Subscribe to On the Editor's Desk RSS Feed

On the Editor's Desk

by: Liz Beaulieu - Tuesday, October 20, 2009

I had an interesting conversation today with a provider who relies on complex rehab for 80% of his business. Here's what he said about the industry's efforts to create a separate benefit for complex rehab:

I realize that everyone has to work for themselves, but I like talking as one industry. When I needed help, the respiratory people were there; the O&P and disposables people were there. I don't like being singled out: Well, you  need more money, but everyone else doesn't need more money. It's true that our situation is a little more dire, because our margins aren't as good as some other aspects of the industry. I'm obviously for it. I just hope it doesn't affect other aspects of the industry to help us.

That's pretty insightful for a provider who, potentially, has a lot to gain from this effort becoming a reality.

Liz Beaulieu

by: Liz Beaulieu - Monday, October 19, 2009

I had already listened to Don Clayback's presentation on creating a new benefit for complex power wheelchairs earlier this month (click here for my story), but I attended his presentation at Medtrade, anyway.

I'm glad I did.

The presentation may have been the same, but because attendees asked different questions, Clayback and other members of the steering committee offered a few new details. Here are a few of those details, plus some observations:

  • What products will be included in the benefit? Clayback says committee members will "get down to the code level at some point," but right now, they're looking more at the process, rather than products. They're asking themselves: What are the outcomes we're looking for? Having said that, the new benefit will likely include alternative systems like standers.
  • "You're on the right track," said one attendee.
  • Will the new benefit affect reimbursement? Committee members plan to address who gets reimbursed and how they get reimbursed, said Gary Gilberti, a committee member and president of NCART. But with "no clear delineation" of the roles between rehab professionals and therapists, it could get messy, pointed out Simon Margolis, a committee member and executive director of NRRTS. The groups need to "work together," he said.
  • Part of the presentation was a strongly-worded call to action. "What concerns me the most is you," Margolis said to attendees. "You're not going to like what comes out of the bottom of the hopper unless you've put some feed in at the top." Those who don't participate in the process "can't bitch at us later," he warned.

Liz Beaulieu

by: Liz Beaulieu - Thursday, October 8, 2009

Greg Parker has been named director of operations at U.S. Rehab, The VGM Group announced this week. Parker comes to U.S. Rehab from Pride Mobility Products, where he was the regional coordinator for the midwest region.

The addition of Parker allows Jerry Keiderling, U.S. Rehab's president, to focus on Accessible Home Improvement of America (AHIA), one of VGM's newer divisions. AHIA helps providers break into the home modifications market.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, October 6, 2009

Unless you've been living under a rock, you're probably familiar with how the industry's efforts to reform the oxygen benefit have been going. In a nutshell: Not very smoothly.

Don Clayback and other industry stakeholders involved in reforming the complex power wheelchair benefit don't live under a rock. That's why they've scheduled several events to gather feedback from interested parties. In addition to two Webinars this month, they've scheduled a consensus conference for Oct. 29 from 8 a.m. to 3:30 p.m. at the Crowne Plaza Airport Hotel in St. Louis.

If you're a complex power wheelchair provider, you must attend. There's no excuse. All are welcome, and it's free to attend. All you have to do is pay for airfare (it would cost me only $158 to fly from Portland, Maine, to St. Louis and back) and probably one night in a hotel.

If you remember, the industry held a similar consensus conference on oxygen reform several years ago. I don't know if all were welcome or if it was free to attend, but I do know that the discussions at that conference formed the basis of the industry's oxygen reform plan, and this year, when that plan was made public, there were some who claimed to be blindsided.

Don't repeat the past.

E-mail Don Clayback for a registration form (

Liz Beaulieu

by: Liz Beaulieu - Monday, October 5, 2009

In a press release posted to today, Sen. Chuck  Grassley, R-Iowa, uses power wheelchair fraud as an example of why Medicare's a "money pit."

Aging Americans rely on Medicare to help pay for quality health care services and equipment that enhance their quality of life well beyond retirement. Unfortunately, a few rotten bananas in the durable medical equipment industry are giving a black-eye to those who conscientiously provide oxygen equipment, diabetic kits and wheelchairs to the disabled and retirees. Just consider recent examples of Medicare fraud by unscrupulous suppliers of motorized wheelchairs. An internal audit recently revealed that Medicare and its beneficiaries paid nearly four times the average paid by suppliers for standard power wheelchairs in the first half of 2007. It’s ridiculous that the government pays more for wheelchairs than any consumer who does basic comparison shopping on-line. Apparently sticker shock doesn’t seem to apply to Uncle Sam."

The OIG report rears its ugly head again. But here Grassley takes the debate in another direction, and if I were the industry, I'd be worried.

When the OIG report first came out, the industry pointed out that the difference between acquisition costs and what Medicare pays isn't all profit. Providers use that money to cover services and general business expenses, leaving them with a single-digit profit margin.

Now Grassley seems to be connecting the difference between acquisitions costs and what Medicare pays with fraud.


Liz Beaulieu

by: Liz Beaulieu - Friday, October 2, 2009

So the OIG released its 2010 work plan this week, and it'll come as no surprise to providers, I'm sure, that power wheelchairs are mentioned more than once. Here's the rundown:

  • The OIG will review payments for power wheelchairs to determine whether they were “reasonable and necessary.” Prior OIG reviews have stated that these products are sometimes not ordered by physicians or not delivered to or needed by beneficiaries. The OIG plans to target geographic areas with high-volume claims and reimbursement.
  • The OIG will review documentation supporting claims for power wheelchairs paid by Medicare and determine whether beneficiaries received the required face-to-face examinations from the referring practitioners prior to receipt of equipment. In 2003, Medicare payments for power wheelchairs peaked at $1.2 billion. In 2004, as a result of expanded CMS program integrity initiatives, power wheelchair spending decreased to $850 million; however, problems may persist. In 2007, about 173,300 Medicare beneficiaries received power wheelchairs, costing $686 million.
  • The OIG will review documentation for payments to DME suppliers for standard and complex rehab power wheelchairs to determine whether suppliers meet Medicare’s coverage criteria and medical necessity documentation requirements. It will also determine whether suppliers had documentation from the beneficiaries’ medical records, as required, that clearly supported the medical necessity of the power wheelchairs.
  • The OIG review servicing records from suppliers and interview beneficiaries regarding their experiences with capped rental DME, including hospital beds and wheelchairs, to determine whether Medicare made proper payments for maintenance and repair services.

Should be a fun year.

Liz Beaulieu

by: Liz Beaulieu - Thursday, October 1, 2009

Rep. Tammy Baldwin, D-Wis., has gone to bat for the complex rehab industry, writing a letter in support of repealing the 9.5% cut as part of healthcare reform. Baldwin now looks to industry stakeholders to collect additional signatures before she sends the letter to Speaker of the House Nancy Pelosi next week. Both NCART and NRRTS are calling to action their members and complex rehab providers at large:

  • Call your representative and ask him or her to co-sign the letter. All representatives have to do is contact Elizabeth Lee in Baldwin's office at 202-225-2906 or
  • Call you senator and ask him or her to send a similar letter to their leadership.

The deadline for collecting signatures: Oct. 6. E-mail NCART's Don Clayback at for a PDF of Baldwin's letter.

Clayback provided the following pep talk:

Yes, we are facing an uphill battle to get this fixed...but if you are in complex rehab you are a proven warrior! This is a very small "fix" and it can still be done if we can get our message out there. We only have a few days. So if you REALLY don't like the 9.5% cut here is something constructive you can do about it."

Liz Beaulieu

by: Liz Beaulieu - Wednesday, September 30, 2009

The Scooter Store today joined a growing group of industry stakeholders that are taking the OIG to task for a report claiming the power mobility industry enjoys enormous profits. That's "laughable," says Doug Harrison, CEO and founder. The OIG, he says, overlooks these services associated with doing business with Medicare:

➢    Customer Intake, Education and Interaction
➢    Documentation Collection and Management
➢    Delivery Set Up, Service, Warehousing, and Training
➢    Claims Management, Reimbursement and Collections
➢    Compliance with State and Federal Regulations

But the OIG doesn't really overlook the services and business expenses involved in providing wheelchairs to Medicare beneficiaries. It states suppliers perform an average of five services for standard power wheelchairs and seven services for complex power wheelchairs. What it's really overlooking: Whether the amount Medicare and beneficiaries pay for those services and business expenses—$2,970 for standard and $5,627 for complex—is too much.

That's where, I think, the industry should be focusing its attention, and that's why I wonder how much of an impact this release, and others like them, will have.

Isn't the only way to put an end to claims like these to show them the money—show them how much, on average, a provider spends on customer intake, documentation collection, etc.?

Industry stakholders say they're working on this. But when I asked one provider whether he had a handle on these expenses for his own business, he wasn't that forthcoming.

Yes we do, but each patient is unique," he said. "We can't just put a methodology out there and have it apply to any situation. I don't know that we'll ever be able to do that."

Well, if that's the case, I don't think the industry is ever going to get the OIG et al off of their backs.

Liz Beaulieu

by: Liz Beaulieu - Tuesday, September 29, 2009

NCART will host a Webinar tomorrow, and again on Oct. 8, to provide an overview of efforts to create a separate benefit for complex rehab. The Webinar starts at 3 p.m. Attendance is open to all interested parties, but advanced registration is required (Click here to register). NCART will give the same presentation at Medtrade. The group also has a Consensus Conference planned for Oct. 29 in St. Louis. Again, attendance is open to all interested parties. More details to come.

NCART...making things happen.

Liz Beaulieu

by: Liz Beaulieu - Friday, September 25, 2009

The Senate Finance Committee has corrected an error in its draft healthcare reform bill that states the elimination of the first-month purchase option for standard power wheelchairs will take effect next year. It will take effect in 2011, according to Seth Johnson, vice president of government affairs for Pride Mobility Products. “That essentially buys us 12 more months,” he said. "Clearly, we're still working to advance an alternative, but it's a positive development."

Liz Beaulieu