Living Without the First-Month Purchase Option: 'We're not Thrilled'

ATLANTA — Medicare's elimination of the first-month purchase option for Group 2 power wheelchairs is entering its third week, and already problems are surfacing that reach beyond the bottom line, according to mobility providers and others.

CMS implemented a new reimbursement model on Jan. 1 that effectively turns standard power wheelchairs into rentals. Rather than getting paid up front for the expensive products, providers must now wait 13 months for the full payment.

Even though it is early in the game, stakeholders are reporting issues ranging from beneficiary access to clear guidance on provider compliance requirements.

"We're not thrilled with the process," said Jim Greatorex of Black Bear Medical in Portland, Maine. "The problem we are seeing is not so much financing, although we are certainly going to have to limit our choices as to what people get. The biggest issue is catching the clients who go into skilled nursing facilities and having to take [the wheelchairs] away from them.

"We're having to be the bad guys. We're going to have clients furious at us for taking their power wheelchairs away … We're talking about a very emotional thing here."

He's also disturbed that patients who go 60 days without the benefit because they are hospitalized or in another facility will have to be re-evaluated all over again to prove medical necessity once they are released.

"Again, who is going to be the villain in this?" Greatorex asked. "Those are extremely negative experiences we are going to have with our clients."

"There is more than a payment methodology change," acknowledged Julie Piriano, director of rehab industry affairs for Pride Mobility Products in Exeter, Pa. "There is some concern with regard to effectively managing through the long-term, 13 months of capped rental."

Documentation is relatively clear for static situations, Piriano said, but beneficiaries are rarely static. They move around. They travel. They go in and out of hospitals and nursing facilities. Once released, they might go to a relative's home for a time rather than their own home.

"There is no clear guidance once it gets complicated," Piriano said. "The logistics of the documentation and the condition of the equipment are really of concern ... When there is a break in service like that, this is expensive equipment and you can't keep track of where it went or who took it. That's a high-value asset to lose."

The issue becomes even murkier if beneficiaries live outside a competitive bidding area and travel into a CBA.