Columbia, S.C.
Stakeholders said they are concerned that in an effort to save Medicare dollars, the final local coverage determinations for power mobility devices will put patients in the cheapest and lowest-quality equipment.
The new LCDs, issued by the Medicare DME Program Safeguard Contractors last month, are effective for claims with dates of service on or after Oct. 1. The LCDs incorporate the 64 new codes for power wheelchairs and power operated vehicles issued in June and include coverage criteria for each individual group of codes.
According to the DME PSCs, the new policy identifies a number of situations in which a “least costly alternative determination” may be made. “The fact that a PMD meets the coverage criteria specified in this policy does not necessarily mean that the item/code will be paid in full,” the document said.
“The biggest concern is that this medical policy will essentially downcode the majority of patients into the lowest-quality products currently out there on the market,” said Seth Johnson, vice president, government affairs, for Exeter, Pa.-based Pride Mobility Products and chairman of the American Association for Homecare's Rehab Council.
According to Johnson, the standard for Group 1, the least expensive PMDs, is lower than 95 percent of products on the market today.
Laura Cohen, a clinical research scientist at the Shepherd Center in Atlanta and co-coordinator of the Clinician Task Force, said she does not think the policy will save Medicare anything.
“People will be forced into less robust equipment but will be using it for all of their activities. Because of that, I think some of this equipment will break down prematurely or need replacing, which will, in the long run, cost taxpayers more money,” she said.
