By Jon Brodkin
Sunday, October 15, 2006

Medicare plans to decrease payments for power wheelchairs and scooters by as much as 41 percent, according to advocates for the disabled who say the plan will cause suppliers to stop selling wheelchairs and force disabled people to use inadequate equipment.

"People are going to get less quality power wheelchairs, which will then inhibit their ability to live independently," said Paul Spooner, executive director of the Center for Independent Living in Framingham. "They won't be able to go out into the community as much....Wheelchairs should be provided based on functional need, not cost."

The Centers for Medicare and Medicaid Services, in a recent press release about its plan to cut reimbursements, said it is designed to combat "numerous instances of fraud and abuse." Medicare expenses for power wheelchairs rose from $43 million in 1995 to $1.2 billion in 2003, an increase of 2,705 percent, according to the release.

Medicare reimbursements will drop by between 21 percent and 41 percent, depending on the equipment, under changes scheduled to take effect Nov. 15, according to opponents of the plan. Andrew Imparato, president and CEO of the American Association of People with Disabilities, said in a press release that "the Medicare mobility benefit as we knew it is gone."

Advocates for disabled people and the elderly say they will ask Congress to intervene.

Power wheelchairs can cost anywhere between $2,000 and $30,000, according to disabled people and manufacturers. The wheelchair Spooner uses cost $10,000, he said.

Medicare revamped reimbursements because it has been paying for top-of-the-line wheelchairs in cases where people received chairs of lesser quality, said Roseanne Pawelec, a Medicare spokeswoman in Boston.

"Medicare and the taxpayers were inappropriately paying prices that far exceeded market price for wheelchairs," Pawelec said. "This will benefit both the Medicare beneficiary and certainly the taxpayer, overall. You pay for what you get."

Pawelec said she did not know the exact amount by which reimbursements will be cut.

Medicare picks up 80 percent of the price it determines is appropriate for a wheelchair. Beneficiaries pay the remaining 20 percent, so their costs would decline if Medicare pays less, Pawelec said.

But advocates for the disabled and wheelchair makers said the new pricing scheme could result in elderly and disabled people paying more than they do now.

"The prices bear absolutely no relationship to what a marketplace price would be. Across the board there are significant cuts," said Cara Bachenheimer, vice president of government relations for Invacare Corp. in Ohio, the nation's largest maker of wheelchairs.

If Medicare determines a wheelchair should cost $5,000, and it actually costs $7,000, the Medicare beneficiary could end up paying 20 percent of $5,000 plus the difference between the actual price and the price Medicare believes the wheelchair is worth, according to opponents of the reimbursement plan.

Another possibility is that a Medicare beneficiary will be forced to accept a substandard wheelchair, according to Spooner.

"If someone needs a wheelchair and it costs $3,000 and Medicare is only going to pay $2,000, then the provider is going to be forced to give the individual a $2,000 chair," Spooner said.

Sitting in an inadequate wheelchair can lead to pressure sores, requiring hospital care, said David Heim, a Marlborough resident who uses a wheelchair. Heim runs a nonprofit that refurbishes used wheelchairs and sells them at reduced cost.

"It's ridiculous, that's for sure, but it makes my cause that much more important," Heim said.

Bachenheimer said medical equipment providers that sell Invacare's products have told Invacare they will no longer be able to distribute power wheelchairs if Medicare goes forward with its proposed payment reductions.

The expense of customizing wheelchairs makes the business a difficult one, even without cuts in reimbursements, she said.

"In this industry the profit margins hover in the 1 to 3 percent range," she said.

(Jon Brodkin can be reached at 508-626-4424 or jbrodkin@cnc.com.)