On Notice

When Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully announced his concern about the increased use of motorized wheelchairs (K0011s), he put the HME industry on notice that it is time to deal with this issue.

In response, our industry must develop a reasonable plan with multiple goals: We must educate policy-makers about why there has been an increase in the use of motorized wheelchairs. We must provide regulators with a process to ensure that all claims for motorized wheelchairs are medically necessary for those receiving them. Finally, we must initiate strategies that will give our industry greater credibility with policy-makers.

At the outset, providers must agree that there are two markets for motorized wheelchairs. The high-end rehab provider primarily serves consumers with permanent total disabilities, such as spinal cord injuries, etc. The consumer mobility provider serves seniors with a variety of chronic conditions that impact their ability to ambulate. I believe we would all agree that the majority of growth in motorized wheelchair use can be attributed to the consumer mobility market.

Changing Demographics

Why has there been such growth in this segment? Demographics, technology development and consumer awareness are three primary reasons.

When you look closely at those who are receiving motorized wheelchairs, you see that on the whole, these products are medically necessary.

Most motorized wheelchair users are over 70 years old, with an average age of 75. The demographics for this particular age category have increased dramatically, and the demands of this senior mobility market will continue to grow.

Improved Technology

Only five to 10 years ago, there were very few motorized wheelchairs on the market that were appropriate for operation in the average American home. Since then, manufacturers have developed motorized wheelchairs that, in both size and maneuverability, are capable of full use within most homes. They require few, if any, structural modifications to the average dwelling.

One of Medicare's criteria for covering a motorized wheelchair is that the wheelchair be usable in the beneficiary's home. However, before the technological developments in today's motorized wheelchairs, Medicare would not cover these items, because the products were not usable within the person's home — even though there were people who needed them.