2009: The Manual Wheelchair Landscape

New Codes & Policies? New Technologies & Materials? Experts Weigh in on What We Can Expect

The rehab industry has had its share of DME headlines in recent years: new seating and power chair coverage criteria and coding, competitive bidding, then the rehab carveout and January’s 9.5-percent funding cut applied to those competitively bid products nevertheless.

During that time, manual wheelchairs have largely been out of the spotlight, relatively speaking, with the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) saying it would revamp coverage criteria, HCPCS coding and allowables after finishing with power chairs. That lengthy project, filled with stops and restarts, was followed by the start of competitive bidding, which was then halted by Congress, who ordered a do-over last July.
In the meantime, SADMERC was replaced by the Pricing, Data Analysis & Coding (PDAC) contractor, who inherited the competitive bidding mess that is largely front and center at this time. Where does that leave the manual chair market for 2009?

Policy Changes Delayed, But Not Forgotten
“The PDAC has indicated that they do not currently plan to restart the process of developing a new set of manual wheelchair codes until late 2009 at the earliest,” says Paul Komishock, GM of government affairs, Pride Mobility Products Corp. “Originally embarked on by the SADMERC, the new codes have been put on hold due to the transition to the PDAC as well as overriding priorities at CMS. Once the new codes are developed, new fee schedules will follow. In addition, a new medical policy will be developed around the new codes by the DME MAC medical directors.”

Komishock added that the evolution of HCPCS codes for manual chairs is likely to take one of two paths: “One is similar to the change that power chair codes underwent in late 2006, where approximately 40 codes in a variety of categories would be developed. A second scenario is one where 10 or so ‘builder’ codes are developed, where options and accessories would be added a la carte.”

Judson Cummins, custom manual product manager at Invacare Corp., said the PDAC “has the new manual codes on their radar screen, however when the codes and fee schedule will come to fruition is unclear. Invacare and other manufacturers will act on behalf of the industry vis-à-vis the codes at the PDAC’s request, and because change is imminent in this industry, we are preparing as if it will happen this year.”

Currently, Cummins adds, the state of manual chair funding is relatively good: “Ultralights and other manual chairs along with accessories provided on them received a five-percent increase Jan. 1, 2009, so relative to other product categories that received a 9.5-percent reduction, manual wheelchairs are as much of an opportunity as they ever have been.”

Says TiLite VP of Marketing Josh Anderson, “I think this year from a manual standpoint, we’re in a good position because (the Medicare allowable) has increased five percent. Funding last year, although challenging, still remained pretty good for manual wheelchairs, and I think given the circumstances this year, that it’ll remain pretty good.”

Advances in Technology
And what are funding sources – and consumers – likely to get for their manual chair investments? Weight is always a buzzword in the ultralight arena, but just as important, manufacturers said, is a chair’s depth of customization.

“In the custom segment, configurability continues to be something our customers demand,” Cummins says. “As manufacturers learn how to build better, lighter, stronger products, we’re also looked at to provide the options that satisfy virtually any funding or functionality-related situation a provider could come across.

Consumers are savvy enough to research their options and demand the best products available; the challenge for providers and manufacturers is to try to provide these choices in a dynamic and not always friendly funding environment.”

Says Mike McCarthy, national sales manager for manual chairs, Quantum Rehab, “Our research has indicated that consumers are demanding ultralightweight, compact manual chairs that are functional and durable enough to serve as their means of everyday mobility. Even as the funding arena continues to evolve, we remain focused on keeping the patients’ best interest at the forefront while supplying our providers with products that are economically efficient choices for their business.”

Part of the economic challenge comes from the fact that funding sources historically have tended to think technological advances such as lighter-weight materials are luxuries, not preventive medicine.

Says TiLite VP of Sales Marty Ball, “I’ve been in the business a long time, and there was a time when everybody would just look at an aluminum chair as the end all and be all… Now we hear, ‘Oh, we don’t pay for titanium’ from some insurance companies. I heard the same thing 25 years ago about aluminum: ‘We don’t pay for aluminum, we only pay for steel.’”

Ball, who uses a titanium chair now but says he used and played sports in a steel chair and has shoulder problems to show for it, adds, “We want people to realize that titanium isn’t a luxury; there’s a reason for it, a lot of reasons for it, and it’s not just weight. It’s better for the user. It’s amazing how much more dependent I’d be without this titanium chair.”

Some Rehab Respect for Manual Chairs
Which brings up another reason manual chairs might not get the funding respect their manufacturers and consumers think they deserve.

“It is important to realize that not all wheelchairs are going to work for every diagnosis,” McCarthy says. “They are designed for specific disabilities and needs.” Yet, are manual chairs typically treated like the customized pieces of assistive technology that they are?

Ball doesn’t think so.
“We’re like the stepchildren,” he says of the manual chair segment. “With complex rehab, (CMS) talks so much about power chairs, they kind of forgot about complex manual chairs, and there are certainly a lot of them. You can talk to any number of users who have chairs different than the others because of specific disabilities. So we need to get ourselves included in that, in the complex (rehab) carveout.”

While complex rehab power chairs – with their different drivetrains, alternative driving controls and power seating options – look obviously distinctive, even to the casual observer, today’s ultralight chairs can look quite similar in construction and setup.
But Anderson says the belief that ultralights are all the same is “not true in any respect. You can have a chair in the ultralightweight category that is just under 30 lbs., and you can have a chair in the ultralightweight category that’s under 20 lbs. And that’s just one, simple, definable aspect. The other aspect is the performance of that chair, which is a little bit harder to just tangibly look at and see the difference. But look at every consumer’s first chair and second chair.

There are huge amounts of changes, typically because of their (post-injury) adjustment period and what they (eventually) find more comfortable and more functional. But those items are all in the same class in terms of how they’re seen by Medicaid or private insurance, in most cases.”

Comparing his own titanium chair to Ball’s chair – they use the same model of TiLite chair, but with highly individualized configurations – Anderson says, “Marty and I use different rear wheels, we use different handrims, we use different sizes of wheels. Being able to customize that to be able to fit Marty and to fit me really makes the chair. If Marty had to use my wheels, yeah, his chair would still be really good, but it wouldn’t be just right.”
Getting that truth through to referral and funding sources – and to the PDAC in charge of the next generation of HCPCS codes – may just be the next major challenge for this industry segment.

Explains Ball, “When the general public thinks of a wheelchair, what do they think of? What they see in an airport or an emergency room. They don’t think of our kinds of chairs. And it’s like the difference between prosthetic devices, between a pegleg and a C-leg, which is a $50,000 artificial limb. That’s where we are. Just like a complex power chair, we’ve taken the same leap.
“We need to have a different name for this; it shouldn’t even be called a wheelchair anymore.”

This article originally appeared in the Seating & Positioning Handbook: March 2009 issue of Mobility Management.

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