Todd Aiazzone, sales and marketing manager, Merits Health Products, Cape Coral, Fla.; Mark Greig, senior product manager, power wheelchairs, Sunrise Medical, Carlsbad, Calif.; Scott Higley, national sales manager, Pride Rehab, Pride Mobility Products, Exeter, Pa.; Julie Jacono, senior product manager, power wheelchairs, Invacare, Elyria, Ohio; DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Dennis Sharpe, director, national HME, MK Battery, Anaheim, Calif.; Jack Sheehan, director of sales and marketing, Bruno Independent Living Aids, Oconomowoc, Wis.; Martin Szmal, general manager, reimbursement services, Pride Mobility Products, Exeter, Pa.

For all its advantages, HCFA's upgrade provision might create problems once it's finally implemented, industry experts fear. Funding sources, for example, could start looking for customers to pay for features that are medically justifiable now, says Mark Greig, senior product manager, power wheelchairs, Sunrise Medical.

Jack Sheehan, director of sales and marketing, Bruno Independent Living Aids, also wonders how much the upgrade provision will drive sales of power wheelchairs. "No question the upgrade provision is going to be a real positive for the Medicare recipient in terms of the broad spectrum," he says. "But in this category, by and large, people getting a power chair under Medicare are really not looking for a lot of very sophisticated things. There could be some movement there, but I think it could be limited."

One approach that could jump-start sales is consumer financing. As with other products for which customers pay out of pocket - scooters, for example - some manufacturers such as Invacare plan to help with financing. "It's a lot easier to swallow $50 a month to pay off your recline option versus a couple thousand at the time you get the chair," notes Invacare's Julie Jacono, senior product manager, power wheelchairs.

THE UPGRADE PROVISION should improve the economics of introducing new power wheelchair features and breathe life into some product options that have languished under the designation of unjustified medical necessity.

Take power seat lifts. As much as anyone might want them, Medicare rarely covers them - and sales have been far from hot. Since Merits Health Products introduced its PSL two years ago, for example, sales haven't been commensurate with the benefits it provides, says Todd Aiazzone, sales and marketing manager. "We've noticed not really that much increase over the last two years for power seat lifts," he says, noting that the upgrade provision should help more people get chairs with that feature - and beef up business.

The new rule might even inspire product innovation in this category - one historically hampered by reimbursement challenges. "Right now, there isn't a whole lot of new technologies coming over the horizon or much to motivate a manufacturer to come up with breakthrough things," says Julie Jacono, senior product manager, power wheelchairs, Invacare. "It's a concern how you are going to be reimbursed." But she says the upgrade provision could give manufacturers more impetus to add value.

"I think it will affect the way we look at designing wheelchairs," says Mark Greig, Jacono's counterpart at Sunrise Medical. "We may start packaging things [with a chair] that customers have been asking for, things that have never been justifiable but now make economic sense for us to start marketing."

And that would be a win-win-win situation for manufacturers, providers and users.