The National Coalition of Assistive & Rehab Technology (NCART) has responded to a recent AARP commentary called “The Case of the Expensive Wheelchair.”
Don Clayback, NCART’s executive director, sent a detailed letter to the story’s author, AARP Editor Jim Toedtman, to explain the nature of complex rehab power chairs and to point out that the cost of a complex rehab power chair includes much more than just the chair itself.
In noting the need for health-care reform that will reduce waste and fraud, Toedtman turns his spotlight on power chairs.
“Consider power wheelchairs,” Toedtman wrote in AARP’s Nov. 1 print edition. “As the population has aged, their use — and cost — has soared. Under Medicare, several hundred suppliers across the country buy wheelchairs from manufacturers and then generally lease them to beneficiaries. In 1997, Medicare and Medicare beneficiaries paid just over $100 million to buy or lease power wheelchairs; today they pay more than $1 billion.”
Toedtman cited several examples of wheelchair MSRPs vs. Medicare’s allowables.
“For elaborate power wheelchairs, the average Medicare allowance was $11,507, almost twice the $5,880 price paid by suppliers,” he wrote.
Later in the article, Toedtman added, “Industry leaders complain that servicing the machinery is getting more expensive and that their companies have been hurt by inflation and reduced Medicare rates. Medicare compensation has indeed been scaled back with a 9.5 percent cut in payments. According to the OIG (Office of the Inspector General), that brought the average payment down to $3,641 in 2009, still three times the price paid by suppliers.”
In his reply, Clayback explained that complex rehab power chairs and seating “account for only 7 percent of the power wheelchairs Medicare pays for. These power wheelchairs are used by Medicare beneficiaries with significant disabilities resulting from spinal cord injuries, traumatic brain injuries, and amyotrophic lateral sclerosis (ALS).”
Clayback also addressed the price tag examples cited by Toedtman, saying, “The ‘product’ cost is only one component of the total cost. The process of providing complex power wheelchairs involves both medical personnel and supplier personnel performing a variety of activities. The activities and costs of the supplier, starting with the initial assessment and continuing through final delivery and ongoing support, are significant. These include initial assessment, trial equipment and simulation, technology assessment, home assessment, recommendation, documentation, assembly, delivery, fitting, adjusting, product training, short term follow-up, and finally ongoing repair and maintenance. A qualified supplier must also have supporting staff, systems, facilities, and credentials in place. These also come with a cost.”
Clayback said NCART agreed “wholeheartedly that health-care reform must include the elimination of Medicare fraud and abuse,” but added, “The solution to fraud and abuse isn’t cutting access to products and services that keep people with disabilities functional and independent. It’s keeping bad apples from getting provider numbers and the ability to bill Medicare.”
