Chad Japhet has used a wheelchair since he was paralyzed in a motorcycle wreck seven years go.
For him, custom cushions — he has three, for different situations — aren’t a luxury, but a necessity.
“Every injury is different, and no cushion is the same,” explained the 46-year-old Olympia man. “A standard, cheap cushion — you can end up developing pressure sores. You’re in your chair most all day, so it’s a big thing.”
However, an impending Medicare change is poised to make it more expensive for people like Japhet to get custom wheelchair accessories and seating systems.
The result of the change, opponents say, is that next year reimbursement rates will go down and out-of-pocket costs will rise for items such as cushions, power recline and tilt systems and specialty drive controls.
Some Tri-Citians are part of an effort to reverse the change — promoting a petition to the White House, reaching out to lawmakers and encouraging others to do the same.
“The reality is, this is less than budget dust (for Medicare). It is almost negligible in terms of the effect on the Medicare budget,” said Josh Anderson, a vice president of the Pasco-based TiLite, which is part of the Permobil family and makes individually customized manual wheelchairs. But “somebody who uses complex rehab technology, and uses an accessory, can’t live without it. In many cases, (losing) it would be catastrophic to their ability to get around.”
The Herald contacted the Centers for Medicare & Medicaid Services but didn’t get a statement in response.
Deadline to sign the national petition is Oct. 25. As of Thursday afternoon, about 72,800 more signatures were needed to meet the threshold for a review by the White House.
A bill also is working its way through the U.S. House of Representatives. Rep. Dan Newhouse, R-Wash., is the first representative from the state to sign on as a co-sponsor.
Sen. Patty Murray previously signed off on a letter opposing the Medicare changes.
Although the change would affect a relatively small number of people, it’s a population that’s particularly vulnerable, said Anderson and others.
About 4 million people in the U.S. use wheelchairs. Of those, about 400,000 use complex rehabilitation technology, or chairs that are tailored specifically to them. In those cases, “we’re talking about a wheelchair that’s a wheeled prosthetic, that is made to measure for that specific person because they use it as their means for getting around,” Anderson said.
The change isn’t justifiable medically, and it doesn’t make sense financially in the big picture, he said.
A custom cushion made to fit the user’s body can cost $400 to $600; Medicare covers between $317 and $362 now, but under the change the amount would drop to about $289, according to information from TiLite.
Meanwhile, treating a pressure ulcer can cost $70,000 to $100,000, said TiLite.
Anderson said the rule change represents a slippery slope, noting private insurance could follow in Medicare’s footsteps.
National groups such as the Muscular Dystrophy Association have publicly opposed the change.
For Japhet, who uses chairs from TiLite, the change wouldn’t have an immediate impact. He’s covered by private insurance.
But, for those on Medicare, “that’s going to make a big difference in their mobility and quality of life,” he said.
Anderson added that, “I really want people to think about their own situation. In their own daily lives, if they didn’t have access to the health aids that they needed, whether that’s a prescription or piece of medical equipment — how would they be affected? Then multiply that by 100. That’s what’s happening to these individuals.”
To learn more about the petition, go to tinyurl.com/complexrehabcuts.