Q&A with Dr. Rory Cooper

• By Laurie Watanabe
• Sep 01, 2007

Cooper: The biggest hot spot is that Medicare won’t get rid of the in-the-home criteria, and it seems to be going in the wrong direction — getting stricter with interpreting the in-the-home criteria. Then other payors are following that and sometimes really misinterpreting what Medicare I think intends.

In some ways, using the wheelchair ANSI/RESNA standards and calling out the ATP and looking toward professionalizing the field is a good move. But on the other hand, you would think that if you’re going to try to professionalize the field and use the standards, then you should also be opening up to a wider range of better-quality products. That’s the whole point, right? Why have a specialized assessment if all you’re going to have is a standard chair?

MM: So you think, for instance, that the 2008 Medicare requirement to have an ATS or ATP involved in complex seating & mobility evaluations is a good thing…

Cooper: Yes.

MM: But…

Cooper: I think not giving additional payment for the category 4 chairs is a bad thing.

If you’re going to require the specialty assessment, then you should also open up to the category 4 chairs and higher payment for category 4 chairs, because you have people who are going to make wise decisions about who needs them and who’s going to benefit from them. And I think Medicare is taking a very narrow view.

I understand they tend to look at the typical Medicare beneficiary who’s an older individual, retired. But (CMS has), through the Ticket to Work initiative act and a number of pieces of legislation, some obligation to help people of working age return to work. Or through Medicare/Medicaid, to help children attend school and eventually go to work.

MM: Do you think in some cases Medicare doesn’t realize what kind of impact it has on other funding sources?

Cooper: I think so. I think there are two things: I think Medicare tries to bury their heads in the sand and ignore the fact they impact private funding agencies, private insurance companies and even the VA. One thing I don’t even think they’re recognizing: If they don’t pay for category 4 chairs, there could be two negative impacts — I realize they do pay for them, they just don’t pay additionally for them. One impact could simply be that other payors follow suit. The other impact could be that even if other payors don’t follow suit, there may not be enough demand for those products, so they’re simply not produced anymore.

If you look at the category 3 and category 4 chairs, you’re usually talking about people with some form of catastrophic disability or illness. That’s a very small percentage of the overall Medicare population. So in a sense, (CMS is) being very shortsighted. You could spend more dollars on those people, because it’s really a small number of people. But the impact you could have on those individuals and their potential for employment is great.

MM: So Medicare really doesn’t have to worry about opening floodgates if it starts funding these chairs, because the demand just isn’t there in large numbers.

Cooper: Right. And they have a gatekeeper system: You have to go to a physiatrist or an ATP. The demand is not going to be that high anyway, and you’ve got someone who’s going to make sure that only appropriate people get it.

MM: But the impact on the people who do get the technology would be…

Cooper: Tremendous.

This article originally appeared in the September 2007 issue of Mobility Management.