Study sheds light on problems with failing wheelchairs covered by Medicare/Medicaid.
In her dozen years at the University of Pittsburgh’s Center for Assistive Technology, D.J. Stemmler has seen a sea change. The center’s administrative manager has ridden that wave herself, scooting around the accessible Forbes Tower offices in a power wheelchair of her own.
When it functions.
“When I first started working here in 2000, I’d see people coming in with chairs 20 years old and more,” says Stemmler. “They lasted forever. Folks would be really reluctant to replace them. Now, what I’ve seen the past four, five years is a trend that’s the opposite: Folks looking to replace chairs right away. Replacing motors, actuators — things that should last.”
She notes that many of today’s wheelchairs not only fail to last as long as government standards say they should, but the chairs don’t fare well at all.
“The Medicare/Medicaid standards say chairs should last up to five years. We not only have chairs that aren’t making it five years, but they aren’t functional, reliable or safe for those five years,” says Stemmler. “I use my chair seven days a week, 20 hours a day. We’re wage-earners, we’re mothers, we’re fathers, the same as anybody else – we’re just doing it sitting down. And the chairs aren’t holding up.”
Growing Exponentially
A research paper published by one of the founders of the center, Department of Physical Medicine & Rehabilitation chair Michael Boninger, MD, puts some actual numbers on Stemmler’s observations.
Earlier this summer, Boninger’s research showed more than half of people with spinal-cord injuries (SCI) sustained at least one wheelchair breakdown in a six-month period. More than one third experienced two to
three malfunctions.
Boninger, the lead author with five others of the 2006–11 study published in the American Journal of Physical Medicine & Rehabilitation, noted the number of consequences per participant was double the statistic found in their 2004–06 study. In sum, the problem was growing exponentially.
Stemmler performed some quick research of her own, poring over the center’s power-wheelchair orders from May 2011 to May 2012. Of 20 users, 13 already had serious issues — “not batteries or tires,” she says. Two already had their chairs replaced.
Boninger’s study found problems existed among manual wheelchairs as well, although nearly two thirds of all consequences were reported by power-wheelchair users — especially those equipped with power-seat functions.
In the 15-page paper, the result of a study encompassing 723 participants, the authors found people on Medicaid and Medicare reported a significantly higher amount of consequences than individuals funded through the Department of Vocational Rehabilitation, Worker’s Compensation, and the Department of Veterans Affairs (VA).
They posed the possibility that, beyond a lack of manufacturing quality, “changes in insurance reimbursement policy and . . . standards enforcement” may be at the heart of this worsening issue.
Tipping Point
Mark Schmeler, PhD, former center director, along with Boninger, harks to the 2006 alteration in policies covering powered-mobility devices for the Centers for Medicare & Medicaid Services (CMS) as the tipping point.
The changes, Schmeler says, were “an attempt to control pockets of waste, fraud, and abuse by some unscrupulous suppliers, manufacturers and doctors.”
Yet, he adds, CMS soon found that power-wheelchair expenditures tripled in a three-year period. So the new policy “included a significant cut in the allowable cost of a power wheelchair and re-emphasized that the devices were to be designed and provided for use in the home.”
In short, the policy change turned wheelchair usage outside-in, for Group IV devices “were categorically determined to be noncovered items by CMS as not medically necessary because they had features that were inherent to outdoor use,” says Schmeler. “Unfortunately, most CMS policies trickle down to other payers, including state Medicaid programs and especially private insurance.
“Therefore, it is no surprise there is an increase in wheelchair failures over the past few years and that there are fewer failures in devices covered by programs like the VA that do not adopt such a restrictive policy and actually support people to go outside their homes and participate in society. This CMS policy is also hypocritical because they do not apply the same restrictions to prosthetic limbs.”
Stuck in Bed
Fewer and fewer wheelchair users utilize a backup plan.
The authors reported a 50% drop from their previous study in the number of individuals owning a backup wheelchair. Indeed, more and more users found themselves suddenly and stunningly stranded, akin to half the motorists clogging a major highway with a vehicle that instantaneously quit functioning.
“What makes these failures so important is that the individuals in the study completely rely on their chairs for independence,” Boninger says. “If their chair fails, they can go from completely independent and fully participating in society to being stuck in bed.”
Absences of timely, nearby service and product quality come into question. Independent testing may be one way to solve product problems. Certainly, Stemmler in her everyday duties notices changes in manufacturing quality.
“What was made with metal is made with plastic. Things that were standard aren’t standard anymore,” Stemmler says.
A user named Rob, who preferred anonymity, was the passenger in a minor automobile accident. His wheelchair twisted while tied down and bent so badly it had to be replaced.
A Call to Re-evaluate
“This paper should serve as a call to re-evaluate and revise current policies and standards testing for wheelchair prescription in the United States,” the study authors concluded.
Schmeler adds there are many problems to deal with, and there hasn’t been much help from the business side of things.
“The wheelchair industry has done little to police itself,” he says. “There remains significant pockets of waste, fraud, and abuse as well as a lack of consistent design and manufacture of wheelchairs to accepted standards.”
