I must admit, when I first started working in the wheelchair industry, I was full of questions. Not only about the end-users, but also the products, the clinical reasoning and the overall process. There was a lot to learn.
I came from the Medicare world, so I understood the coverage criteria for all durable medical equipment, including all types of wheelchairs. But even then, I could not understand why the claims I saw had such crazy high dollar amounts. In time, I realized I did not know everything that went into developing complex rehab technology (CRT) and the process involved to complete the delivery to an end-user.
Like me, many people still ask: Why are wheelchairs so expensive? To understand this completely, we need to break things down.
First and foremost, we need to recognize the difference between “standard” mobility and CRT. Any person’s need for a wheelchair is certainly important, but there are varying types of wheelchair users. There are those that have issues ambulating, but their need is more typically for longer distance, extended time or outside their home. Wheelchairs for these users can be more “standard” and do not require much modification to fit the user. The features are more basic because the end-user’s needs are truly focused on longer distanced ambulation.
CRT wheelchairs have very different requirements, as these wheelchairs allow the end-user to be as independent as possible, both inside and outside their homes. CRT wheelchairs, especially power wheelchairs, must have the ability to meet some very complex needs – including both seating and electronics. These power wheelchairs are not what we call “sit and drive.” And it’s because of these complexities that prices start to climb.
CRT wheelchairs also require many clinical considerations to take place. These can be as simple as the “footprint” of the wheelchair, to how a power tilt system could change the seated position of the end-user, to how a person without use of their hands could safely and independently drive their power wheelchair.
It starts with the initial ideas, then engineering, development, testing, more testing, FDA requirements and submissions, insurance coding submissions, the actual manufacturing, education and, finally, shipping. It’s not only the frame of the wheelchair being developed but also the seating and electronics. This list just covers the manufacturers steps, and I am certain I missed at least some steps. Manufacturers will also review products while they are being developed with key clinicians and other Assistive Technology Professionals (ATPs) as well. Of course, all of this takes time and money, so you can see how costs start going up, especially when it’s done right.
One then must consider that manufacturers of CRT wheelchairs – power or manual – do not sell direct to the end-user; they sell to the equipment suppliers. This adds more costs as the equipment suppliers have their own expenses – and profits to make. Key areas that suppliers are responsible for are sales and insurance billing. This may sound rather simple, but it really is not. When working with clients needing CRT, it’s not like selling a cane right off the shelf or even a basic standard wheelchair.
The suppliers’ ATPs are part of the team who will work with the ordering clinicians/seating therapists, the end-user and possibly the caregivers. To start, a thorough seating evaluation is completed. This could involve multiple visits for certain end-users and could include varying trials of wheelchairs, plus there is the final delivery, set-up and adjustments. Meanwhile, the suppliers’ internal funding teams must collect all the documentation necessary to submit for any required prior authorization and eventually a claim to their customers insurance. Each of these functions take time, and there is no separate payment for this from the insurance companies.
I always tell people to think of their doctors’ bills or hospital bills, which can be especially frightening. One single Tylenol pill could be charged at a rate of $15 – one pill, not one bottle. By all means, the insurance companies do not pay $15 – everything is negotiated – but it all varies based on each insurance plan. Sadly (and reason enough for a whole different article), those without insurance are stuck with the $15 charge.
So, back to the original question. Why does a power wheelchair cost so much?
As you can see, there are a lot of pieces to this puzzle. All types of wheelchairs are considered medical devices, so they inherently have regulations that must be met. Add to the fact that we are talking about CRT, and this makes them that much more complex in the overall process.
It can be frustrating and sad that insurance companies continue to try to lump all types of wheelchairs into the same category – CRT & Standard Mobility is a lot like apples and oranges. Insurers also continually try (and sometimes succeed) in lowering what they will pay for items. Everybody’s costs continue to rise, but somehow Medicare and other funding sources continue to drive pricing down. This causes technology to be stifled and end-users to lose out on improvements that will truly make their lives better. Don’t you think it’s time for a change?
Claudia Amortegui is president of The Orion Group, a consulting company specializing in the reimbursement of rehab equipment. Her extensive and diverse experience comes from consulting for over 20 years, and from working on all sides of the industry, with Medicare, a manufacturer, and a provider. She has been published numerous times in national industry publications and has conducted education programs throughout the United States and Canada.