One more push on Competitive Bidding
Tom Gorski, CAE
Description
Collection
Title:
One more push on Competitive Bidding
Creator:
Tom Gorski, CAE
Date:
6/7/2002
Text:
Posted by Tom Gorski, CAE, Executive Director
American Academy of Orthotists and Prosthetists
If you heard President Bush's address last night and the commentators afterwards, then you might be thinking that the timetable for his changes may cause healthcare issues to go to the back burner. Medicare Reform doesn't seem to have been impacted by the speech because we've learned it will likely be marked-up and introduced next Thursday.
What does this mean to you? We need to move fast. If you haven't written, faxed, called, or emailed your Congressional representatives, PLEASE DO SO TODAY! DO IT NOW! Especially if you live or work in one of these states: : AZ, CA, CO, CT, FL, GA, OH, IA, IL, IN, KY, LA, MA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NM, NY, OR, PA, TN, TX, VA, WA, WI, WY.
Please call (202) 225-3121 and ask for the office of your Congressional Representative and your two Senators. Then ask to speak with the healthcare legislative assistant (or if you prefer, ask for the email address of that individual). When you send an email please cc the Academy at <Email Address Redacted> A list of Congressmen by state on the key committees that will review this legislation is listed at the end of this message.
What to Say on Your Call
First, you should ask to speak to the Legislative Director and if he/she is not available, the Legislative Assistant who handles health care issues. You will probably be asked about the purpose and the nature of your call. You should say that you are a constituent and want to speak with the Legislative Director to express your grave concern regarding a proposal being considered as part of the Medicare Reform Bill. Be persistent (but polite) in seeking to speak to the Legislative Director or the Legislative Assistant for health care issues.
Essentially, you need to argue that there should be a total exemption for orthotics and prosthetics from Medicare competitive bidding. In the alternative, the proposal should apply to a very limited number of truly off-the-shelf orthotics that do not require any clinician to fit those items and the need for small supplier set-asides and a mechanism to allow small suppliers to form networks to compete with larger suppliers.
TALKING POINTS. In speaking with the Congressional offices, focus on the following reasons for exempting O&P:
* Patients Will Be Harmed - There is little doubt that subjecting these services to a competitive bidding process would inevitably lead to a degradation in patient care as companies seeking to offer the lowest bid will decide against using clinicians to provide orthotics. Tell the Congressional office about what happens when skilled professionals are not involved in fitting even pre-fabricated items.
* Competitive Bidding in the Area of Orthotics Is Unproven--and, Therefore, Dangerous - Only one demonstration project, which is still currently underway in San Antonio, has even involved competitive bidding for these services, and it has not yet concluded. There has been no opportunity to analyze and debate its effects. It is irresponsible to gamble with patient care by subjecting these services to the competitive bidding process. This is particularly true because orthotics comprise only a small fraction of Medicare spending.
* Smaller Providers Will Not Be Able to Compete - Competitive Bidding will mean that small clinicians will no longer be able to provide their services, that are absolutely essential to ensuring patient access, safety and quality of care. Clearly, the criteria for supplier qualification will disadvantage small suppliers. In this way, the proposal threatens to drive small clinicians out of the market which would negatively impact patient access, safety and quality of care.
In addition to pressing the points above, ask if the Member of Congress has taken a position on this issue and what it is. If the Member has not taken a position, ask when the Member will be making that decision. Call back on a weekly basis until the office tells you what position it has taken.
IF YOU CHOOSE TO EMAIL YOUR REPRESENTATIVE OR SENATOR
Please use the sample letter below as a guide when composing your e-mails. Remember, only send a letter to a Member of Congress if you reside or practice in that Congressman's state.
SAMPLE LETTER
Date
Dear Congressman _____________:
I am a certified orthotist and/or prosthetist practicing in __(state)____. As the Ways & Means and Energy & Commerce Committees consider imposing government-run competitive bidding on Medicare clinical laboratory, durable medical equipment (DME), and some orthotics and prosthetics (O&P), I ask you to support a total exemption of O&P from this provision because this provision threatens access to services, patient safety, and the quality of the services. I cannot underscore enough how important it is that this exemption be created.
Providing professional orthotic and prosthetic care consists of highly specialized and individualized clinical services involving the design and development of customized devices. Professional O&P care is provided by clinicians with extensive training in the treatment of patients requiring orthoses (orthopedic braces) and prostheses (artificial limbs). Orthoses and prostheses should not be competitively bid because it will have the effect of eliminating the clinical component of care. This will inevitably mean that patient care and the quality of the services will suffer. We cannot afford a threat to patient safety.
Because professional O&P care is a labor-intensive service, quality of care will suffer as providers search for ways to cut corners and costs so they can make ends meet. Low bidders will inevitably use employees with no training in anatomy, physiology, pathology, manual muscle testing or observational gait analysis, setting them loose on unsuspecting patients who will assume that they are clinicians. Again, O&P services must be provided by practitioners with specialized training and expertise. When low-ball bidders provide substandard care, competitive bidding will actually cost Medicare more than the current system. This is because there will be a resulting need for increased patient visits, replacements necessitated by ill-fitting orthoses and prostheses, and the cost of related medical complications.
Competitive Bidding for O&P is premature. Medicare's Polk County competitive bidding demonstration project did not include any O&P services and the San Antonio demonstration, which did include some non-customized orthotics-over the objections of many concerned about patient care and safety-will not conclude until December 2002. It would be dangerous and reckless to move forward with such a sweeping change based what is clearly inadequate and thin data. The suggestion that we move forward now with competitive bidding, without waiting for the current demonstration project to be finished and thoroughly and carefully evaluated, represents a sudden and unexplained departure from previous Congressional policy.
Professional O&P Care is customized to each patient, not generic. All prostheses and most orthoses are custom designed to address the specific anatomical and functional needs of each patient. Even pre-fabricated orthoses should not be subject to competitive bidding because the professional judgment of the O&P clinician is still needed to determine whether a prefabricated orthoses will suffice or whether a custom fabricated orthoses is necessary. Patients can and will be hurt. Nothing in the proposal sets any specific quality requirements for bidders.
Competitive bidding eliminates choice. Medicare beneficiaries under the competitive bidding system will be restricted in the provider of their choice. Long-standing relationships between beneficiaries and familiar providers will be interrupted causing disruption in service and dissatisfaction for patients.
The proposal is also fundamentally unfair to the most well-trained and most highly skilled professionals who so frequently provide services in small or even solo practices. The proposal has no provision for small practitioner set-asides. It has no provision for small practitioners to band together to provide services. The effect of the proposal--whether intentional or unintentional--is to target the very people who so often are in the best position to provide the most skilled and the safest services. Medicare beneficiaries deserve better.
For these reasons, I urge you to support a total exemption for O&P from Medicare competitive bidding. It is the right thing to do for the Medicare beneficiaries and the Medicare program. I will be calling your office soon to learn about your position. This issue is critically important to me and the Medicare beneficiaries whom I serve.
Thank you for your attention to this important matter.
Sincerely,
American Academy of Orthotists and Prosthetists
If you heard President Bush's address last night and the commentators afterwards, then you might be thinking that the timetable for his changes may cause healthcare issues to go to the back burner. Medicare Reform doesn't seem to have been impacted by the speech because we've learned it will likely be marked-up and introduced next Thursday.
What does this mean to you? We need to move fast. If you haven't written, faxed, called, or emailed your Congressional representatives, PLEASE DO SO TODAY! DO IT NOW! Especially if you live or work in one of these states: : AZ, CA, CO, CT, FL, GA, OH, IA, IL, IN, KY, LA, MA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NM, NY, OR, PA, TN, TX, VA, WA, WI, WY.
Please call (202) 225-3121 and ask for the office of your Congressional Representative and your two Senators. Then ask to speak with the healthcare legislative assistant (or if you prefer, ask for the email address of that individual). When you send an email please cc the Academy at <Email Address Redacted> A list of Congressmen by state on the key committees that will review this legislation is listed at the end of this message.
What to Say on Your Call
First, you should ask to speak to the Legislative Director and if he/she is not available, the Legislative Assistant who handles health care issues. You will probably be asked about the purpose and the nature of your call. You should say that you are a constituent and want to speak with the Legislative Director to express your grave concern regarding a proposal being considered as part of the Medicare Reform Bill. Be persistent (but polite) in seeking to speak to the Legislative Director or the Legislative Assistant for health care issues.
Essentially, you need to argue that there should be a total exemption for orthotics and prosthetics from Medicare competitive bidding. In the alternative, the proposal should apply to a very limited number of truly off-the-shelf orthotics that do not require any clinician to fit those items and the need for small supplier set-asides and a mechanism to allow small suppliers to form networks to compete with larger suppliers.
TALKING POINTS. In speaking with the Congressional offices, focus on the following reasons for exempting O&P:
* Patients Will Be Harmed - There is little doubt that subjecting these services to a competitive bidding process would inevitably lead to a degradation in patient care as companies seeking to offer the lowest bid will decide against using clinicians to provide orthotics. Tell the Congressional office about what happens when skilled professionals are not involved in fitting even pre-fabricated items.
* Competitive Bidding in the Area of Orthotics Is Unproven--and, Therefore, Dangerous - Only one demonstration project, which is still currently underway in San Antonio, has even involved competitive bidding for these services, and it has not yet concluded. There has been no opportunity to analyze and debate its effects. It is irresponsible to gamble with patient care by subjecting these services to the competitive bidding process. This is particularly true because orthotics comprise only a small fraction of Medicare spending.
* Smaller Providers Will Not Be Able to Compete - Competitive Bidding will mean that small clinicians will no longer be able to provide their services, that are absolutely essential to ensuring patient access, safety and quality of care. Clearly, the criteria for supplier qualification will disadvantage small suppliers. In this way, the proposal threatens to drive small clinicians out of the market which would negatively impact patient access, safety and quality of care.
In addition to pressing the points above, ask if the Member of Congress has taken a position on this issue and what it is. If the Member has not taken a position, ask when the Member will be making that decision. Call back on a weekly basis until the office tells you what position it has taken.
IF YOU CHOOSE TO EMAIL YOUR REPRESENTATIVE OR SENATOR
Please use the sample letter below as a guide when composing your e-mails. Remember, only send a letter to a Member of Congress if you reside or practice in that Congressman's state.
SAMPLE LETTER
Date
Dear Congressman _____________:
I am a certified orthotist and/or prosthetist practicing in __(state)____. As the Ways & Means and Energy & Commerce Committees consider imposing government-run competitive bidding on Medicare clinical laboratory, durable medical equipment (DME), and some orthotics and prosthetics (O&P), I ask you to support a total exemption of O&P from this provision because this provision threatens access to services, patient safety, and the quality of the services. I cannot underscore enough how important it is that this exemption be created.
Providing professional orthotic and prosthetic care consists of highly specialized and individualized clinical services involving the design and development of customized devices. Professional O&P care is provided by clinicians with extensive training in the treatment of patients requiring orthoses (orthopedic braces) and prostheses (artificial limbs). Orthoses and prostheses should not be competitively bid because it will have the effect of eliminating the clinical component of care. This will inevitably mean that patient care and the quality of the services will suffer. We cannot afford a threat to patient safety.
Because professional O&P care is a labor-intensive service, quality of care will suffer as providers search for ways to cut corners and costs so they can make ends meet. Low bidders will inevitably use employees with no training in anatomy, physiology, pathology, manual muscle testing or observational gait analysis, setting them loose on unsuspecting patients who will assume that they are clinicians. Again, O&P services must be provided by practitioners with specialized training and expertise. When low-ball bidders provide substandard care, competitive bidding will actually cost Medicare more than the current system. This is because there will be a resulting need for increased patient visits, replacements necessitated by ill-fitting orthoses and prostheses, and the cost of related medical complications.
Competitive Bidding for O&P is premature. Medicare's Polk County competitive bidding demonstration project did not include any O&P services and the San Antonio demonstration, which did include some non-customized orthotics-over the objections of many concerned about patient care and safety-will not conclude until December 2002. It would be dangerous and reckless to move forward with such a sweeping change based what is clearly inadequate and thin data. The suggestion that we move forward now with competitive bidding, without waiting for the current demonstration project to be finished and thoroughly and carefully evaluated, represents a sudden and unexplained departure from previous Congressional policy.
Professional O&P Care is customized to each patient, not generic. All prostheses and most orthoses are custom designed to address the specific anatomical and functional needs of each patient. Even pre-fabricated orthoses should not be subject to competitive bidding because the professional judgment of the O&P clinician is still needed to determine whether a prefabricated orthoses will suffice or whether a custom fabricated orthoses is necessary. Patients can and will be hurt. Nothing in the proposal sets any specific quality requirements for bidders.
Competitive bidding eliminates choice. Medicare beneficiaries under the competitive bidding system will be restricted in the provider of their choice. Long-standing relationships between beneficiaries and familiar providers will be interrupted causing disruption in service and dissatisfaction for patients.
The proposal is also fundamentally unfair to the most well-trained and most highly skilled professionals who so frequently provide services in small or even solo practices. The proposal has no provision for small practitioner set-asides. It has no provision for small practitioners to band together to provide services. The effect of the proposal--whether intentional or unintentional--is to target the very people who so often are in the best position to provide the most skilled and the safest services. Medicare beneficiaries deserve better.
For these reasons, I urge you to support a total exemption for O&P from Medicare competitive bidding. It is the right thing to do for the Medicare beneficiaries and the Medicare program. I will be calling your office soon to learn about your position. This issue is critically important to me and the Medicare beneficiaries whom I serve.
Thank you for your attention to this important matter.
Sincerely,
Citation
Tom Gorski, CAE, “One more push on Competitive Bidding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 8, 2024, https://library.drfop.org/items/show/219107.
