In June 2023, a tire on Michelle Duprey’s power wheelchair stopped working, causing her to jolt to the side every time she would brake. After she contacted her wheelchair provider to request a repair, it took two consultations, numerous phone calls with customer service and nearly a month of waiting before her chair was fixed.
“My experience on repairs has always been pretty poor,” said Duprey, who works as an attorney for the city of New Haven. “But I’ve noticed that it declined in the past 10 years or so. Prior to that, they were local companies that knew you and knew your situation.”
Around the country, wheelchair users struggle to get timely repairs. For the roughly 5,500 wheelchair users in Connecticut, wait times have increased in recent years and grown even more in the wake of the COVID-19 pandemic.
Today, legislators will hear testimony regarding a proposal that, among other measures, would require that wheelchair providers complete repairs within 10 days of receiving a request, as long as any necessary insurance verification has been obtained.
It would also allow the state to issue penalties to wheelchair companies that don’t comply with timelines, including withholding or reducing Medicaid funding. If it succeeds, it would be the first law in the country to directly regulate repair times.
“What my wheelchair means to me is independence,” wrote Michelle Johnson, who is non-verbal, in emailed comments to The Connecticut Mirror. Johnson is a wheelchair user living in Manchester who works as an artist and disabilities advocate. “If the bill goes through I would not have to wait [an] excessive amount of time for repairs.”
Current wait times vary depending on a number of factors, including whether consumers request that assessments and repairs be conducted in-shop or at their homes.
People who go into a shop for assessments and repairs currently wait more than four days, on average, from the time they issue a request to the time the repair is completed. But the vast majority of users, many of whom can’t make it into a shop, opt for in-home assessments and repairs. They wait more than 49 days, on average, from request to repair.
Industry representatives acknowledged that the wait times must improve but said that the businesses face headwinds that they can’t control, including low reimbursement rates, supply chain disruptions and staffing shortages.
Wayne Grau, the executive director for the national organization of wheelchair providers, National Coalition for Assistive and Rehab Technology, or NCART, said that the industry has made investments to improve wait times, including hiring more staff and building inventories of spare parts.
“We’ve been working on this for a while,” Grau said. “The industry recognizes that keeping wheelchairs in good working condition is vital.”
There are over 250 complex wheelchair providers nationwide, but two Tennessee-based companies dominate the market: Numotion and National Seating & Mobility, or NSM. Together, the companies make up roughly half of the market nationwide but account for over 90% of the market in Connecticut, according to data presented by NCART.
A spokesperson for National Seating & Mobility said that the company would comment through NCART. Numotion did not respond to multiple requests for comment.
Numotion and NSM are also both owned by private equity firms, which some consumers blame in part for the deterioration in service. Within the health care industry, private equity owners have garnered a reputation for, in some cases, prioritizing increased profits at the expense of patient care and experience.
Wait times
This marks the second year in a row where the Connecticut legislature will attempt to tackle the issue. In the last legislative session, a bill failed to pass that aimed at giving consumers the right to fix their own chairs, which some insurance providers’ policies currently forbid.
Instead, a measure passed to create a Wheelchair Repair Task Force — staffed by state legislators, advocates, and representatives from the two wheelchair companies in the state — to issue a report of recommendations for future legislation.
During a task force meeting last November, several consumers shared how the long wait times have impacted their lives.
Joe Shortt said he now has to wait months to get a wire replaced in his joystick, a fix that used to take less than a day. Jamie Moger waited three months for a repair after the company ordered the wrong replacement parts — twice. Maureen Amirault said she was still waiting on a footplate for her chair, more than two years and 37 phone calls later.
To initiate the repair process, a consumer first files a request. Then, a technician conducts an assessment to understand the extent of the damage and required repairs, which can occur either in a shop or in the consumer’s home. After the assessment, a slew of other steps must occur before the repair, including obtaining any necessary parts, insurance verification and prior authorization.
Industry representatives on the task force reported that several factors outside of their control severely impede their ability to make timely repairs. They’re still facing challenges resulting from COVID, including supply chain issues and a major backlog of outstanding service orders. As of November 2023, Numotion had 740 outstanding service orders and NSM had 687.
Insurance also poses a challenge. Wheelchair companies have to wait on insurance verification, including prior authorization.
But they reported that they are trying to make improvements. Chief among them is a push to hire more staff. Numotion currently has 16 technicians in Connecticut and an open position to hire one more. NSM has 15 and is actively hiring two more.
In February, the task force issued a final report of 12 recommendations for how to reduce wait times for repairs, including one outlining a requirement that in-home and in-shop repairs must be completed within 10 business days of obtaining any necessary parts or prior authorizations.
Both consumers and suppliers issued addendums to the report objecting to the proposed timelines. Consumers demanded assessment wait times of a maximum of four days and an additional four days from third-party approvals to repairs. The industry said that achieving the same wait times for in-shop and in-home services would be impossible, but did not provide an alternative limit.
In-home vs. In-shop
Another major point of disagreement between consumers and suppliers was the issue of in-home repairs.
In 90% of cases, consumers opt to have assessments conducted at home. In-home repairs served as one of the recurring points of debate between the consumer and industry representatives on the task force.
Industry representatives said suppliers will always offer in-home services but could reduce wait times overall if more people opted to come into the shop for assessments and repairs.
The companies reported that they can complete an average of 7.5 repairs per day in-shop, but only 4.5 in-home. In-home visits are also more costly because suppliers only get reimbursed by insurance for the parts and labor time, but not for travel time.
But consumer advocates say that in-home repairs are crucial, and people shouldn’t be made to feel pushed into going into the shop. Traveling for an assessment or repair is impossible for someone whose wheelchair is seriously damaged. And, even in situations where the wheelchair is still usable, getting to the limited number of shops can still be costly and time-consuming, especially for those who do not have access to their own transportation. Numotion has one Connecticut location in Rocky Hill and NSM has two — in Newington and Niantic.
Duprey said she believes it’s important to offer the same repair timelines for both in-home and in-shop repairs. In the past, she has taken time off work to travel to the shop, but said she’s in a privileged position where she gets paid time off, which isn’t an option for everyone.
“I had the ability to take sick time to go up to Numotion,” she said. “I shouldn’t have to use my sick time, but I did.”
Proposed legislation
The bill also proposes eliminating prior authorization for Medicaid, as well as requiring companies to maintain a customer service support line and a sufficient stockpile of wheelchair parts.
“Sen. Seminara and I have been very conscious that we want to get a bill out that will pass,” said Rep. Jay Case, R-Winchester, during an interview with the CT Mirror that also included Sen. Lisa Seminara, R-Avon. Case and Seminara served as legislative representatives on the task force. “But, once again, it’s unacceptable for somebody to not have the mobility to get around.”
Consumers and suppliers agreed on points that would require changes to insurance policies, including eliminating certain prior authorization and prescriptions requirements.
Consumers are continuing their calls to further reduce the wait times, saying the proposal doesn’t go far enough.
Because she’s non-verbal, Johnson typically uses an iPad to communicate via email and text with others, including with her wheelchair company when she needs a repair. In the past, her emails have gone unanswered for months and she’s only been able to get updates after having her mother call the companies directly.
In a perfect world, said Johnson, suppliers would respond to her email requests within 24 hours and conduct repairs within four business days of any required parts and insurance authorization.
“They should have in stock most repair parts or expedite the shipping of parts not onhand and complete the repair within 4 business days,” Johnson wrote in an email.
Grau also took issue with the proposed legislation, saying that wheelchair suppliers deal with several factors that would make compliance impossible.
“The types of equipment we provide are physician-prescribed and customized to meet the individual needs of the consumer,” said Grau in emailed comments. “If the part must be customized from the manufacturer, that will take longer and would put us out of compliance with the 10-day limit in the bill. It is simply not feasible.”
Private equity’s role
Many consumers who spoke during the task force meetings pointed to private equity’s dominance over the industry as at least partly responsible for the deterioration in service.
Over the past 10 years, both Numotion and NSM have acquired smaller competitors at a rapid pace. Since 2013, Numotion has acquired at least 25 competitors and NSM has acquired at least 42 other companies, according to a November 2023 report by the Private Equity Stakeholder Project.
Eileen O’Grady, one of the authors of the report, said that growth through acquisition of competitors is a common tactic used by the private equity industry.
“It rolls them all up into one big company that can then dominate the market,” explained O’Grady.
During one of the task force meetings, David Morgana explained that he has been a Numotion customer for over 25 years, though the company has operated under different names over that time. He said he remembers the days when he could call the shop and speak to a local staff member who knew him. Wait times didn’t seem long, and customer service was good. Today, that’s no longer the case.
“That personal connection to local staff has been essentially severed in the interest of efficiency,” said Morgana, explaining that fixes can take weeks and calls for service are often rerouted to national or international call centers. “I’m stuck in a dysfunctional relationship inside a broken system — a broken system controlled by corporate interests.”
Grau said he believes that private equity has improved the industry’s ability to take care of its customers, including by making investments in remote technology for assessments, increasing the amount of spare inventory kept on hand, and paying out bonuses to technicians during COVID.
“A lot of the small companies just couldn’t afford to stay in business,” said Grau. “The new ownership has had the resources to make investments.”
O’Grady acknowledged that the industry faces challenges but said private equity hasn’t had a demonstrated upside for wheelchair users.
“Consolidation has not benefited consumers. We’ve seen that in the ability for people to access repairs for their wheelchairs,” she said.
Duprey said she wants to remain hopeful that the legislation will pass, but she thinks that, ultimately, corporate interests will override the demands from wheelchair users.
“We have the wheelchair, but we don’t have any leverage,” said Duprey, explaining that, as consumers, wheelchair users can’t simply refuse to purchase the product if it’s too expensive or the service isn’t good. “There’s business interests here and people with disabilities don’t have much political network.”
