Sunday, August 7, 2011

Throwing the baby out with the bathwater

In this morning’s paper there was an article from the McClatchy Newspapers in Ft. Lauderdale, Fl.  The title was “Report targets unnecessary power wheelchairs … 61% paid for by Medicare were not needed”.  

The article sites a July report by the Inspector General of Health and Human Services stating the chairs were not needed or not right for the elderly patient wasting about $100 million in a six month period in 2007.
These findings led to a 10% cut in payments and tougher regulations.  Furthermore, nine metropolitan areas in south and central Florida are testing a controversial new system for power wheelchairs and other medical equipment.  Suppliers must pass an accreditation process.  They hope this process will weed out many of the companies that are taking advantage of the elderly.  As part of the system, Medicare and the patients will pay 25-30% less for the power chairs.
I believe Medicare fraud, not just with wheelchairs, is a huge issue that no one has been able to get their hands around.  This problem is partly due to the patient’s inability or lack of desire to review and question charges made to Medicare on their behalf.   Medicare sends out statements every time a charge is made against a patient’s account.  There is a fairly easy process available to challenge any questionable payments.

Don't Penalize Everyone
That being said, I believe the real problem is that all rules and regulations are normally established for the very small group who take advantage of the system.  Probably 90-95% of all charges are legitimate.  It is the 5-10% that cause the problem for everyone else.  And, with the government trying to keep the dike from leaking, they rebuild the entire dam making it less user friendly and far less functional.
For example, the government does not recognize that some people might need a power seat on their wheelchair.  Chairs are designed to provide mobility for anyone that can no longer safely walk with a walker or cane.  The regulations are strictly designed to satisfy the mobility need.  However, transferring is never considered even though it is a mobility issue and safety concern.  I believe this happens because the people making the regulations have never been in a wheelchair or consulted with people that need the ability to have a power-assisted transfer capability.
As anyone in the later stages of Kennedy’s Disease knows, our arm strength weakens as much or even more than our leg strength.  We cannot easily transfer to the bed or toilet, for example, by sliding across on a board or using our arms to swing over.  I need a power chair to get around safely.  I also need a power seat to be able to transfer safely (and not cause my wife to hurt herself trying to help me transfer).  
A power seat is an expensive option on any wheelchair, but it is a necessity for some of us.  Quality of life should be taken into consideration when accessing the need for mobility equipment.  
Focus on the Corruption

Yes, we need to stop corruption within our Medicare system.  And, yes, medical necessity should be the determining factor for mobility equipment.  BUT, don’t penalize everyone that needs mobility equipment just because of a few fraudulent companies.  clip_image003Instead, focus on the corruption.  

And, take it one step further.  Stop generalizing the interpretation of necessity.  Allow the doctors and medical equipment specialists (i.e., physical and occupational therapists) to provide adequate documentation that a long-term need exists for a particular piece of equipment or accessory.  


I would even go one step further.  Establish a follow-up with the patient to review of the mobility equipment prescribed to make certain it satisfied their needs.  If not, go back to the specialists and hold them accountable for the recommendation.  Begin to suspend licenses, if necessary.  But, don’t continue to tighten the regulations to make it even more difficult to obtain mobility equipment.
I know I am just dreaming, but it would be nice to have at least one system that works the way it is supposed to.

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