Medicare when they need a power wheelchair to remain independent, and out of institutions.”—Greg Thompson

Pure Politics
Democrats Slam Republicans on PMD Cuts
In a move sure to focus even more light on recent PMD cuts, the Democratic National Committee (DNC) issued a blistering pre-election press release titled “Bush Republicans Deny Mobility and Independence for Seniors and People With Disabilities.”

The official comment from the DNC caps off weeks of largely positive press in consumer media throughout the country. The strongly worded statement shows election-year politics at work and a belief by the Democrats that the issue is ripe for political gain. “America’s senior citizens and people with disabilities are once again paying the price for the failed leadership and misplaced priorities of the Bush Republicans in Washington,” said the release issued on October 23. “This month, the Bush Republicans running the Centers for Medicare and Medicaid Services issued a new power mobility devices (PMD) fee schedule and a new coverage policy that will drastically reduce reimbursements and eligibility for power mobility equipment.”

“The Administration’s decision to make wheelchairs less accessible to seniors and Americans with disabilities is one of the most glaring examples of the need for a new direction for America,” said Becky Ogle, DNC Senior Advisor on Disability, in the release. “For many seniors and people with disabilities—including people diagnosed with ALS, muscular dystrophy, cerebral palsy, spinal cord injuries, and severe brain injuries—mobility equipment is vital for independent living. Every American deserves the opportunity to live the American Dream, and to make their contribution to our society. Robbing people of their mobility and independence robs them of that vital opportunity.”

The partisan rhetoric continues with a link to tax cuts. “By slashing the Medicare reimbursement to pay for their special interest tax cuts, the Bush Republicans have once again put the interests of their party and their special interest friends ahead of the country,” adds Ogle.

Morrison Informatics Finds Flaws in OIG Oxygen Report
Echoing industry concerns with the September 2006 HHS Office of Inspector General report, Medicare Home Oxygen Equipment: Cost and Servicing, a Morrison Informatics analysis found that findings in the OIG report were based on “limited and inadequate data about the actual costs of providing home oxygen therapy.” The report concluded that the OIG report considers only the costs of oxygen concentrators and understates actual costs. The analysis reiterated that costs of oxygen equipment comprise only 28% of home oxygen providers’ total costs.