Are power wheelchairs moving the scooter market in a new direction? Several manufacturers are concerned that the current Medicare reimbursement structure is putting the brakes on some scooter sales. A scooter might cost less, they note, but it's harder to get Medicare approval for it than for a power wheelchair because Medicare views the device as a life-enhancement product rather than a medical necessity.

"The way the Medicare system is structured now drives the market," says Bob Senn, president of DCC Shoprider. "Overall, I think the scooter market isn't growing; actually, it's fairly flat. A lot of the business is going to power chairs. It's just a function of reimbursement."

Use of the Medicare K0011 code, which covers standard-weight power wheelchairs with controls, has, in fact, grown significantly since 1995, according to a report on code use compiled by the Health Care Financing Administration, Office of Information Services. In 1995, Medicare spent $23.6 million for K0011 reimbursement; by 1997, that number had jumped to $140.2 million, according to HCFA. Medicare's total reimbursement for scooters during that period was unavailable. However, a Durable Medical Equipment Carriers list does not include it among the top 500 products.

"We believe a number of individuals who would normally be put into scooters are put into power bases," says Bob Smith, vice president of sales and marketing for Golden Technologies. "We as a company feel that is impacting us significantly. If you were a provider, what would you do? Would you choose to make $1,000 on a scooter or $3,500 on a power base?"

Medicare reimbursement for a scooter averages $1,800, compared with $3,800 to $4,800 for a power wheelchair, manufacturers say.

Ron Weldon of Leisure-Lift agrees that power wheelchairs are siphoning off some business from the scooter market, but says scooter sales actually grew in 1998. "I expect 1999 to be a better year for scooters, because I predict reimbursement is going to get tougher on power wheelchairs."

Other manufacturers say more power chairs than scooters are being sold because of new advancements. Before the advent of mid-wheel-drive power wheelchairs, many scooter providers sold only a couple of power chairs a year, says Dan Meuser, senior vice president of Pride Mobility Products. "Until this innovation, providers had to turn away potential customers who couldn't operate the wigwag of a scooter or maneuver a rear-wheel-drive power chair in their home," he says. "Now that there is a product to fill that need, sales are growing."

Cash Is King Despite the reimbursement dilemma, most manufacturers agree the scooter market is still growing, although in a different direction. "There are," says Smith, "two significant scooter markets: the third-party payers, and the private individuals who do not qualify under Medicare but have discretionary income."

A lot of providers have forgotten about cash sales because of the focus on Medicare reimbursement, says Mike Bruno Sr., president of Bruno Independent Living Aids. "Demographics show this business will be strong for the next 25 years, because people over 50 control over 80 percent of the assets in this country and have money enough to pay for these products with cash," he says.

Senn says the difficulty in finding reimbursement for scooters has its up-side. "A positive trend that has come out of it is that a lot of our providers are becoming marketers as opposed to order-takers," Senn says. "You are seeing a new breed of provider. That seems to have taken off with mobility providers, which are more marketing-oriented than the HME provider of the past. The mobility providers have had to rely on marketing because such a small percentage of their overall marketing portfolio is covered by Medicare."