The Restore Access to Mobility Partnership (RAMP), a coalition working to ensure that all beneficiaries with medical need have access to mobility products, has been working with clinicians and consumers across the country to achieve this objective. This month, I'd like to take backstage and let one clinician explain her perspective on the current Medicare coverage policy for power wheelchairs.
Susan Taylor is a clinician at the Rehabilitation Institute of Chicago, one of the nation's leading providers of specialized therapy services. She has spent more than 20 years working with consumers with disabilities.
How do power wheelchairs help your patients?
As an occupational therapist, I have seen wonderful changes after powered mobility has provided someone with independent mobility. I have worked with individuals of all ages and disabilities, and providing powered wheelchairs is a large part of my recommendation for their independence. It helps them get from point A to point B in their rehabilitation.
Powered mobility is for anyone who is unable to walk safely or propel a manual wheelchair in all of the environments that they encounter. Mobility is not exercise; it's not a choice. We don't take the stairs because it's fun. We don't look for the farthest parking space at the mall. People need mobility to function.
Are power wheelchairs a key part of your treatment?
Ninety-eight percent of my patients are not ambulatory in a functional manner. Their choices are usually [among] a manual chair, an independent manual chair or some form of powered mobility. Researchers at the University of Pittsburgh have found that the repetitive stress of long-term use of a manual wheelchair negatively impacts the shoulder girdle, carpel tunnel/wrist area and neck.
For individuals aging with a disability, these long-term effects have sometimes resulted in the inability to use their upper extremities for daily activities due to the muscular damage or pain. Powered mobility is very important to sustaining these individuals over the long-term.
Do power wheelchairs have a psychological impact on your patients?
Anytime someone's mobility is restricted there is a devastating psychological impact, especially in relation to self-esteem and autonomy. Activities become too difficult to plan or manage; they become more dependent on others. Their worlds become smaller and smaller until they simply give up. Improving their mobility can improve their spirits and give them hope.
The psychological ramifications of not being able to self-propel or keep up with family and peers are also significant. Individuals who are empowered with independent mobility often demonstrate increased self-esteem, which has led to increased socialization, motivation to do other tasks independently and decreased “learned helplessness.”
Should Medicare pay for power wheelchairs?
Medicare should definitely pay for power wheelchairs. A population of aging adults and those with complications such as stroke, joint disease and other neurological involvement require powered wheelchairs for independence in getting from one point to another.
Independent mobility is a human right that should not be denied to anyone capable of achieving it. If someone lost a leg in an accident, Medicare would pay for prosthesis to provide [that person] mobility. When someone cannot walk without endangering their health, or push a manual wheelchair, he or she also needs mobility.
Restoring functional mobility should be the goal. A power wheelchair should be provided to help accomplish that goal. Moreover, providing a power wheelchair can also save the government money. A study by the Alliance for Aging Research found that an immobile senior costs Medicare $13,000 more per year than an independent senior.
Does the Medicare coverage policy have too many restrictions?
Yes. The most restrictive is the “in home use” policy. I just saw a man yesterday with end-stage renal disease and a history of stroke. He can make it around his house, but not in the community at all. He would like to get outside, but he cannot. He depends on relatives and cabs to get places.
I had to give him the news that he did not qualify for a power wheelchair. Naturally, he was very upset, and tears welled in his eyes.
What should the Medicare coverage policy say?
After discussion with several colleagues, we agreed that coverage for wheelchairs should include a formal assessment completed by a clinician and supplier with recommendations focusing on function, physical condition, complications and disease process, safety and environment. Anyone unable to walk without endangering his or her health should have alternative mobility. Prior authorization would provide for verification of reasonable payment to suppliers and a means of appeal for those who are denied.
A competitive bidding system is not the way to go as it does not take into account the expertise of the supplier/therapist team, evaluation and fitting time and services that can be provided by the supplier.
What have you noticed happening to patients over the last six months during the confusion over the Medicare policy?
A big change has taken place. The result is that clinicians can no longer use our judgment as to whether someone is functionally able to be mobile. The way it is now, if they can walk a few steps to the bathroom, they can't get a wheelchair.
There has been a lot of talk in Washington about what the policy should be. But clinicians I have talked with agree that … we are not going to give clients false hope by saying they can get a power wheelchair when Medicare claims that were approved previously are now being rejected.
The RAMP coalition includes power wheelchair providers, manufacturers and their representatives. Its members include Invacare Corp., The Med Group, Mobility Products Unlimited LLC, Pride Mobility Products, The Scooter Store, Sunrise Medical and the American Association for Homecare.
A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
