New Perspectives

Independent Providers Speak Out: Patient Advocacy & Capped Rentals

Independent rehab providers are always balancing the complex, unique needs of patients and caregivers with the realities of running a business. In today’s heavily regulated reimbursement climate, the decision to get patients what they need can add up to documentation nightmares involving a maze of levels and acronyms, and years of waiting for the reimbursements needed to make payroll. The most difficult decisions — whether to turn down a patient or reduce staff hours — linger among the hundreds of decisions providers make to keep business viable. That’s why it’s important to speak out about our issues and advocate for important policy positions.

U.S. Rehab and our other VGM divisions were created to assist independent providers with guidance and opportunities that are otherwise difficult to obtain due to financial and time constraints. More than just a buying group, we help providers plan ahead for changes in the business climate, ensure your staff have access to the best ATP preparation available and provide marketing tips such as how to make social media work for you. This is the first of several columns that will address these needs of the CRT provider and help to keep important strategies at the forefront of our day-to-day lives.

Your Chair Is Your Life

Patient Advocacy: How Five Mobility Providers Influenced 34,700 Video Views

Does it seem impossible to organize patients to speak out? It requires time, explanation of potentially difficult topics, and then what?

Working as a team to get the job done is how five providers from different parts of the country influenced almost 35,000 wheelchair policy video views on the People for Quality Care YouTube page. People for Quality Care, VGM’s patient advocacy group, was created to recruit beneficiaries to speak out about the policies that hurt their access. Located in Iowa, the team relied on providers nationwide to introduce them to participants willing to be filmed, photographed or to have their stories shared in written form.

The process, which seems difficult, was actually quite straightforward to achieve. Providers who had developed extensive relationships with their customers simply asked their customers to get involved. They organized a day in which their customers came to the office to be filmed. People for Quality Care sent their team to conduct the interviews, then returned to edit the video and used social media and the Web to help advance the information.

The video process was not perfect. It was common for patients to cancel due to one of the many unexpected complications that arise on a day-to-day basis related to health or transportation. Most times patients were not well versed in the policies. However, they were very well versed in what it meant to have access to a technical team and after-hours service to help during wheelchair mechanical or system malfunctions. The discussions always tied back to the policies, and offered a unique view of what we do, which is not always evident to the public. What was important: their personal stories that brought attention to the policy issues that affect their access to our service. The patient and provider stories are linked, and therefore it’s vital they are heard.

An Ear for Your Patients: The Beneficiary Complaint Hotline

The People for Quality Care beneficiary complaint hotline was created for medical equipment users to report the issues they are experiencing related to Medicare reimbursement. Any beneficiary, caregiver or provider with a real, Medicare-related medical equipment problem can call the hotline to report their problem, no matter what policy is causing the issue. Common complaints include difficulty finding a provider who can fix a power wheelchair, long delays for service, and increased cost to the beneficiary when Medicare denies service. People for Quality Care has received more than 3,000 phone call complaints, which are used when we talk to Congress about the issues and to help educate other beneficiaries that speaking out is the right thing to do.

What we hear most from the hotline is that patients and caregivers feel lost in their search for the services they need. They don’t know how to access them now with all of the changing policies. And the Centers for Medicare & Medicaid Services (CMS) is not listening to their problems. In April, a woman from San Antonio was beside herself when she called. She was trying to find a provider in New Orleans to fix her father’s broken wheelchair, but after several calls, a multitude of issues were standing in her way. Not only was her story recorded in our records to share with Congress, it was shared on our dearmedicare.com site, and we transferred her call directly to the Congressional switchboard to tell her story to staff members.

Hotline information cards are available for you to distribute to customers at no cost. E-mail Lalaina.rabary@peopleforqualitycare.org with the quantity you need and your address.

Our Latest Issue: How To Talk About Capped Rentals

It’s difficult to explain to people, including Congressional members and staff who don’t understand the daily needs of wheelchair users and providers, why the capped rental change is so illogical and damaging. But it will be important to vocalize why it’s not a viable, cost-savings solution. Consider personalizing the talking points when you make the case. Your participation in speaking out about this problem is critical.

1. Explain why providing multiple part-by-part repairs for 13-month rented items is going to make you choose between caring for customers and running a viable business. You’re in a pinch. You want to help as many people as you can to be independent and have a high quality of life. But your cash flow will suffer, making it difficult to plan for the future and offer the best-quality high-tech options. Give examples of the way your practice will suffer when you’re unable to offer the best possible care.

2. Speak to the administrative nightmare that capped rental creates. If one customer requires seven repairs over a sliding, 13-month period, that’s a multitude of claims and co-payments. Now multiply that times the number of clients you see in a year. Not only will the billing be confusing for beneficiaries, it’s extremely taxing to your company and CMS. CMS has self reported to be backlogged by 164,000 claims. This new rule simply complicates the process.

3. PMD technology has changed drastically since 1986. The CMS methodology to determine which components would be capped relied on 1986-1987 utilization and purchasing statistics, when medical equipment was very different. Technology has drastically changed standard mobility and complex rehab wheelchairs, making the CMS comparisons inaccurate.

4. Finally, no other industry is expected to function this way. No matter the business, cash flow is necessary to keep it running. Providing power and complex rehabilitation wheelchairs, which is extremely important to maintaining the independence and quality of life of Medicare beneficiaries with disabilities, is no different. The capped rental rules are unsustainable, and damaging to our system that provides for Americans with disabilities.

A Call To Action

Whether you’re getting your patients or their caregivers involved, or if you want to speak out yourself, we must tell our story. Give us a call if you want to get involved, and we’ll be happy to help make your voice be heard. Call (800) 987-7342 or e-mail Kayla at kayla.mahler@vgm.com.

This article originally appeared in the June 2014 issue of Mobility Management.

About the Author

Greg Packer is the president of U.S. Rehab. His background includes sales management for Pride Mobility Products Corp. and Biocore Medical Technologies Inc. He also served three terms in the Kansas House of Representatives.

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