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When patients seek your help in getting a device that can allow them live at home instead of having to move to a long-term care facility, you have to navigate through a confusing maze of Medicare regulations to submit the order, only to find out that you are being blamed for the latest government healthcare expense boondoggle. What is really behind a recent government report blaming physicians for insufficient documentation for power wheelchairs?
The Medicare consumer guide on how to get a power wheelchair or scooter makes it all look so simple for patients: Visit with your physician to discuss your options, have your physician send a prescription to a mobility supplier, undergo a home assessment, and then have the equipment delivered to your home no more than 4 months later.
No wonder so many of your elderly or disabled patients seek your help in getting a device that can allow them to live at home instead of having to move to a long-term care facility.
Unfortunately, their dream can quickly turn into your nightmare: First, you have to navigate through a confusing maze of Medicare regulations to submit the order. Then you find out that, despite your best efforts, you are being blamed for the latest government healthcare expense boondoggle.
A recent Office of Inspector General (OIG) report found that 9% of wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary, and another 52% had claims with insufficient documentation to determine medical necessity, accounting for $95 million of the $189 million Medicare allowed for power wheelchairs during that period.
The OIG examined records submitted by suppliers that provided power wheelchairs and discovered that 78% of claims were medically necessary, based on the supplier’s records, but were not supported by the physician records.
So what’s the real issue here?
Jerald Winakur, MD, of the University of Texas Health Science Center in San Antonio told Medical Economics eConsult that hard-to-follow Centers for Medicare and Medicaid Services (CMS) requirements and the OIG report “are all about saving money for the Medicare program more so than trying to help frail elders live independently in their own homes.”
Winakur, who practices internal and geriatric medicine, also said:
• The documentation requirements for physicians who attempt to procure a power wheelchair for their patients are onerous, yet they receive “paltry” payment for their time and effort. That includes separate medical chart entries that duplicate other forms and a face-to-face visit for a "power mobility consultation" even for regular patients.
• CMS has failed to approve an attempt by several state medical societies to standardize such a form to explain the medical necessity more clearly. Winakur paraphrased the agency’s answer as: "Send us the information you think we want and somewhere down the line we will let you know if what you sent is sufficient for our determination."
• Those policies put honest power mobility companies that try to follow the rules at a competitive disadvantage to more unscrupulous companies who will deliver a device to patients and then make up the documentation after the fact.
While the American Association for Homecare (AAHomecare) was quick to point out that its members, the durable medical equipment suppliers, were blameless in all of this, it also leapt to the physicians’ defense.
AAHomecare President Tyler Wilson said that the OIG report does not focus enough attention on what his group considers the real problem-CMS’ failure to provide a comprehensive medical necessity assessment template that can be understood and used by all types of physicians.
Don’t expect the issue to go away anytime soon. U.S. Sen. Tom Carper (D-Delaware), chairman of the subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, said that he would work with others in Congress to take “the steps necessary to address this specific report's findings and address other areas of Medicare and Medicaid that remain vulnerable to waste, fraud, and abuse."