
Imagine being significantly limited in your ability to go where you want or do what you want, unable to freely move about your house or safely travel to the grocery store, because your legs simply are not up to the task. They can’t hold you upright for more than a few minutes, and they can’t cover distances of more than a few yards before they are overburdened. Imagine no one could help you fix that situation for 30-45 days.
All too often, that is the kind of limitation or restriction that wheelchair users experience when their wheelchairs need repair.
“Wait times have grown, and many wheelchair users are frustrated by that experience,” says Tim Casey, General Counsel at Numotion, the nation’s leading provider of products and services to help individuals with mobility limitations. “People are looking for solutions to figure out how to reduce the time spent to get a complex wheelchair repaired.”
Almost everyone involved in the process agrees that this must change. But how? To answer that, we must ask “why” these long wait times exist.
Complex rehabilitative technology (CRT) is equipment highly customized to the individual using it. It involves custom configurations and parts and it can be expensive to purchase and to repair. That means insurance companies, including government programs, want to be sure they’re paying for only what is necessary. Suppliers can’t stock all of the parts needed for each custom repair, and the people who do the repair often must have a level of skill and expertise that not everyone has.
Put it all together and it’s a recipe for long delays. Casey breaks the problem down into four root causes of today’s service and repair challenges:
- Unnecessarily heavy administrative burden. To get a new wheelchair, or even just repairs, users need a prescription and often need prior authorization. “Insurance companies often want to review everything before you can do even minor repairs, or they require medical documentation demonstrating that the customer still needs to be in the chair,” Casey says. It’s too much, he says.
- Poor reimbursement models for service and repair. Casey keeps it simple. “Reimbursement models are insufficient,” he says. They also look different in different states. In some states, for instance, Medicaid will pay for a maximum one unit of labor — call it 15 minutes. “If we do a repair that takes five hours, we’re going to get just that one amount,” he says. “Everybody pays differently, and many pay low labor rates.”
And no one reimburses for travel.
- Disconnect between what payers will reimburse for and how customers use their equipment. Medicare pays for wheelchairs that people use in the home. But most people use their wheelchair outside the home, and some are very active users. This creates two disconnects: one between how manufacturers build chairs and what users need from the chairs, and when Medicare does or does not reimburse, and how much.
“The reimbursement models are set up to cover only chairs that are built to withstand the rigors of life inside the home,’” Casey says. “That means manufacturers are going to build chairs that can withstand the daily rigors of use inside your home, but people are putting these chairs in their cars. They’re going to work, they’re going to the grocery store. They’re out and about.” That leads to a level of wear and tear that insurance programs, like Medicare, can perceive as unusual.
- No preventative maintenance or backup equipment. Because of the disconnect, people are using chairs in situations that the chair is not designed to handle. That leads to wear and tear, which drives increased repair needs. But preventative maintenance nor back-up equipment tend not to be available. It’s basically “wait and see when it breaks,” Casey says.
“We’re doing nothing to prepare for the fact that these are mechanical devices that will have trouble from time to time,” he says. “With no preventative maintenance, we’re increasing the likelihood that the necessary repairs will be larger and more time consuming. And with no backup equipment, people are just out of luck when these things are down.”
5 industry changes Numotion wants to see
Obviously Casey recommends changes that serve as the opposite of each of the challenges above. But he’s more specific than that. His five industry changes:
- Eliminate the need for a medical documentation or prescription for a repair, and eliminate prior auth for repairs under $2000. “That will leave a small sliver of repairs that are expensive, and insurance companies might want to review that,” he says. “That’s fine. But that really reduces the administrative burden.”
- Reimburse for travel and diagnosis. Have a level of compensation strictly for home repairs, for users who don’t want to travel to the shop. “We understand,” he says, “but we need to be paid for that.”
- Require people who sell the chairs to service the chairs. Normally, chair manufacturers and suppliers are repairers too. But during COVID, a number of chair suppliers did not want to handle as many repairs. Numotion saw a massive increase in customers who wanted service from them, including 30% who didn’t buy Numotion chairs. Since COVID hit, challenges in supply chain, labor and reimbursement saw some suppliers duck out of service repairs. Casey wants to see that end.
- Pay for preventative maintenance or wear-and-tear. “We know wheels are going to wear out — the useful life of the wheelchair is five years,” he says. “We know certain things aren’t going to last that long; batteries lose their charge. We know that’s going to happen.”
- Increase “right to repair” rights for users. “There are certain repairs that we believe either a customer or caregiver can do safely,” he says. Removing those restrictions improves customer experience.
“We’re in this for our customers to be happy,” he says. “We want to work with the consumer to get this right. There is increasing movement throughout the country on legislation around this. We think there’s a solution here where everyone benefits, the customer first and foremost. The insurance companies get a happier beneficiary, and we get a happier customer. It’s good for everyone when we put the customer first.”
This Views article is sponsored by Numotion. Visit them at numotion.com.