US Politics: Accepting a Congressional DME Freeze OR Competitive Bidding

US Politics: Accepting a Congressional DME Freeze OR Competitive Bidding

Anthony T. Barr

11/29/2002

> As pointed out by VGM and AOPA, a compromise proposal has been
> developed to place a three
> year freeze to Medicare DME payments instead of imposing a legislative
> proposal of competitive bidding program to all of DME and O&P.
>
> Inspite the recent claims by OPGA and AOPA, these legislative proposals
are
> not budget driven.
> They are driven by multiple documented fraud and abuse cases, unqualified
> providers seekin reimbursement and lack of regulation of the industry.
>
> It is no wonder that VGM and AOPA , both of whom are primary
> representatives
> of the DME industry, choose to dismiss both proposals.
>
> Since you stated you would like possible solutions here they are.
>
> Due to the obvious, conflict in representations and cross breeding
> representation of DME and O&P interests, it is my estimation neither
> organization, AOPA nor OPGA will advance legislative proposals that could
> raise the current standards nor the very least maintain current coverage
to
> O&P members.
>
> AOPA leadership must separate their representation of both or the Academy
> should negotiate their own legislative policy without consideration of
> looking after the interests of DME manufacturers.
>
> This focus on Medicare reform initially came about as an effort to
> discourage and
> reduce the tremendous fraud and abuse that has occurred and continues in
> Medicare billing, from a industry and profession that is generally
> unregulated. Most of this fraud and abuse in Medicare billing is DME
> related.
> However,it is the O&P professionals that are taking the rap!
>
> Now Congress asks the industry and profession to reach a compromise.
>
> In absence of the this country's national consumer organization , ACA,
> and their unwillingness to address similar advocacy issues for amputees
nor
> support or
> oppose either regulation or these proposals, indulge me with some points
> that may interest you.
>
> This is not a new battle nor is it the first assault upon providers of O&P
> goods and services for Medicare reimbursement.
> I remember the same issues in the late 1970's occurring.
> That threat was derailed primarily as the result of a amputee Senators
> input to Congress and the industry's and the Academy's promise to support
> regulation .. That did not occur and they issues are baaaack!!
>
> The industry is opposed to any control or regulation that maybe imposed on
> their members that include DME manufactures whom were the primary culpurts
> and focus to
> reduce fraud and abuse by the federal government.
>
> AOPA and VGM also speak on behalf of the profession, since the
professional
> association ,the Academy
> delegated to them the authority to negotiate on their behalf all O&P
> legislation issues with Congress.Yet it is the industry whom has made
> repeated doomsday predictions and pleas for the support of O&P
practitioners
> and consumers to oppose all such initiatives.
>
> Whom is speaking on the behalf of patients requiring these services?
>
> In the interest of the profession and the patients and recipients of
> comprehensive O&P health care services,why not support a freeze on DME
> payments for three years to avoid the immediate threat of CB and preserve
> the integrity of O&P coverage from both Medicare and Medicaid ?
>
> While the solution remains in limbo and contention, several state
> governments are considering eliminating O& P coverage.
> What would be best for the patient to help stop this threat ?
>
> Why not support the mandatory posting of surety bonds by providers of DME
> products to help curb fraud and abuse?
>
> Why not support and help enact state by state regulation efforts of the
> profession as well
> as coming to consensus on qualification language of providers for Medicare
> reimbursements for O&P services ?
>
> Most O&P professionals that I have met, want to be regulated in their
> perspective states and deserve the recognition and reimbursements of
> becoming licensed health care professionals. They don't wont to be
labeled
> as DME providers.
>
> If AOPA's position in not supporting the freeze to the competitive
bidding
> alternative, is their fear the freeze would roll into all O&P services,
> then
> they should educate the lawmakers of the differences instead of suggesting
> that the qualifications and issues of protecting the public of both DME
> manufactures and O&P providers are comparable.
>
> If the primary goal is for AOPA to help Congress distinguish between O&P
> and DME, how can you effectively do so when you represent both interests.
>
> Lawmaker's confusion between distinguishing between O&P and DME is a
matter
> of design.It is why the word patient was often replaced by consumer
to
> imply that
> government regulation , both state and federal, and oversight is not
needed
> for delivery of these services and durable goods !
>
> However, the recipient of these services the word patient and protection
> of the patient are often
> resurrected to encourage increased coverage and proper reimbursement
> levels.
> You can not continue to have it both ways.
>
> Is educational qualification or a competitive bidding initiative for
> wheelchairs, hospital beds and off the shelve orthoses as important to
> protect
> the public, to correctly prescribe, fabricate and deliver a custom
> prosthesis or scoliosis brace?
>
> All O&P practitioners and patients of these services should be comforted
> to know that this DME freeze proposal could be an acceptable alternative
to
> competitive bidding
> and support it.
>
> They should also consider helping AOPA and OPGA/VGM clearly define to
> congressional leaders, whom they represent
> and what the differences are of DME and comprehensive O&P services , since
> it appears they could use the help!
> Now, to go work off some more turkey.
> Have a nice weekend!
>
> Tony Barr