Among the differences I have discovered, since moving, between New York City and Portland, Maine is a much larger number of people in Portland who use power wheelchairs and scooters. I can’t prove that statement, but it appears to be so.

Hardly a day goes by that I don’t see elders and disabled people tootin’ along in the supermarket, the mall, Home Depot, Target and smaller stores too, and on sidewalks flat and steep. Many have baskets to carry belongings and purchases, and I noticed one with an umbrella attached in case it rains.

If you have ever been even temporarily disabled due to a broken leg or knee surgery or a foot injury, you know how maddening it is to be dependent on others for such simple acts as going to the kitchen for a glass of water, answering the telephone or, most difficult of all, to get the shopping done. For those who are permanently disabled, motorized scooters and wheelchairs help them remain as independent as possible, handle many of their own needs, and continue to be part of and contribute to their communities.

Now, on 1 October, new Medicare rules go into effect that some say will limit beneficiaries to low-powered, inexpensive wheelchair and scooter models that will not meet the needs of disabled people.

"’These changes will impact the thousands of people who will need power wheelchairs and scooters,’ Andrew Imparato, president and CEO of the American Association of People with Disabilities, said in a statement. ‘As Baby Boomers grow older, there will be an increased need to meet their mobility needs, but Medicare won't be there for them.’"

- Forbes, 12 September 2006

Ellen Griffith-Cohen, a public affairs specialist at the Centers for Medicare and Medicaid Services, said in a telephone interview that the new rules are an improvement, beneficiaries will get the equipment they need and some beneficiaries will pay less under the new rules (all pay 20 percent of the cost of the equipment).

That’s because, she says, the new payment rates and billing codes that go into effect on 1 October have been refined to more accurately reflect what wheelchair and scooter models are available in the marketplace making it easier to match a wheelchair to a beneficiary’s needs. And with these changes, says Ms. Griffith-Cohen, some people will save money on their 20 percent co-pay if, for example, a $2,500 wheelchair will do the job instead of a $5,000 wheelchair.

Geoff Swindle, the founder and president of Cirrus Data, an online customer acquisition company for the healthcare industry, said in an email interview:

“…no one will know how the changes in Medicare rules affecting mobility equipment will play out until some time has gone by. Equipment providers may not be able to afford the level of service they have delivered in the past, but in the longer term, they will improve efficiency and their ability to get the needed equipment to consumers in the same manner and at the same cost as in the past should not be disrupted.”

[Disclosure: Cirrus Data pays Time Goes By a fee for the power wheelchair and scooter advertisement in the right sidebar.]

It’s difficult to have an opinion on this change in Medicare, but I suspect that more rules will change as the number of baby boomers swell the ranks of beneficiaries in coming years. Two things are important: that beneficiaries get the care and equipment they need, and that costs be carefully monitored and contained when possible.

All bureaucracies are cumbersome, slow-moving and sometimes their decisions seem arbitrary. Bureaucrat-bashing is favorite pastime of anyone who has ever dealt with a governmental agency and often with good reason.

But I was impressed with Ms. Griffith-Cohen’s knowledge of the issue when I called, her eagerness to track down the correct answers to my questions – and, she passed on this useful bit of advice for all Medicare beneficiaries:

Whenever you have questions, a dispute, complaint or bureaucratic snafu regarding your care, go first to your Medicare carrier – the insurance company. If your issue is not resolved, then contact your regional office of the Centers for Medicare and Medicaid Services (CMS). They are the people charged with gathering information on what works and what doesn’t to help improve service and will follow up to resolve your problem.

On the issue of scooters, I believe there needs to be a policy change from the top. Medicare currently covers few scooters, which are meant primarily for outdoor use, because Medicare does not pay for durable medical equipment unless it is required inside the home.

As our population ages, the more we as a society can do to keep people mobile and independent for as long as possible will save untold billions of dollars in institutional care and homecare, and allow elders to continue to participate fully in the life of their communities.

Elderblogger PhoneCon Poll
I was surprised at the small response to yesterday’s announcement of Elderblogger PhoneCon on 24 October. I had expected that most regular readers of TGB would be interested in the opportunity to talk with one another, add another kind of conversation to the community and get to know one another a bit better. But maybe I’m mistaken. So let’s have a poll: