Re: Results of used prosthetic componets
Description
Collection
Title:
Re: Results of used prosthetic componets
Text:
In a message dated 3/30/99 11:46:38 PM Eastern Standard Time, WLewis379
writes:
I am posting the reply's I have received regarding the use of
used prosthetic components. Thanks to all that replied.
Happy Trails
Bill Lewis C.P.
------------------------------------------------------------------------------
------------
Bob Van Hook forwarded your inquiry on to me for response. I have
discussed this with Kathy Dodson, AOPA's Reimbursement Director, and
here's our attempt to answer your questions.
Is it unlawful for an HMO to request a socket replacement rather than
provide a complete new prosthesis?
This is not a simple yes or no answer.
Socket replacement is an accepted practice if the no other components need
to be replaced. Replacing just the socket does not render the current
compomnetry used. The warranty on the compomnetry would remain in tact
for that device if just the socket is replaced. The warranty would be void
if the components were recycled to make a new device for another patient.
You as the prosthetist must use your best clinical judgment to decide if a
socket replacement or a complete replacement is necessary. I am told that
the usual reasons for a complete replacement are wear and tear and/or a
change in the patient's condition (this option usually requires a prescr
option).
If in your clinical judgment you believe the patient needs a new device,
you are going to have to work that out with the HMO.
New compomnetry is covered by a manufacturer's warranty if the part should
fail. The warranty applies only to the original owner/user of the device.
Warranty issues are covered by product liability law. This rule of law
has been developed in case law (court decisions) over many years and
continues to be upheld in U.S. courtrooms.
I hope this answers your questions. Please feel free to contact me if I
can be of further assistance.
Martha Rinker
Director of Government Relations
703/836-7116
<Email Address Redacted>
------------------------------------------------------------------------------
-----------
I do not know of any law that would address used components.
One thought though, you may wish to communicate to the HMO that if you
do a socket replacement only, you cannot warranty the prosthesis any
longer. You may want to see if they will agree to pay for any
adjustments, repairs or visits to modify the prosthesis.
That may get their attention and they may want to authorize a whole
new limb.
Just giving you my two cents!
Steve Fletcher, CPO
Shands Hospital at the University of Florida
------------------------------------------------------------------------------
----------
Bill:
Since HSFA has assigned specific codes to replacement sockets, I have assumed
they are legal and I have been doing that for managed care companies without
asking myself the excedllent questions you have posed. Please post your
answers as I, among many others, will be anxious to read them.
Thanks.
David
------------------------------------------------------------------------------
-----------
Of course you are responsible for any prosthesis that you modify, whether it
is of your own making, or others. This is no different from changing
(bending, drilling, sanding, whatever) components from a components
manufacturer. Once this is done, you are on the hook and the manufacturer
or previous professional will likely be able to wiggle out from under any
legal liability and responsibility. My guess is that even though you
document that the insurance company requires you to make a single
component replacement, if something goes wrong you will still be
responsible. A jury will likely determine that you (the expert in your
field - not the insurance company) should have known better than to replace
only a socket, when other changes were indicated or unknown. Having survived
a ridiculous $20,000,000.00 wrongful death lawsuit, I believe I have more
than a token experience with such a matter.
What would be required to protect you for such a matter would be a waiver of
legal liability and I doubt that such a document exists or is enforceable?
If it is, the WORLD needs to know about it.
In reality, the insurance companies should be legally at risk when they ask
or insist that a prosthetist provide a specific service for a device they
know little or nothing about.
However, until consumers realize that there is no such thing as a free
lunch, HMOs, and other similar health care systems will prosper at the
expense of the consumer and health care professional.
------------------------------------------------------------------------------
-----------
Of course you are responsible for any prosthesis that you modify, whether it
is of your own making, or others. This is no different from changing
(bending, drilling, sanding, whatever) components from a components
manufacturerer. Once this is done, you are on the hook and the manufacturer
or previous professional will likely be able to wiggle out from under any
legal liability and responsibility. My guess is that even though you
document that the insurance company requires you to make a single
component replacement, if something goes wrong you will still be
responsible. A jury will likely determine that you (the expert in your
field - not the insurance company) should have known better than to replace
only a socket, when other changes were indicated or unknown. Having survived
a ridiculous $20,000,000.00 wrongful death lawsuit, I believe I have more
than a token experience with such a matter.
What would be required to protect you for such a matter would be a waiver of
legal liability and I doubt that such a document exists or is enforceable?
If it is, the WORLD needs to know about it.
In reality, the insurance companies should be legally at risk when they ask
or insist that a prosthetist provide a specific service for a device they
know little or nothing about.
However, until consumers realize that there is no such thing as a free
lunch, HMOs, and other similar health care systems will prosper at the
expense of the consumer and health care professional.
------------------------------------------------------------------------------
-----------
Bill Lewis' question raises another in my mind. I have never thought twice
about doing a socket change (endoskeletal and occasionally exoskeletal) if
there are no signs of wear of fatigue in critical areas, and I haven't really
considered that we were at any increased risk. However, we never use used
parts from a different patient although the potential wear or fatigue may be
no different, but I wonder if the risk is any different?
We also never reuse halo parts. but I wonder if there have been any
studies on metal fatigue or pin hole wear in the halo rings after use? The
parts seem to be in good shape after use. I'm sure the manufacturers would
disapprove of reuse, but the HMO's would surely want a bigger discount if
reuse was acceptable.
------------------------------------------------------------------------------
-----------
In a message dated 3/26/99 8:11:40 PM Central Standard Time, <Email Address Redacted>
writes:
<< I have had several request from one of the HMO's that we do business with
to do a socket replacement rather than do a complete prosthesis AK or BK. Most
of the request have been for endoskeletal systems. I guess my question is! Is
it unlawful to do this? >>
I have always believed that this was one of the design concepts of the modular
system. I cannot fathom how it would be unlawful.
>>I assume that the warranty for the on the components would be null and
void.>>
I see no reason what so ever that any court would say a manufactures warranty
would be null and void for this reason.
>>If I replace the socket am I responsible for the liability of the used
components?>>
As I understand it you have liability exposure any time you work on a
prosthesis. The liability of the manufacturer for the components should remain
unchanged.
I would be very interested in seeing the legal opinion on this one. Of course
each state will be different.
Al Pike, CP
------------------------------------------------------------------------------
-----------
We have taken the position that we only do socket replacements on prostheses
that we originally provided. It has been our position that you become liable
for the entire prosthesis after any repairs or socket replacements are
completed.
Good luck.
Ralph W. Nobbe CPO
writes:
I am posting the reply's I have received regarding the use of
used prosthetic components. Thanks to all that replied.
Happy Trails
Bill Lewis C.P.
------------------------------------------------------------------------------
------------
Bob Van Hook forwarded your inquiry on to me for response. I have
discussed this with Kathy Dodson, AOPA's Reimbursement Director, and
here's our attempt to answer your questions.
Is it unlawful for an HMO to request a socket replacement rather than
provide a complete new prosthesis?
This is not a simple yes or no answer.
Socket replacement is an accepted practice if the no other components need
to be replaced. Replacing just the socket does not render the current
compomnetry used. The warranty on the compomnetry would remain in tact
for that device if just the socket is replaced. The warranty would be void
if the components were recycled to make a new device for another patient.
You as the prosthetist must use your best clinical judgment to decide if a
socket replacement or a complete replacement is necessary. I am told that
the usual reasons for a complete replacement are wear and tear and/or a
change in the patient's condition (this option usually requires a prescr
option).
If in your clinical judgment you believe the patient needs a new device,
you are going to have to work that out with the HMO.
New compomnetry is covered by a manufacturer's warranty if the part should
fail. The warranty applies only to the original owner/user of the device.
Warranty issues are covered by product liability law. This rule of law
has been developed in case law (court decisions) over many years and
continues to be upheld in U.S. courtrooms.
I hope this answers your questions. Please feel free to contact me if I
can be of further assistance.
Martha Rinker
Director of Government Relations
703/836-7116
<Email Address Redacted>
------------------------------------------------------------------------------
-----------
I do not know of any law that would address used components.
One thought though, you may wish to communicate to the HMO that if you
do a socket replacement only, you cannot warranty the prosthesis any
longer. You may want to see if they will agree to pay for any
adjustments, repairs or visits to modify the prosthesis.
That may get their attention and they may want to authorize a whole
new limb.
Just giving you my two cents!
Steve Fletcher, CPO
Shands Hospital at the University of Florida
------------------------------------------------------------------------------
----------
Bill:
Since HSFA has assigned specific codes to replacement sockets, I have assumed
they are legal and I have been doing that for managed care companies without
asking myself the excedllent questions you have posed. Please post your
answers as I, among many others, will be anxious to read them.
Thanks.
David
------------------------------------------------------------------------------
-----------
Of course you are responsible for any prosthesis that you modify, whether it
is of your own making, or others. This is no different from changing
(bending, drilling, sanding, whatever) components from a components
manufacturer. Once this is done, you are on the hook and the manufacturer
or previous professional will likely be able to wiggle out from under any
legal liability and responsibility. My guess is that even though you
document that the insurance company requires you to make a single
component replacement, if something goes wrong you will still be
responsible. A jury will likely determine that you (the expert in your
field - not the insurance company) should have known better than to replace
only a socket, when other changes were indicated or unknown. Having survived
a ridiculous $20,000,000.00 wrongful death lawsuit, I believe I have more
than a token experience with such a matter.
What would be required to protect you for such a matter would be a waiver of
legal liability and I doubt that such a document exists or is enforceable?
If it is, the WORLD needs to know about it.
In reality, the insurance companies should be legally at risk when they ask
or insist that a prosthetist provide a specific service for a device they
know little or nothing about.
However, until consumers realize that there is no such thing as a free
lunch, HMOs, and other similar health care systems will prosper at the
expense of the consumer and health care professional.
------------------------------------------------------------------------------
-----------
Of course you are responsible for any prosthesis that you modify, whether it
is of your own making, or others. This is no different from changing
(bending, drilling, sanding, whatever) components from a components
manufacturerer. Once this is done, you are on the hook and the manufacturer
or previous professional will likely be able to wiggle out from under any
legal liability and responsibility. My guess is that even though you
document that the insurance company requires you to make a single
component replacement, if something goes wrong you will still be
responsible. A jury will likely determine that you (the expert in your
field - not the insurance company) should have known better than to replace
only a socket, when other changes were indicated or unknown. Having survived
a ridiculous $20,000,000.00 wrongful death lawsuit, I believe I have more
than a token experience with such a matter.
What would be required to protect you for such a matter would be a waiver of
legal liability and I doubt that such a document exists or is enforceable?
If it is, the WORLD needs to know about it.
In reality, the insurance companies should be legally at risk when they ask
or insist that a prosthetist provide a specific service for a device they
know little or nothing about.
However, until consumers realize that there is no such thing as a free
lunch, HMOs, and other similar health care systems will prosper at the
expense of the consumer and health care professional.
------------------------------------------------------------------------------
-----------
Bill Lewis' question raises another in my mind. I have never thought twice
about doing a socket change (endoskeletal and occasionally exoskeletal) if
there are no signs of wear of fatigue in critical areas, and I haven't really
considered that we were at any increased risk. However, we never use used
parts from a different patient although the potential wear or fatigue may be
no different, but I wonder if the risk is any different?
We also never reuse halo parts. but I wonder if there have been any
studies on metal fatigue or pin hole wear in the halo rings after use? The
parts seem to be in good shape after use. I'm sure the manufacturers would
disapprove of reuse, but the HMO's would surely want a bigger discount if
reuse was acceptable.
------------------------------------------------------------------------------
-----------
In a message dated 3/26/99 8:11:40 PM Central Standard Time, <Email Address Redacted>
writes:
<< I have had several request from one of the HMO's that we do business with
to do a socket replacement rather than do a complete prosthesis AK or BK. Most
of the request have been for endoskeletal systems. I guess my question is! Is
it unlawful to do this? >>
I have always believed that this was one of the design concepts of the modular
system. I cannot fathom how it would be unlawful.
>>I assume that the warranty for the on the components would be null and
void.>>
I see no reason what so ever that any court would say a manufactures warranty
would be null and void for this reason.
>>If I replace the socket am I responsible for the liability of the used
components?>>
As I understand it you have liability exposure any time you work on a
prosthesis. The liability of the manufacturer for the components should remain
unchanged.
I would be very interested in seeing the legal opinion on this one. Of course
each state will be different.
Al Pike, CP
------------------------------------------------------------------------------
-----------
We have taken the position that we only do socket replacements on prostheses
that we originally provided. It has been our position that you become liable
for the entire prosthesis after any repairs or socket replacements are
completed.
Good luck.
Ralph W. Nobbe CPO
Citation
“Re: Results of used prosthetic componets,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 15, 2024, https://library.drfop.org/items/show/211514.
