Wheelchair lobby takes on Medicare

Armand Legault must make a pretty persuasive lobbyist.

The 58-year-old Connecticut resident is knowledgeable, articulate and good-natured. But when it comes to his efforts to convince Congress to protect patients’ access to complex power wheelchairs, Legault’s best asset might be his physical presence.

{mosads}Legault is paralyzed because of muscular dystrophy and is only able to move around – and get to Capitol Hill – because of his wheelchair, a custom-fitted, high-tech contraption with gears and levers that allow him to position and reposition his body.

In an ordinary electric wheelchair, Legault would be vulnerable to circulation problems and painful pressure sores.

“You can’t just get fitted for a wheelchair like this off the street,” Legault said. It can take 10 visits to a vendor to fit the chair properly.

Now Legault is worried that changes to a Medicare program designed to cut costs could affect the quality of service associated with these high-end wheelchairs.

An army of professional lobbyists is working toward the same goal as Legault, a retired state tax auditor and patient advocate, but their mutual success is far from assured.

In a series of lobbying meetings in April, organized by Quinn Gillespie & Associates and the National Coalition for Assistive and Rehab Technology (NCART), Legault and the lobbyists have sought to convince lawmakers to exempt complex wheelchairs from a new competitive bidding program for Medicare.

Perhaps foremost among the difficulties will be making lawmakers understand the difference between these Stephen Hawking-style wheelchairs and standard electric wheelchairs and scooters, which are costing Medicare hundreds of millions of dollars a year in spending. Those costs have raised eyebrows on Capitol Hill.

Under Medicare’s new program, durable medical equipment (DME) suppliers have to bid to be allowed to sell their products to Medicare beneficiaries. It is a business worth billions of dollars: the program covers items ranging from diabetes test strips and walkers to oxygen tanks and power wheelchairs, both simple and complex. In all cases, suppliers will get paid less than they are now.

NCART is a relatively small contributor to the high-stakes lobbying mission, which has been intensifying for almost five years.

Medicare will spend $468.1 billion this year. NCART says it would cost  $46 million over the next five years to exclude complex rehabilitative equipment from the program.

Medical equipment industry representatives and patient advocates will plead their cases at a hearing before the House Ways and Means Health Subcommittee on Tuesday. Centers for Medicare and Medicaid Services (CMS) acting Administrator Kerry Weems is expected to defend the program.

Influential corporate interests, especially wheelchair and oxygen suppliers like Invacare, are furiously working to get Congress to postpone the program. Lobbyists say CMS is mishandling the program, that the pay rates are too low to cover the cost of providing the supplies and that patients are going to be stuck with poor service from suppliers that low-balled their bids to win market share.

CMS says the program has adequate safeguards to guarantee access to high-quality equipment.

The challenge faced by Legault and NCART lies in trying to convince Congress that they are not just one more special interest complaining about Medicare payments – a popular sport in Washington.

“As you can probably imagine, the DME industry would love to have this be the face of their cause,” said Allison Giles, a Quinn Gillespie lobbyist who represents NCART. Giles was a senior staff member on the House Ways and Means Committee when the competitive bidding program was conceived.

NCART’s members should not have been included in the program in the first place, and were assured by CMS they would not be, said Richard Forman, the president of Tisport, a wheelchair manufacturer based in Washington state. Giles said lawmakers were not taking aim at complex wheelchairs when creating the bidding program.

A CMS spokesman flatly denied that complex wheelchair suppliers were ever told they would not be part of the program or that the agency went against congressional intent. “This is just not true,” he wrote in an e-mail.

{mospagebreak}In the coming days, CMS will announce the winners of the first round of bids. The program takes effect on July 1 in 10 metropolitan areas. Also in July, CMS will begin accepting bids for 70 more metro areas as part of a multi-year, nationwide phase-in.

Patients like Legault could face big changes. Many will have to sever long-standing relationships with trusted providers. On the other hand, they stand to save money as a result of the lower average prices CMS promises.

{mosads}“The problem is, guys like myself, and there are quite a few of us out there, are going to have to take the hit for a study – and that’s not fair. I may end up losing the ability to get out of bed, OK, because somebody wants to do a study to see if the numbers fit,” Legault said.

Rep. Pete Stark (D-Calif.), the Ways and Means subcommittee chairman who has been skeptical of industry complaints, expressed openness to modifying the program.

“We have heard from both suppliers and beneficiary advocates that the [medical equipment] competitive bidding program is not working as well as it is supposed to. I look forward to hearing their concerns, as well as from CMS, as we consider whether changes need to be made before the program is further expanded,” Stark said in a statement that accompanied the hearing advisory.

House Minority Leader John Boehner (R-Ohio) is the most prominent lawmaker to call for the program to be pushed back. Freshman Democratic Rep. Jason Altmire (Pa.) has led a rank-and-file movement in the House.

Ohio Sens. George Voinovich (R) and Sherrod Brown (D) and Pennsylvania Sens. Arlen Specter (R) and Bob Casey Jr. (D), among others, have written the administration to complain about the program.

The complex wheelchair advocates have their own champions in Reps. Tom Allen (D-Maine) and Ron Lewis (R-Ky.) and Sens. Debbie Stabenow (D-Mich.), Tim Johnson (D-S.D.) and Olympia Snowe (R-Maine), who have sponsored legislation to get them out of the bidding program.

{mospagebreak}Congress instructed CMS to design and implement the competitive bidding program in a 2003 statute.

Lawmakers saw evidence mounting  that Medicare spending on durable medical equipment was growing at an alarming rate. Medicare spending on power wheelchairs spiked 450 percent between 1999 and 2003, when it topped $1 billion, according to the Government Accountability Office.

{mosads}“When they hear ‘power wheelchair,’ they think of overutilization and fraud and abuse,” said Paul Bergantino, the president of ATG Rehab, a Connecticut-based vendor of power wheelchairs, scooters and other equipment.

“We got caught in the crossfire,” said Bergantino, whose firm supplies and services Legault’s wheelchairs.

Legault is worried about what all of this will mean to him and his health. A vendor that does not specialize in complex wheelchairs cannot provide the service he needs, he said.

“They’re going to deal with me? … They’re going to laugh and walk away. … They have no idea what is entailed, so I’m going to get a bad product.”

The Week in Congress

APPROPRIATIONS
• The House Appropriations Defense subcommittee has scheduled a hearing to discuss outsourcing of the federal government’s defense contracts on Wednesday at 1:30 p.m. in Room 140 of the Capitol.

• The Senate Appropriations Labor, Health and Human Services and Education subcommittee has scheduled a hearing to discuss the Labor Department’s budget request on Wednesday at 9:45 a.m. in 124 Dirksen. Labor Secretary Elaine Chao is scheduled to attend.
 
• The Senate Appropriations Energy and Water Development subcommittee will review the Energy Department’s decision to restructure the FutureGen program at a hearing on Thursday at 9:30 a.m. in 192 Dirksen. Energy Secretary Samuel Bodman is scheduled to attend.

COMMERCE
• The House Energy and Commerce Telecommunications and the Internet subcommittee will review the Internet Freedom Preservation Act of 2008 at a hearing on Tuesday at 9:30 a.m. in 2322 Rayburn.

DEFENSE
Various House Armed Services subcommittees plan to mark up their portion of the 2009 defense authorization bill this week:

• On Wednesday, the Air and Land Forces subcommittee will meet at 10:30 a.m. in 2118 Rayburn; the Military Personnel subcommittee will meet at 11:30 a.m. in 2212 Rayburn; and the Strategic Forces subcommittee will meet at 1 p.m. in 2218 Rayburn.

• On Thursday, the Terrorism, Unconventional Threats and Capabilities subcommittee will meet at 9 a.m. in 2118 Rayburn; the Seapower and Expeditionary Forces subcommittee will meet at 11 a.m. in 2212 Rayburn; and the Readiness subcommittee will meet at 1 p.m. in 2118 Rayburn.

ENERGY
• The House Energy and Commerce Energy and Air Quality subcommittee examines issues relating to the Renewable Fuels Standard at a hearing on Tuesday at a 10:30 a.m. in 2123 Rayburn.

ENVIRONMENT
• The Senate Environment and Public Works Public Sector Solutions to Global Warming, Oversight and Children’s Health Protection subcommittee will review regulatory policies as they relate to science and the environment at a hearing on Wednesday at 9:30 a.m. in 406 Dirksen.

HEALTHCARE
• The Senate Finance Committee holds a hearing on health reform with former Health and Human Services secretaries Tommy Thompson and Donna Shalala on Tuesday at 10 a.m. in 215 Dirksen.

• The House Ways and Means Committee’s Health subcommittee will review competitive bidding for durable medical equipment at a hearing on Tuesday at 1 p.m. in 1100 Longworth.

• The House Oversight and Government Reform Committee holds a hearing on the effect of pending Medicaid regulations on hospitals’ capacity to respond to emergencies on Wednesday at 9:30 a.m. in 2154 Rayburn.

• The House Energy and Commerce Committee’s Oversight and Investigations subcommittee holds a hearing on direct-to-consumer advertising for prescription drugs on Thursday at 10 a.m. in 2123 Rayburn.