Why You Need to Ask for Your Cushion by Name

Guest blog post by Bob Vogel

In my experience with DME (durable medical equipment) dealers, competition leads to quality. I was injured in 1985 — a T10 complete paraplegic — my first cushion and wheelchair were covered by Medicaid and provided by a local DME dealer. In the 90’s I worked as a sales rep for a wheelchair manufacturer, selling to and working with DME dealers. After that I worked as a sales rep for a DME dealer.

In my experience, a good DME dealer has the knowledge and takes the time to properly fit and provide the best cushion, wheelchair, etc., to meet their client’s needs. DME dealers strive to provide the best service and best products to meet our needs because it’s the right thing to do, and because it’s good business. We have the power to take our business to another DME dealer and word of mouth — good or bad — is powerful when it comes to business.

Unfortunately, because of competitive bidding, this paradigm is changing. The CMS (Centers for Medicare and Medicaid Services) competitive bidding program has DME dealers bidding to see who can provide equipment in a certain category for the lowest price — for you and I this category complex rehab, from cushions  and wheelchair backs to manual chairs and high-end power chairs. Round I of competitive bidding is already in place in 9 regions. Round II of competitive bidding is looming on the near horizon with 91 regions including the largest cities in the country.

Under competitive bidding, instead of Medicare beneficiaries having five to ten Medicare providers to choose from that compete based on the quality of the products and service they provide, we may only have one in our region — eliminating the competition and the need to provide quality products and service. Have a local DME dealer who didn’t win the bid that you have been going to for years? Tough. Don’t like the way the winning bid DME dealer does business? Tough. It’s not just Medicare — Medicaid and many private insurance companies have track records of following the Medicare competitive bidding guidelines.

The way competitive bidding is set-up encourages DME dealers that are only concerned with profit to underbid DME dealers that are truly concerned with providing the right product for their client. As an example, let’s take a look at a common type of cushion. Let’s say your skin and seating requires a ROHO^® HIGH PROFILE^® Single Compartment Cushion — the government HCPCS (Healthcare Common Procedure Coding System) code for this type of cushion is E2622. Now let’s say there is a dealer who is only in it for profit, winning the bid, and becoming the only game in town. Medicare’s Pricing, Data Analysis and Coding (PDAC) for E2622 includes 915 different cushions. According to this data, every cushion on the list will protect your skin just the same. If dealer only who is in it for profit carefully goes through the list they will find some real “bargains,” including a layered foam cushion with a 1/4″ gel cover that retails for $39. But hey, it fits into the code so it “should” protect your skin just like a ROHO HIGH PROFILE Single Compartment Cushion — right? Wrong!

When I left rehab in 1985, my therapist sent me home on a memory-foam cushion saying it “should” protect my skin just as well as the ROHO HIGH PROFILE Single Compartment Cushion I had requested. Despite regular weight shifts, I developed a tiny pressure ulcer within 3 months. Regular mirror-skin checks enabled me to catch it right away — I got the ROHO Cushion and was able to heal at home, feeling like I had dodged a bullet.

A dealer only interested in profit could submit a lowball bid of say $250 for this category — win the bid and start shoving $39 cushions under clients while collecting $250 per cushion from Medicare.

This is why it is vital that you, working with your clinician, request the exact cushion that you need on a doctor’s prescription/documentation. Because even if you are in an area that already has competitive bidding, there is a clause in competitive bidding that says if a doctor’s prescription specifies the make, model and product, then the winning bidder — the DME dealer — has to provide that cushion, or find another winning bidder DME dealer that will provide the cushion. As competitive bidding looms, it is more important than ever for each of us to advocate for our proper seating. Make sure your prescription includes exactly what your seating needs are, for example ROHO® HIGH PROFILE® Single Compartment Cushion (4″). Make sure the size of the cushion needed is included on the prescription, for example 16″ x 16″.

In addition, there is still time to phone, email, or write your representative and senators and tell them you do not want competitive bidding. Explain that while competitive bidding may save money in the short term, the wrong cushion risks life threatening pressure ulcers that will cost taxpayers in excess of $50,000 per occurrence in hospitalization alone.

So what can you do to change the outcome?
1. Send letters to your representative and senators. It’s OK if you don’t know what to write, we have a letter already written and all you have to do is fill in the blanks.
2. Go to competitivebiddingconcerns.com and fill out a form to record your personal struggles with getting mobility equipment.

To view the list mentioned in this blog, go to the Medicare Pricing, Data Analysis and Coding list (PDAC) https://www.dmepdac.com/dmecsapp/do/search. Next, scroll down to the green bar that says “Search DMEPOS Product Classification List.” Under the green bar to the right, type in E2622 and click on the purple GO button and all 915 cushions that meet the criteria for this code will appear.

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Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog.

Pressure Ulcer Webinar Recordings Now Available

This past summer the National Pressure Ulcer Advisory Panel hosted two webinars on pressure ulcers. Because of the limited capacity and high interest, the NPUAP is now offering recordings of the webinars. For a limited time only, you can save $25 when you purchase BOTH webinar recordings!

More information on the educational webinars is below.

To order, please go to http://www.regonline.com/recordings. To obtain your $25.00 savings on the purchase of both webinars, please select the first product option to purchase the recordings of webinars 1 AND 2 for $125.00.

Pressure ulcers are avoidable — Or are they?!
June 22, 2011
Participants will learn how to:
1. Compare and contrast the terms “avoidable” and “unavoidable”
2. Identify physiological issues and clinical conditions that may contribute to the development of unavoidable pressure ulcers
3. Identify other factors potentially contributing to pressure ulcer development (nutrition, staffing, medical devices, etc.)

Presenters:
Diane Langemo, PhD, RN, FAAN
Laura Edsberg, PhD

How do I stage THIS pressure ulcers?! Staging issues and root-cause analysis for pressure ulcer development
August 3, 2011
Participants will learn how to:
1. Delineate staging challenges and how to address them
2. Describe the root-cause analysis process for agency-acquired pressure ulcers
3. Discuss patient scenarios of pressure ulcer development within the root-cause analysis process

Presenters:
Diane Langemo, PhD, RN, FAAN
Joyce Black, PhD, RN, CWCN, CPSN, FAAN

Competitive Bidding Advocacy Letter July 2011

Don’t know what to write in a letter to your representative and senators regarding competitive bidding concerns? Don’t worry, we have you covered. Simply copy and paste the letter and fill in the blanks for the letter below. Then send the letter to your congress people. To find out who your US Representative and Senators are and how to contact them visit http://www.contactingthecongress.org/.

_________________________________________________________

<DATE>

 

The Honorable __________

______________<Senate / House> Office Building

Washington, DC 20515

Dear <Senator / Representative> _________________:

I am writing to express my concern regarding adjustable skin protection seat cushions being included in the second round of Medicare’s Competitive Bidding Program.  Clearly there is a wide disparity of opinions regarding this program for durable medical equipment (DMEPOS).  However, there is one thing on which everyone appears to agree.  For the DMEPOS competitive bidding program to be considered a success it must:

• Produce real cost savings for the Medicare system and beneficiaries.
• Insure that beneficiaries have ongoing access to the quality goods and services that they need. 

In order to achieve these goals bidding rules and product specifications must be clear, concise and distinct.  If this does not occur bidders would be incented to factor minimal service and only the cheapest products into their bids resulting in a race to the bottom regarding quality and access.

Currently Medicare is using Healthcare Common Procedure Codes (HCPCS) to bid products.  The HCPCS codes that adjustable skin protection seat cushions are assigned to (E2622-E2625) are not clear and concise.  There is a wide variety of products assigned to these codes comprised of various materials, shapes, sizes, performance, durability, adjustability and, subsequently, bidder cost.  Yet, these codes were included in round one of bidding.  The evidence from round one reinforces the concern that beneficiary access will be restricted to products that cost the winning bidders the least to obtain, rather than those that most effectively address the beneficiaries’ needs.  As such, the program goal to maintain beneficiaries’ access to quality goods and services they need will not be achieved.

In addition, the intent of adjustable skin protection cushions is to reduce the incidence of skin breakdown.  Wheelchair bound individuals over the age of sixty-five are at the highest risk for skin breakdown and have the greatest incidence of breakdown.  Skin breakdown in and of itself is debilitating; however, it can also lead to numerous other complication, including death.  Further, the cost to treat and heal skin breakdown can cost over one hundred times more than the cost of a cushion that may have prevented skin breakdown from occurring.  Any increase in the incidence of breakdown resulting from bidding these under-defined codes could actually produce an increase in costs to the Medicare system and beneficiaries.   As such, the program goal to reduce cost is unlikely, and costs may actually go up.

For these reasons we would ask that you reach out to CMS and direct them to work with experts in the field of adjustable seating to enhance the definitions and minimum specifications for the adjustable seat cushion HCPCS codes in order to insure that these codes do represent distinct, homogenous groups of products.  Further, the adjustable seat cushion HCPCS codes (E2622-E2625) should be excluded from future rounds of competitive bidding until such enhancements to these codes are implemented.

Thank you very much for your time, consideration and support in this matter.

Sincerely,

The Net Impact wins TAM Award for The ROHO Group’s Homepage Redesign

The Net Impact, a St. Louis-based internet and web development and design company, won a Gold TAM award in the Website Development—Landing Page category. The TAM Awards (Targeted Advertising & Marketing) Awards highlight the best business-to-business marketing campaigns in the St. Louis area. The awards honor agencies, companies and the individuals who make them. The awards are presented by the Business Marketing Association of St. Louis.

The awards feature several categories including print advertising, direct mail, trade exhibits, large format displays, promotional materials, public relations and human resource communications, corporate identity graphics, annual reports and newsletters, web development and social media, and multifaceted campaigns.

The awards reception was held on Monday, September 12, 2011 at the Starlight Roof at the Chase Park Plaza.

Congrats to The Net Impact team! We appreciate all that you’ve done!

Dad’s Dream Road Trip

by Bob Vogel

This past summer I was able to relive one of my favorite childhood memories of a family camping trip — at age 51 — when I took my 10-year-old daughter Sarah and my German shepherd service dog Schatzie on a 21-day 3000-mile road trip from California to Colorado.

In addition to packing the Jeep and trailer with an adaptive off-road bike, camping gear and luggage, I made sure to pack a “skin check” mirror and the right cushions. I’m in my 26^th year as a T10 complete para — over the years I’ve developed a pelvic obliquity, my left ischium (butt bone) sits lower than my right. To compensate for the obliquity I use a ROHO^® QUADTRO SELECT^® Cushion on my chair, and to protect my butt in the car I sit on a custom two-chamber ROHO that doubles as a handcycle cushion. This would be especially important on the 10–12 driving days that lay ahead. As a journalist I’ve written about many wheelers that have gone decades without a pressure sore, only to get one and spend many months in the hospital with major skin flap surgery. Twenty-six years after rehab, I still do a morning and evening mirror skin-check.

My plan for the trip was to “drive until it’s time to stop” and then find an inexpensive hotel room. This being tourist season, finding a room without a reservation at late hours was going to be tough enough, forget about finding an accessible room with a roll-in-shower. No problem, a ROHO ADAPTOR^® PAD on the standard shower floors gave me a safe — and clean — place to transfer down to.

Our first destination was a campground nestled high in the Rocky Mountains next to the Colorado River near Eagle, Colorado. I was there to compete in the Adventure TEAM Challenge — a three-day multi-sport adaptive adventure race. The race is made up of five-person teams — two athletes on each team must have a disability, one of which must be a wheelchair user, the other three team members are non-disabled athletes. The focus of the event is teamwork — working together to get all five members through a race that includes mountain biking, white water rafting, zip line, hiking, climbing and navigating in the mountain wilderness.

During the long race days I wore a climbing harness that I lined with ADAPTOR PADs — held in place with contact cement. Not only did this protect my skin going over rocky terrain — the harness made it easier for my teammates to help me transfer over difficult obstacles.

At the event, Sarah and Schatzie had a great time camping and were able to tag along with the camera crew to watch the race and cheer me on. The team I raced with ended up in 5^th place — the highest placing rookie team.

Our next stop was Winter Park, Colorado for the No Barriers Summit — a four-day seminar that included the latest innovations in adaptive sports and adventure, adaptive technology, disability-related scientific presentations and adaptive adventure films.

More than 600 people with disabilities from around the world attended this year’s summit. For four days the Winter Park village became a hub of disability culture.

Sarah joined me on an adaptive white-water raft trip on the Colorado River. At times she would excitedly call out “Daddy, that’s where we were taking pictures of you during the race!” Sarah and Schatzie were also able to participate in adaptive kayaking — Sarah with me in a double kayak, Schatzie swimming from shore to our kayak and back. During rafting and kayaking, my skin was protected by my harness with an ADAPTOR PAD.

From Winter Park, we followed the same route through Colorado that my folks drove when I was Sarah’s age. Highlights included touring the mining town of Leadville — elevation 10,152 feet — driving over the continental divide and spending a day in Aspen. We watched the 4^th of July fireworks in Telluride, a scenic mountain town at the end of a box canyon surrounded by 13,000-foot mountain peaks — each display would light up the canyon walls and the boom’s echoed about the walls to Sarah’s delight. I was relieved that Schatzie is not gun-shy — she fell asleep halfway through the show.

From Telluride we drove to Durango to ride behind a steam locomotive on the famous Durango & Silverton Narrow Gauge Railroad. The route goes through a steep gorge, high in the San Juan Mountains and offers amazing views. The engine and coaches were built in the 1800’s with one very cool addition — a wheelchair lift on the coach nearest the engine — the most coveted spot for a rail fan.

Sarah loved the view — but said “Daddy, I’m getting cinders in my hair.” I replied “when we were kids, Grandpa explained that a real rail fan loves the cinders and soot, and we would see who could get the most.” From then on Sarah kept her head out of the coach as much as possible.

By the end of the line, Sarah was covered with soot and grinning from ear to ear — so was I — and grateful to have had this experience when I was a boy, even more grateful to share it with my daughter!

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Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog.

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