Re: AOPA meetings with HCFA Re: SNFs

Re: AOPA meetings with HCFA Re: SNFs

Robert VanHook

7/23/1999

I hear what you are saying, Bracedude. What AOPA is doing with HCFA is
just a band-aid. The Balanced Budget Act (BBA) of a couple of years ago
created the SNF PPS system (and did a lot of other bad stuff). It is now
the law. HCFA's job is to implement it. HCFA can't circumvent the entire
law passed by Congress, but they can bend it a little. That's why they
have asked us to identify the higher priced services. Based on the
information we received from our members, we have been clear with HCFA from
the beginning that SNF PPS is bad for patient care. That SNFs will deny
access to needed prosthetic and orthotic services, and that's wrong.

More important that what HCFA is considering is what we have been trying to
do in Congress. Like I said, SNF PPS is the law. If we want to exempt O&P
(and we do), Congress is the place to do it. Both Houses of Congress are
now considering fixes to the BBA. AOPA has been working with them on
language to exclude O&P since before this session started.

If any of you want to help, write to your Senator and tell him/her how this
provision is hurting patient care. Write to your Representative and tell
him/her the same thing. AOPA members can find guidelines on writing members
of congress on our website at
<URL Redacted>
ols.htm

Thanks for your comments and your help with this important matter.

Bob

Robert T. Van Hook, CAE
Executive Director
American Orthotic and Prosthetic Association
1650 King Street, Suite 500
Alexandria, VA 22314
Phone: 703/836-7116
Fax: 703/836-0838
Email: <Email Address Redacted>
        Webpage: www.opoffice.org


On Thursday, July 22, 1999 10:01 PM, <Email Address Redacted>
[SMTP: <Email Address Redacted> ] wrote:
> I hope I am not alone in my concerns about the direction of talks between
> AOPA and HCFA regarding payment for orthotic and prosthetic devices while
the
> Medicare enrollee is in a skilled bed in a SNF. If you share my concerns
I
> encourage you to contact the government relations committee at AOPA.
> July 20 AOPA In Advance reported that as a result of meetings with
HCFA
> they were willing to consider removing a limited number of high cost
items
> from this [PPS) billing methodology, primarily in lower limb prosthetics.
> During the discussion, AOPA discouraged HCFA from limiting the items
being
> removed to prosthetics. Sounds good on the surface. When I called the
> reimbursement expert at AOPA I got a clear impression that it is AOPA
that is
> recommending that the exceptions be limited to prosthetics. I was told
that
> it was the big ticket items that posed a particular hardship for SNFs,
and
> that the SNFs should be able to pay for those little items like $800 AFOs
> from their Medicare reimbursements. The AOPA expert said we couldn't
> approach them with the whole shebang all at once
> Well excuse me but those little items are my bread and butter!!
> Orthotics has been just as impacted by this ridiculous payment
methodology as
> prosthetics. Whether the item costs $500 or $5,000 the fact is that very
few
> nursing homes are willing to spend anything that they don't have to. We
can
> piss and moan all we want to and report the situations to the OIG or the
> state investigatory agencies but I feel nothing is going to change until
HCFA
> recognizes that O and P AS A WHOLE needs to be excepted from the PPS. I
> believe AOPA should be very clear on this, the issue does not just impact
> big ticket prosthetics.
> Again, I encourage all practitioners that are impacted by this to
> contact AOPA to let them know how you feel.