Technologists Still Watching Effects of Medicare Decision

by Terry Costlow

To be sure, technology provides ways for people to cope with disabilities. But products customized for specific disabilities are often expensive, and many times are not covered by insurance. Two years ago, in a move that’s still being analyzed throughout the field, Medicare approved payment for alternative and augmentative communication devices, bringing some long-awaited assistance to users.

One of the most visible users of this type of communication device is physicist Stephen Hawking, a sclerosis victim who uses a computer to communicate. Input devices range from keyboards to joysticks to user interfaces that use Morse code, among others. But as with many products for people with disabilities, these devices must often be customized; engineers and clinicians work with individual patients to tailor hardware and software to match specific abilities and needs.

Customized Systems are Costly

That customization makes assistive technology products expensive. Communications devices, for example, average $5,000. So it was a huge success for many people when Medicare added communications aids to the same category as wheelchairs and other medical necessities. And while benefiting those who need these devices, Medicare’s move has also boosted the market for such products.

“In my practice, it’s had a tremendous effect,” said Patricia Ourand, a Baltimore speech and language pathologist. Ourand said that her patients are mainly victims of Lou Gehrig’s disease. Most are typically in their 50s or older, so they are covered by Medicare. The coverage also allows for “fast-tracking” victims who aren’t yet old enough for Medicare.

Decision Has Far-Reaching Implications

The Medicare decision has wide implications across the medical technology field, setting precedents in many ways. The biggest potential is for other technologies to follow suit. “Once this becomes routine, people can start looking forward and do the same for other technologies,” said Bud Rizer, director of the Center for Disabilities at California State University at Northridge.

That’s something that the government was concerned about when it decided to cover communication devices. Cash-strapped agencies such as Medicare are cautious about increasing payment allowances for new devices.

“One of the reasons they put us in the durable medical equipment (DME) category instead of (in the category with) prosthetic devices is that they felt they had greater control over what’s needed and what isn’t,” said Lewis Golinker, an Ithaca, N.Y., lawyer who led the drive to alter Medicare’s communications device coverage. He said one Medicare stipulation continues to raise concern: DMEs must be used primarily for medical purposes. Many communication aids, though, employ versatile notebook computers.

Currently, notebook computers sold as alternative and augmentative communication devices must have a locking feature that prevents people from using them for non-communication uses. They can be unlocked, but usually only if the user ships the unit back to the supplier. “This only accomplishes driving up costs and taking the system out of the patient’s hands. We’re trying to get that requirement changed,” Ourand said.

What About Coverage for Other Technologies?

To date, no other technical product has moved through the process and gotten coverage, although a handful of groups has applied. Golinker said that for the communication devices, once the paperwork was filed, Medicare gave a tentative decision within about four months and made the decision public policy within the year.

Budget-conscious government workers have strong incentives for limiting the number of technologies they cover, but those attempting to help people who need such technologies are motivated to seek coverage even beyond Medicare.

“As Medicare goes, so go many state funding programs and coverage from many private insurance companies,” said Ourand, who was also on the team that got Medicare to approve paying for communication devices. Though she feels the government’s decision on communication devices has helped many, she added that, as with any government program, these benefits come with their own set of issues. “Only devices dedicated for speech are covered. A computer like Stephen Hawking’s wouldn’t be covered because of potential fraud — situations such as people getting laptops for their grandkids.”

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Terry Costlow has written about the electronics industry for more than 20 years, covering a wide range of technologies and topics.