Re: Response to Chalres Levy's post re:Neg Reg submission by PVA
Description
Collection
Title:
Re: Response to Chalres Levy's post re:Neg Reg submission by PVA
Date:
10/6/2003
Text:
Below is Harley Thomas's, of the Paralyzed Veterans of America, and primary
Neg Reg committee member, reply to Charles Levy's of AAPM&R comments posted
this morning.
Mr.Harley's comments were similar to mine at the time Neg Reg was in session
and when we still had an opportunity to reach consensus at the final Neg Reg
committee meeting.
I even suggested at the time, that in the spirit of reaching consensus,
perhaps some thought should be given by the O&P groups to allow those PTs
and OTs in licensed states, be grandfathered w/o further qualification in
only those states (4) where their specific Scope of Services included
delivery of comprehensive O&P services in their perspective state statues.
My position for suggesting this that it seemed highly unlikely that CMS (
Medicare )could deny any indivisual state licenced provider of
comprehensive O&P services, whom already have within their state statue and
within their Scope of Services, the right to deliver O&P and seek
reimbursement from Medicare.
However, I also added that every O&P provider of comprehensive O&P be
required to take continuing education courses and obtain educational credits
to continue to be qualified and informed about the most recent technology,
to be able to continue to provide those services.
Since there seem to be no agreement to my suggestion, by the O&P groups nor
the PTs and OTs, to present this to CMS and other members of the Neg Reg
committee, no consensus was reached after 19 days of meetings.
It became a whole new ball game and a post Neg Reg submission of signatories
from most all the O&P groups and our organization was made, excluding
Hanger and BOC.
The real question here and rebuttal should not be directed to the consumer
organizations whom have no financial interests,but should be directed to
Hanger and BOC and why they did agreee to sign on to the submission
submitted August 26th.
Mr. Thomas requested I send his response(below) to Dr.Levy's post, to the
subscribers of the O&P List serve and to the prior Neg Reg committee
members.
Tony Barr
Barr Foundation
www.oandp.com/barr
===========================================================================
=====================
Tony,
Good to hear from you, I hope your summer went well.
I suppose the only comment I have regarding the position statement from
AAPM&R would be as follows:
During the final comments made by several members of the committee including
yourself, I stated that I had personally stated to both the OT’s and PT’s
that there was no way I could ever agree that Licensure equated to Qualified
without further definitive measures. I did however state that in the spirit
of “negotiations” I was willing to accept their position in order to reach
consensus.
For AAPM&R to make the statement:
“In fact, the only consumer group that seems willing to endorse physical
therapists and occupational therapists as qualified to have unrestricted
access to construct all prostheses and orthoses through current
education/licensure alone appears to be the Paralyzed Veterans of America.”
I was more than willing to review and probably sign on to your group letter
as requested had the document been submitted for review prior to the 11th
hour in which I was out of town. I indicated to you that I needed to see
something prior to my departure, but unfortunately that didn't’t happen.
Peter Thomas, legal advisor to NAAOP, delivered a copy of the document to
my office the day the deadline and wanted our stamp of approval.
Unfortunately I was out of town and our staff was unwilling (as they should
have been) to take on the responsibility to sign on indicating our
concurrence.
I’m not sure why the ‘group’ feels it necessary to formally rebut my
letter. I do not believe that I stated anything in the letter that was not
true nor were the facts distorted one way or the other, nor did I endorse
the OT & PT community.
Regards,
Harley
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>]On
Behalf Of Levy, Charles
Sent: Monday, October 06, 2003 9:20 AM
To: <Email Address Redacted>
Subject: [OANDP-L]
Dear Friends,
I thought you might like to see the stand taken by the American Association
of Physical Medicine and Rehabilitation in regards to the recent Neg Reg
meetings.
Yours,
Charles E. Levy, MD
September 25, 2003
Mr. Robert Loyal, Director
Division of Provider Supplier
Centers for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD 21244-1850
Dear Mr. Loyal:
I am writing on behalf of the American Academy of Physical Medicine and
Rehabilitation (AAPM&R) to inform you of the position of the AAPM&R
regarding the recently completed session of the Negotiated Rule Making
Committee for Special Payment Provisions for Prosthetics and Certain Custom
Fabricated Orthotics. In addition, this letter is intended as a direct
rebuttal to the letter written by Mr. Harley Thomas of the Paralyzed
Veterans of America, addressed to you on July 16, 2003.
The AAPM&R is the national medical specialty society of nearly 7,000
physical medicine and rehabilitation physicians, also called physiatrists.
Approximately 90% of all physiatrists practicing in the United States are
members of the AAPM&R. Physical medicine and rehabilitation, recognized as a
board-certified medical specialty in 1947, focuses on restoring function to
people with problems ranging from simple physical mobility issues to those
with complex cognitive involvement. Physiatrists also treat patients with
acute and chronic pain and musculoskeletal as well as neurological
disorders.
At the invitation of CMS, the AAPM&R participated in the negotiated
rulemaking process. In the view of the AAPM&R, there were two groups
present at the table during the process: those with a direct financial
stake in the process (representatives of various prosthetist/orthotist
organizations, manufacturers' representatives, and representatives of
physical therapy and occupational therapy professional organizations) and
those with a primary interest in the outcome for people in need of
prosthetic and orthotic services, but with no direct financial stake in the
outcome of the process (the American Association of Orthopedic Surgeons, the
American Academy of Physical Medicine and Rehabilitation, The Barr
Foundation, and the Paralyzed Veterans of America).
The AAPM&R sent a total of three representatives to the meetings. AAPM&R
representatives' collective experience includes more than 40 years of
working with amputees in a variety of settings including various academic
and privates practice settings as well as Veterans Administration Medical
Centers. The AAPM&Rrepresentatives included advocates for amputees, authors
of research articles and contributors to standard textbooks regarding
rehabilitation following amputations, an associate editor of the American
Journal of Rehabilitation, a chairman of a prestigious department of
physical medicine and rehabilitation, and a member who himself is an
amputee. One of the AAPM&R representatives is on the faculty of a department
of occupational therapy at a major university.
All three AAPM&R representatives participate in the instructional curriculum
of physical and occupational therapists. The members are clearly aware of
the general strengths of physical and occupational therapy degree programs.
However, the members are also quite aware of the specific and significant
inadequacy of such programs in regards to the practice of prosthetics and
orthotics. Simply put, these programs are not designed to deliver nor are
they delivering the complete education and experience necessary to prepare
their graduates to practice comprehensive prosthetic and orthotic services.
It is the AAPM&R's unequivocal position that the current standard
educational requirements for certification/registration/licensure for
occupational and physical therapy are insufficient to allow unrestricted
billing under the L codes for prosthetic and orthotic devices. The AAPM&R's
position is based on concern for patients. The field of physical medicine
and rehabilitation is dedicated to maintaining and improving the quality of
life for individuals with disabilities. Properly fabricated and fitted
orthoses and prostheses allow patients to walk, to run, to grasp, to dress,
in short to participate in life to the fullest. Unfortunately, poorly
constructed devices can limit mobility and self care and cause pain and skin
breakdown. This compromise of the skin can cause infection resulting in
further amputation and even death. Patients need and deserve the strongest
guarantees of competence. Allowing unrestricted access to prosthetic and
orthotic L codes to all physical and occupational therapists by virtue of
their diplomas/state licenses alone exposes patients to unnecessary dangers
and risks, and will undoubtedly lead to avoidable injury and mortality
It is the AAPM&R's opinion that many physician groups share our view. The
Barr Foundation and the Amputee Coalition of America have stated positions
endorsing the highest standards for prosthetists and orthotists, and reject
the concept that occupational and physical therapists should be regarded as
qualified by degree or licensure alone. In fact, the only consumer group
that seems willing to endorse physical therapists and occupational
therapists as qualified to have unrestricted access to construct all
prostheses and orthoses through current education/licensure alone appears to
be the Paralyzed Veterans of America.
A constructive solution to allow occupational therapists and physical
therapists to act as prosthetists and orthotists would be to require
additional certification for such practice. The AAPM&R would be happy to
work with American Occupational Therapy Association and the American
Physical Therapy Association and other appropriate organizations to set
proper standards.
Thank you for the opportunity to comment on the negotiated rulemaking
process. If you have any questions about these comments, please contact
Allison Waxler at the AAPM&R national office at 312/464-9700.
Sincerely,
<<...OLE_Obj...>>
Daniel Dumitru, MD, PhD
President
cc: Alberto Esquenazi, MD
Todd A. Kuiken, MD
Charles E. Levy, MD
Ronald A. Henrichs, CAE, Executive Director
R. Dawn Brennaman, MPA, Director, Health Policy and Practice Services
Allison Waxler, Policy Analyst, Practice Management
Neg Reg committee member, reply to Charles Levy's of AAPM&R comments posted
this morning.
Mr.Harley's comments were similar to mine at the time Neg Reg was in session
and when we still had an opportunity to reach consensus at the final Neg Reg
committee meeting.
I even suggested at the time, that in the spirit of reaching consensus,
perhaps some thought should be given by the O&P groups to allow those PTs
and OTs in licensed states, be grandfathered w/o further qualification in
only those states (4) where their specific Scope of Services included
delivery of comprehensive O&P services in their perspective state statues.
My position for suggesting this that it seemed highly unlikely that CMS (
Medicare )could deny any indivisual state licenced provider of
comprehensive O&P services, whom already have within their state statue and
within their Scope of Services, the right to deliver O&P and seek
reimbursement from Medicare.
However, I also added that every O&P provider of comprehensive O&P be
required to take continuing education courses and obtain educational credits
to continue to be qualified and informed about the most recent technology,
to be able to continue to provide those services.
Since there seem to be no agreement to my suggestion, by the O&P groups nor
the PTs and OTs, to present this to CMS and other members of the Neg Reg
committee, no consensus was reached after 19 days of meetings.
It became a whole new ball game and a post Neg Reg submission of signatories
from most all the O&P groups and our organization was made, excluding
Hanger and BOC.
The real question here and rebuttal should not be directed to the consumer
organizations whom have no financial interests,but should be directed to
Hanger and BOC and why they did agreee to sign on to the submission
submitted August 26th.
Mr. Thomas requested I send his response(below) to Dr.Levy's post, to the
subscribers of the O&P List serve and to the prior Neg Reg committee
members.
Tony Barr
Barr Foundation
www.oandp.com/barr
===========================================================================
=====================
Tony,
Good to hear from you, I hope your summer went well.
I suppose the only comment I have regarding the position statement from
AAPM&R would be as follows:
During the final comments made by several members of the committee including
yourself, I stated that I had personally stated to both the OT’s and PT’s
that there was no way I could ever agree that Licensure equated to Qualified
without further definitive measures. I did however state that in the spirit
of “negotiations” I was willing to accept their position in order to reach
consensus.
For AAPM&R to make the statement:
“In fact, the only consumer group that seems willing to endorse physical
therapists and occupational therapists as qualified to have unrestricted
access to construct all prostheses and orthoses through current
education/licensure alone appears to be the Paralyzed Veterans of America.”
I was more than willing to review and probably sign on to your group letter
as requested had the document been submitted for review prior to the 11th
hour in which I was out of town. I indicated to you that I needed to see
something prior to my departure, but unfortunately that didn't’t happen.
Peter Thomas, legal advisor to NAAOP, delivered a copy of the document to
my office the day the deadline and wanted our stamp of approval.
Unfortunately I was out of town and our staff was unwilling (as they should
have been) to take on the responsibility to sign on indicating our
concurrence.
I’m not sure why the ‘group’ feels it necessary to formally rebut my
letter. I do not believe that I stated anything in the letter that was not
true nor were the facts distorted one way or the other, nor did I endorse
the OT & PT community.
Regards,
Harley
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>]On
Behalf Of Levy, Charles
Sent: Monday, October 06, 2003 9:20 AM
To: <Email Address Redacted>
Subject: [OANDP-L]
Dear Friends,
I thought you might like to see the stand taken by the American Association
of Physical Medicine and Rehabilitation in regards to the recent Neg Reg
meetings.
Yours,
Charles E. Levy, MD
September 25, 2003
Mr. Robert Loyal, Director
Division of Provider Supplier
Centers for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD 21244-1850
Dear Mr. Loyal:
I am writing on behalf of the American Academy of Physical Medicine and
Rehabilitation (AAPM&R) to inform you of the position of the AAPM&R
regarding the recently completed session of the Negotiated Rule Making
Committee for Special Payment Provisions for Prosthetics and Certain Custom
Fabricated Orthotics. In addition, this letter is intended as a direct
rebuttal to the letter written by Mr. Harley Thomas of the Paralyzed
Veterans of America, addressed to you on July 16, 2003.
The AAPM&R is the national medical specialty society of nearly 7,000
physical medicine and rehabilitation physicians, also called physiatrists.
Approximately 90% of all physiatrists practicing in the United States are
members of the AAPM&R. Physical medicine and rehabilitation, recognized as a
board-certified medical specialty in 1947, focuses on restoring function to
people with problems ranging from simple physical mobility issues to those
with complex cognitive involvement. Physiatrists also treat patients with
acute and chronic pain and musculoskeletal as well as neurological
disorders.
At the invitation of CMS, the AAPM&R participated in the negotiated
rulemaking process. In the view of the AAPM&R, there were two groups
present at the table during the process: those with a direct financial
stake in the process (representatives of various prosthetist/orthotist
organizations, manufacturers' representatives, and representatives of
physical therapy and occupational therapy professional organizations) and
those with a primary interest in the outcome for people in need of
prosthetic and orthotic services, but with no direct financial stake in the
outcome of the process (the American Association of Orthopedic Surgeons, the
American Academy of Physical Medicine and Rehabilitation, The Barr
Foundation, and the Paralyzed Veterans of America).
The AAPM&R sent a total of three representatives to the meetings. AAPM&R
representatives' collective experience includes more than 40 years of
working with amputees in a variety of settings including various academic
and privates practice settings as well as Veterans Administration Medical
Centers. The AAPM&Rrepresentatives included advocates for amputees, authors
of research articles and contributors to standard textbooks regarding
rehabilitation following amputations, an associate editor of the American
Journal of Rehabilitation, a chairman of a prestigious department of
physical medicine and rehabilitation, and a member who himself is an
amputee. One of the AAPM&R representatives is on the faculty of a department
of occupational therapy at a major university.
All three AAPM&R representatives participate in the instructional curriculum
of physical and occupational therapists. The members are clearly aware of
the general strengths of physical and occupational therapy degree programs.
However, the members are also quite aware of the specific and significant
inadequacy of such programs in regards to the practice of prosthetics and
orthotics. Simply put, these programs are not designed to deliver nor are
they delivering the complete education and experience necessary to prepare
their graduates to practice comprehensive prosthetic and orthotic services.
It is the AAPM&R's unequivocal position that the current standard
educational requirements for certification/registration/licensure for
occupational and physical therapy are insufficient to allow unrestricted
billing under the L codes for prosthetic and orthotic devices. The AAPM&R's
position is based on concern for patients. The field of physical medicine
and rehabilitation is dedicated to maintaining and improving the quality of
life for individuals with disabilities. Properly fabricated and fitted
orthoses and prostheses allow patients to walk, to run, to grasp, to dress,
in short to participate in life to the fullest. Unfortunately, poorly
constructed devices can limit mobility and self care and cause pain and skin
breakdown. This compromise of the skin can cause infection resulting in
further amputation and even death. Patients need and deserve the strongest
guarantees of competence. Allowing unrestricted access to prosthetic and
orthotic L codes to all physical and occupational therapists by virtue of
their diplomas/state licenses alone exposes patients to unnecessary dangers
and risks, and will undoubtedly lead to avoidable injury and mortality
It is the AAPM&R's opinion that many physician groups share our view. The
Barr Foundation and the Amputee Coalition of America have stated positions
endorsing the highest standards for prosthetists and orthotists, and reject
the concept that occupational and physical therapists should be regarded as
qualified by degree or licensure alone. In fact, the only consumer group
that seems willing to endorse physical therapists and occupational
therapists as qualified to have unrestricted access to construct all
prostheses and orthoses through current education/licensure alone appears to
be the Paralyzed Veterans of America.
A constructive solution to allow occupational therapists and physical
therapists to act as prosthetists and orthotists would be to require
additional certification for such practice. The AAPM&R would be happy to
work with American Occupational Therapy Association and the American
Physical Therapy Association and other appropriate organizations to set
proper standards.
Thank you for the opportunity to comment on the negotiated rulemaking
process. If you have any questions about these comments, please contact
Allison Waxler at the AAPM&R national office at 312/464-9700.
Sincerely,
<<...OLE_Obj...>>
Daniel Dumitru, MD, PhD
President
cc: Alberto Esquenazi, MD
Todd A. Kuiken, MD
Charles E. Levy, MD
Ronald A. Henrichs, CAE, Executive Director
R. Dawn Brennaman, MPA, Director, Health Policy and Practice Services
Allison Waxler, Policy Analyst, Practice Management
Citation
“Re: Response to Chalres Levy's post re:Neg Reg submission by PVA,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/221972.
