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Paralyzed from the waist down after being struck by a truck in 2012, Douglas Howey is one of hundreds of thousands of Americans who rely on what is known as “complex rehabilitation technology.” In Howey’s case: a Permobil F5 Corpus motorized wheelchair outfitted with an elevator lift motor, two batteries, headlights, and a joystick. Brand-new, it retails for almost $35,000.
In just two years, Howey logged 4,000 miles in his chair. Then, in early August, a bearing seized, stranding him in bed until he could get a technician to service the chair. Howey called Numotion, the manufacturer responsible for repairs, right away. But Numotion didn’t replace the part until October 26, more than 80 days after Howey first called.
A sudden loss of mobility can affect everything from wheelchair users’ nutrition to their finances. Pressure sores from long stays in bed can lead to infections, hospitalization, even death. But Howey is one of thousands of disabled Americans increasingly experiencing long waits in a fast-consolidating market dominated by a handful of large national suppliers backed by private equity firms.
To understand this sudden transformation in the $56 billion durable medical equipment market, of which complex rehabilitation technology (CRT) is one part, experts and advocates point to a decade-old decision by Medicare to abandon set prices in favor of ones set by competitive bidding. By one estimate, the move reduced the federal government’s costs by 35 percent. But at the same time, locally owned wheelchair shops quickly began to disappear as large corporations offered rock-bottom bids to Medicare and private insurers.
Numotion, based in Brentwood, Tennessee, was one of the winners to emerge from the new system. Formed by the union of two PE-backed companies, Numotion spent the last decade buying up dozens of smaller suppliers from coast to coast, now employing about 3,000 people in 47 states. National Seating and Mobility, based outside Nashville and owned by the PE firm Cinven, is Numotion’s biggest competitor; it has acquired more than 50 suppliers in the United States and Canada since 2014 and now has 2,600 employees in 174 locations. Brendan Schroeder, a senior analyst at the health care advisory firm Provident, estimated that Numotion and NSM together control more than half the CRT industry. “They’re the two behemoths,” he said. (Neither company was willing to disclose revenue figures or other financial information when asked.)
But consolidation and the downward pressure on reimbursement rates have come at a big cost to wheelchair users, according to customers and advocates for disabled people.
Howey obtained his first motorized wheelchair from a local supplier in Denver called USA Mobility, “a mom and pop shop” that spent hours measuring his body and giving him a chair that “fit like a glove.” When it came time to order a replacement a few years later, however, USA Mobility was gone. The Numotion field technician who measured him for his new chair got the 6-foot-4 Howey’s measurements wrong. “I’d try to use it, but after 20 minutes, I would be in spasms,” he said.
Bruce Goguen’s supplier, Colorado-based Peak Wheelchair, also disappeared, acquired by a larger vendor in 2011 and later folded into Numotion. Since then, Robin Bolduc, Bruce’s wife, said the couple has struggled with endless waits and bureaucracy to keep Bruce’s chair working. “They come out to repair a tire and they have no tire,” she told me. “They come out with the right part and the wrong tool, or the wrong tool and the wrong part.” Peak Wheelchair wasn’t perfect, she said, but it was far better at meeting her husband’s needs.
Such experiences are symptoms of an old private equity standby: cutting overhead. Chris DeHaven worked as a Numotion field service technician from 2016 to 2019 and said he was responsible for about 1,500 to 2,000 customers in the downtown Denver area, which meant up to 10 appointments a day. “I think Numotion tries to run a skeleton crew to minimize costs,” he said.
There is evidence that such practices are taking a toll. Numotion has been the subject of at least 30 personal injury lawsuits across 18 states since 2015. Many cite bodily harm stemming from faulty or delayed repairs, like a 2020 Arizona lawsuit filed against Numotion and the wheelchair maker Permobil by Roman Armando Gallegos, a partial quadriplegic who dislocated and fractured both of his tibias when his power wheelchair malfunctioned. Gallegos alleged Numotion was “negligent in the evaluation, set-up, fitting, configuration, adjustment, and/or programming of the subject wheelchair.” The case was settled out of court.
In written responses, Numotion CEO Mike Swinford and a senior executive at NSM both acknowledged that delays of months or more can occur but said they are not the norm. Both pointed to arcane insurance requirements that add weeks to repair and service orders, as well as staff and supply-chain shortages linked to Covid-19. (A Numotion spokesperson also called reimbursement rates “incredibly low” and said the company loses money in its service business.)
Julie Reiskin, the executive director of the Colorado Cross-Disability Coalition, said that while the health care system plays a part, the long waits for repairs are a feature, not a bug, of national CRT suppliers. “They have a business model of waiting until something dies, then they go out,” she said. She routinely fields calls from people with disabilities who receive slow service from Numotion.
Frustrated by long waits for repairs and the lack of accountability, wheelchair owners have joined the front lines of a nationwide effort to win a right to repair their own equipment—and legislators are listening. Earlier this year, Colorado state Rep. Brianna Titone introduced a bill that would democratize repair, making parts, software, tools, or repair manuals and schematics for power wheelchairs available to owners and independent repair shops.
Right-to-repair laws would help, Robin Bolduc told me. “Why can’t the local bicycle shop change the flat tire on our wheelchair?” she asks. Titone hopes her fellow legislators agree. “We represent them. We care about them and their mobility,” she said. “This is important.”
Additional reporting by Carolynn van Arsdale