Fw: [OANDP-L] O&P Profession and the Patient Defeated at Neg Reg

Fw: [OANDP-L] O&P Profession and the Patient Defeated at Neg Reg

Anthony T. Barr

7/19/2003

It would seem the O&P professional groups would post their own closing statements thru this media without benefit of the reader having to obtain a password. I would encourage them to do so.

To avoid making individual responses to questions raised from my post containing the Barr Foundation's closing statement, it maybe more appropriate to address subsequent questions and statements raised by individuals to more effectively inform everyone of the O&P subscribers and Amputee Listserves. I thank Paul and Wayne for allowing this dialogue on their list serves and request access to other national disability association list serves..

Perhaps these subscribers can make suggestions to bring into fold other disability organizations that will also be effected by a proposed rule.

Since there was no consensus reached, every committee members sworn oath and written statement to secrecy required beofe the meetings began ( which I found disturbing) is no longer valid.

POST NEG REG Comments:

Questions have been raised regarding the Negotiated Rules Making Process.
Relevant inquiries and statements have subsequently followed.

Early on in the Neg Reg process, all the committee members agreed that the delivery of any and all comprehensive prosthetics would warrant ABC/BOC/Third pathway qualifications.

In their words, prosthetics were off the table for consideration of any exemption of provider qualification criteria.

This was one of the reasons ACA stated they did not feel it would be necessary for them to participate in the negotiations.

These educational /qualification requirements were to be in compliance to the federal statue i.e BOC/ ABC credentialing/third pathway proposed by Secretary of Health and proposed by the committee.

AS the meetings progressed the PTs, OTs and NOMA members proposed a deal that as long as the O&P supplier language was acceptable to them, the provider qualification language re: delivery of all prosthetics indicated in a agreement statement, would required further qualification via ABC/BOC credentialing or third pathway a proposed by Secretary of Health, PROVIDED..... they were able to provide all orthotic services and bill Medicare for them without the requirement of further educational requirements.

Some 55 orthotic codes were later proposed and submitted to the O&P groups to require ABC/BOC/Third pathway qualifications.

I was not participating in the Neg Reg committee , nor were any other patient organizations, to represent the interests of comprehensive orthotic patients and users (braces,halos,etc).I was there to represent the interests prosthetic users.
This in itself is a mystery.
Were national disability organizations, representing the interests of orthotic users, even invited to participate except via the mundane federal registry?
Why had not the O&P groups and the Medical organization(American Academy Of Physical Medicine and Rehabilitation and the American Academy of Orthopedic Surgeons) whom participated not recommended their participation knowing the agenda and the crucial precedent that was to be determined when the solicitation of participants were known to them?

I supported this concept of provider qualification since I was and will continue to be determined to protect the interests of prosthetic users.

We never had the chance to reach the agreement of supplier qualification, since the PTS and OTS reneg on a understand that custom prosthetic providers would be required to obtain further qualification.
They and NOMA (representing orthotic a manufacturing interests) then collectively used it as a major leveraging strategy not to stand by their previous commitment.

In interest of reaching agreement, I suggested that those six (6) states where PT and OT Scope of Services included delivery of O&P services, be grandfathered and not require by law to obtain further qualification,except for a continuing education mandate.
This was not accepted by the O& P groups to submit to APTA,AOTA and NOMA since they either felt this would compromise the safety and qualified delivery of orthotic services in 6 states or that the three members would not accept the proposal.
My belief that the committee cannot override existing these state laws permitting them to continue already deliver and ill Medicare/Medicaid for these services

At least they have a license to lose which is more than I can say for the O&P profession in 41 states!!!

ABC provided a worthy statement in their closing statement:

Medical and health care licensure is the primary means by which health care providers are enabled to care for patients. However licensure alone does not guarantee competency.
Certification also can not guarantee quality,competent care. In essence ,claims of competency merely by assertion of a licensure,based on underlying practice acts that may or may not uniformly articulate the relevant scope of service is insupportable.
I am sure BOC is also in agreement.

The two Neg Reg Members and national associations of AOTA and APTA, which memberships comprise of less than 60 % of the total licensed providers of PT and OT services, asserted that the federal statue clearly indicates that since they have a state license in the delivery of PT and OT services, they are also fully qualified to provide fabrication ,delivery and post fitting services of all comprehensive orthotic and prosthetic deliveries without regard to further mandatory education /qualification criteria, to seek reimbursement from Medicare !

In hopes of raising the level of importance to the delivery of qualified comprehensive O&P services.
Please,during this effort to come to resolution, don't minimize the importance of the health care delivery system by identifying recipients of comprehensive O&P services, as consumers.

Let us refrain from using the word consumer as to the end users of comprehensive qualified prosthetic and orthotic devices to further support state and federal O&P regulation and resolving CMS's dilemma of recommending a acceptable proposed rule.
Tony

----- Original Message -----
From: undisclosed
To: < <Email Address Redacted> >
Sent: Friday, July 18, 2003 3:11 PM
Subject: RE: [OANDP-L] O&P Profession and the Patient Defeated at Neg Reg


Tony:

Thanks for this post. It truly believe the O&P community negotiated in good faith to reach consensus to the point of concessions being discussed in side-bars that if implemented would definitely have hurt the very patients your foundation routinely helps.

I am glad consensus was not achieved on this basis and I look forward to the Barr foundation joining a majority consensus position that will give CMS the guidance they need to properly regulate professional O&P care.

This consensus must only recognize the traditional and proper role of therapists on the rehab team, not explicitly empower them to over-utilize and bill for definitive O&P care on the backs of consumers and taxpayers. I believe that any consensus by O&P groups would have required this and would have been far worse than leaving it to CMS. Our goal now must be to give them the guidance they need with the Barr Foundation leading the charge to have all consumer groups join our position as a true majority report.

Please join this effort and continue to provide leadership in the arena of state licensure for O&P as well, Both are complementary agendas, since the content of a final rule may not do all that we wish for all the consumers you mention.

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