Ensuring Power Mobility is Available for People Living with Disabilities
For 12 years, Gerald Sloan, owner of Progressive Medical Equipment, LLC, has provided home medical equipment to Medicare patients from his retail outlets near Kansas City and St. Louis, and he is also vice president of the Midwest Association for Medical Equipment Services (MAMES). Today, Sloan is concerned that the elimination of the first month purchase option for Medicare beneficiaries requiring power wheelchairs will prevent patients in rural areas from receiving the mobility assistance that has been prescribed by their physicians. This change is scheduled to be implemented on January 1, 2011, but Sloan has joined the chorus of voices from across the nation urging Congress to delay implementation of this policy change for one year so that businesses can adjust to the abrupt change that will impact their cash flow and their ability to continue providing power wheelchairs to Medicare beneficiaries. Mobility Matters recently talked with Sloan about the impact of the policy change, and the affect on providers in the Midwest.
MM: How has your company performed in recent years?
SLOAN: I started off as the owner running the company alone; we peaked at 13 employees about two years ago and then with competitive bidding over the past two years we have dropped to eight employees. So we had a nice curve upwards during the good times and now we're forced to adapt in the bad times.
MM: Why is the elimination of the first month purchase option so impactful on your business, and on other providers?
SLOAN: Well it simply comes down to cash flow for everybody. There's a lot of preparatory work that goes into providing power wheelchairs for Medicare beneficiaries. Things like making sure there is proper documentation for the government, and home assessments. There's a considerable investment beyond the price of the wheelchair. It goes into every wheelchair delivery, so it creates a serious cash flow problem for many small providers when their payments from the government will be spread out over a 13-month time period.
MM: Do feel that the Centers for Medicare & Medicaid Services (CMS) and policymakers in Washington have failed to understand the resources and work it takes to provide a power wheelchair to Medicare beneficiaries?
SLOAN: Yeah, for sure. They have absolutely no clue what goes into the process for delivering any kind of medical equipment. Under the current situation, something as simple as a walker all the way up to power wheelchairs, you're asking for a lot of administrative overhead that goes into the process before you ever even consider ordering or delivering that piece of equipment.
MM: CMS is always looking to cut Medicare costs. Do you believe that tax dollars could be saved if the Medicare program adopted a more efficient administrative process?
SLOAN: Well that's an interesting question. I have spoken to Sen. Pat Robert's office about the need for a better documentation process. They're creating tighter and tighter standards to the point where it's almost impossible to meet them. Everything requires more documentation, and that means more time and resources that providers have to spend on paper work.
MM: So if CMS improved the administrative process, would it also help Medicare beneficiaries?
SLOAN: Well absolutely! One of the big arguments for CMS about their so-called competitive bidding program is that it would save Medicare beneficiaries on their co-pays and reduce the overall expenditures on medical equipment. Well, better oversight of the Medicare program and more efficient administration would save consumers money and not put a strain on providers.
MM: How are you and other providers dealing with the problems that will arise if the first month purchase option for power wheelchairs is eliminated in January?
SLOAN: We're a mid-sized company. Our revenues are above small providers and below large providers. Fortunately for us, we carry the credit capacity to handle the situation. The greater concern for me geographically speaking and also as Vice President of MAMES is that large providers aren't servicing rural areas, so patients in those areas are dependent on small providers. These are the businesses that provide two to three power wheelchairs a month. These are the providers that will be hard pressed to overcome the financial burden of providing power wheelchairs for Medicare beneficiaries if the first month purchase option is eliminated. They just won't be able to do it.
MM: What are other concerns for these smaller providers?
SLOAN: The way that the program is set up, if a patient dies or goes into a nursing home during the 13-month rental period, the power wheelchair is returned to the provider and rental payments from the government stop. Well, if a small provider is hit hard with returns one month, they may not have enough cash flow to carry that weight and their business would likely fold. Some providers won't take that risk and will go out of business or not carry power wheelchairs anymore. This is what I'm hearing from small providers in MAMES, which covers Missouri, Kansas, Iowa, Nebraska, Minnesota, South Dakota and North Dakota. All of those states have rural areas, where Medicare beneficiaries may have difficulty obtaining power wheelchairs in the future.
MM: Sounds like the elimination of the first month purchase option will be a disaster for Medicare beneficiaries in rural areas?
SLOAN: Yes, there are not many providers in rural areas where the population is less than in cities. Smaller providers right now cover those areas, but as smaller providers opt out of the Medicare program, beneficiaries will be lacking for service.
MM: Is it disappointing that CMS and other Washington policymakers don't understand the consequences of this policy change?
SLOAN: Yes, there very clearly is a disconnect with Washington. And, unfortunately, it looks like Medicare beneficiaries will be the victims.
Medicare Advantage enrollment does not affect frailty trajectories