iBOT WHEELCHAIR'S PRICE TAG BUMPS UP AGAINST U.S.

HEALTH BUDGET -- But, VA is now providing $26,100

"wheelchair of the future."

Background here about the VA program that provides the iBot wheelchair to eligible veterans... http://www.vawatchdog.org/old%20newsflashes/newsflash12-26-2005-1.htm

Story here... http://www.bloomberg.com/apps/news?pid=20601070&sid=aOU7coSRoS2g&refer=home

Story below:

--------------- 

J&J's $26,100 Wheelchair Bumps Up Against U.S. Health Budget

July 18 (Bloomberg) -- Johnson & Johnson, the world's biggest maker of medical equipment, and about 70 nonprofit groups are fighting the U.S. Medicare program over a proposed coverage limit for a wheelchair that can climb stairs, curbs and even traverse gravel and sand.

Johnson & Johnson's device, called the iBot, is priced at $26,100, almost five times as much as the $5,300 that Medicare, the federal health plan for the disabled and people 65 or older, plans to pay. Users would be on the hook for the balance.

Three years after the iBot's introduction, a lack of Medicare coverage has limited worldwide sales to fewer than 1,000, as New Brunswick, New Jersey-based J&J tries to offset reduced drug revenue caused by generic drug competition. Wheelchair users say the U.S. government's efforts to keep Medicare spending in check is forcing them to forgo unprecedented independence offered by iBot's enhanced functions.

``It's frustrating to know the technology exists and is out of reach,'' says Laurel Labdon, 35, a former Miss Wheelchair Massachusetts. ``This is not just about the iBot. It's about changing the mindset of the health community. It's about not settling for what lets you just get by.''

Labdon says she would snap up an iBot to travel the streets of Brewster, on Cape Cod, in the event Medicare would cover the cost. Instead, she will stick with an almost-$30,000 wheelchair that lets her stand but not surmount curbs.

Private Policy

Labdon's private insurance company, which supplements expenses Medicare doesn't cover and helped pay for the chair, won't buy her another device. Medicare's limited reimbursement makes the iBot unaffordable, Labdon says.

J&J is trying to help people get around a U.S. rule that restricts Medicare coverage to equipment deemed essential for eating or bathing inside homes. As a result of federal law, agency officials say, Medicare can't pay for devices that climb stairs, sidewalk curbs, or traverse rough terrain.

``We are bound by the restrictions of the statute,'' says Laurence Wilson, director for chronic-care policy at the Baltimore-based Centers for Medicare & Medicaid Services.

Shares of J&J rose 45 cents, or less than a percent, to $60.91 yesterday in New York Stock Exchange composite trading. The stock fell 5.7 percent in the 12 months through yesterday, underperforming a 1.1 percent gain in the Standard & Poor's 500 Index in that time.

In an appeal to Medicare, J&J and allies are asking for expanded coverage for the iBot and other mobility devices for which the government limits payments. Among those siding with J&J are the Washington-based National Multiple Sclerosis Society, the Alexandria, Virginia-based American Physical Therapy Association and the Bethesda, Maryland-based National Spinal Cord Injury Association.

Invacare Objects

Power-wheelchair maker Invacare Corp., based in Elyria, Ohio, also is urging Medicare to reconsider its restriction.

At the same time, Invacare opposes treating J&J's chair as a special category. The company wrote in a comment to Medicare that granting the status to J&J would discriminate against manufacturers with comparable devices. Invacare's power wheelchairs don't climb stairs and so couldn't benefit from a special status granted for iBot and similar devices.

In a preliminary ruling, Medicare on April 28 rejected J&J's proposal to treat the iBot as a ``mobility system'' not subject to the wheelchair limit. The designation would be new, with a level of coverage to be set later. Medicare is accepting public comments before making its decision final.

`A Lot of Obstacles'

``There is no question that Medicare has decided to control costs,'' says Grant Bagley, a former federal policy maker for Medicare coverage of new technology. The program ``has a lot of obstacles that it can throw in the way of things that it doesn't want to pay for,'' says Bagley, now a lawyer at Arnold & Porter in Washington.

The iBot advocates have fired off more than 150 letters and e-mails to Medicare -- all posted publicly on a Web site -- in hope of swaying the ultimate ruling, due Oct. 26.

The cost of the iBot is justified, as the product provides ``a return to normality that is immeasurable, irreplaceable and priceless,'' wrote Craig Luigart, 52, a disabled former Navy aviator who is chief information officer at the health unit of the U.S. Department of Veterans Affairs in Washington.

While about two-thirds of the 2.7 million adult users of wheelchairs or power scooters in the U.S. are enrolled in Medicare, not all favor iBot funding. Jamie Stephenson, of Atkinson, New Hampshire, says the iBot requires more arm and torso strength than many disabled people possess.

`Extravagant'

``The price tag of over $25,000 is extravagant for a taxpayer-funded agency to pay while not covering other types of stair-climbing devices and manual assist wheelchairs for those too frail or weak,'' Stephenson, 56, a writer with the Web site of New Hampshire Challenge, a quarterly newsletter on disability issues, told Medicare.

Medicare's decisions on paying for costly new technology are often used by private health insurance companies to set their reimbursement rates. An estimated 55 percent of the disabled have commercial policies in addition to Medicare. People buy supplemental insurance, or they may be covered by their employers or former employers or family members' coverage. That doesn't ensure iBot coverage.

Insurers tend to look to the agency as an expert on assessing the need for technology, says Cara Bachenheimer, vice president for government relations for Invacare.

``Insurance companies tend to follow what Medicare does,'' she says.

WellPoint, Kaiser

Indianapolis-based WellPoint Inc., the biggest U.S. health insurance company by enrollment, won't cover devices that Medicare doesn't, says Kellie Bernell, a company spokeswoman. Kaiser Permanente, a nonprofit health provider based in Oakland, California, also won't pay for the iBot unless Medicare does, says spokesperson Alexandra Matisoff-Li.

Robert Gregory, 50, of Lincolnshire, Illinois, has private insurance that covers iBots. Gregory, who has multiple sclerosis, got his iBot under a Cigna Corp. plan provided by his former employer, Deerfield, Illinois-based Baxter International Inc., where he worked in marketing.

``Now I can get to people's houses,'' says Gregory, who works as a volunteer multiple sclerosis fundraiser and helps run a youth sports league. ``I can get to the field.''

The joystick-operated iBot has four-wheel drive, as well as software and gyroscopes that help balance the device. Those elements increase the price, J&J says. The company couldn't make a profit by selling the machines for Medicare's proposed $5,300, the standard amount for motorized wheelchairs, Howard says.

Congress `Leery'

U.S. lawmakers seek to curb health spending that may more than double the Medicare budget to $677 billion by 2013, the Congressional Budget Office says. Medicare consumes about 3 percent of the value of U.S. goods and services, and may eat 8 percent by 2036, according to the Medicare Payment Advisory Commission, which counsels Congress.

Even without the iBot, Medicare patients more than quadrupled their spending on power wheelchairs to about $1.2 billion in 2003 from 1999, the Government Accountability Office said in a November 2004 report.

In 2004, the latest year for which figures are available, Medicare patients spent $822.2 million on power wheelchairs, with the agency picking up $653.8 million, according to government figures.

That still leaves many Americans without any power wheelchairs, let alone iBots. A 2005 survey of disabled people in California found that 60 percent lacked equipment to help get around, says Steve Kaye, a researcher at University of California at San Francisco.

Advocates of the disabled, and J&J itself, say they will keep pressing the battle to increase Medicare payments on new mobility-enhancing technology, even in the event the company doesn't prevail now.

``It's like turning around a huge aircraft carrier,'' says Andrew Imperato, president of the Washington-based American Association of People with Disabilities. ``It's going to take a long time to get it pointed in the right direction.''

To contact the reporter on this story:
Kerry Dooley Young in Washington kdooley@bloomberg.net

---------------

Larry Scott

(go back to VA Watchdog dot Org Home Page)

	Web www.vawatchdog.org

FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such materials available in an effort to advance understanding of veterans' issues. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed an interest in receiving the included information for educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml   If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
 

Now we have VA Watchdog Stuff

Cups, Hats, Shirts and more

Click here to order and support the site