Re: ACA - representing beneficiaries - is part of workgroup that also includes manufacturers of myoelectric/computerized devices...
tony barr
Description
Collection
Title:
Re: ACA - representing beneficiaries - is part of workgroup that also includes manufacturers of myoelectric/computerized devices...
Creator:
tony barr
Date:
6/10/2004
Text:
With all due respect, to ACA's recent post and announcement of A newly
launched attempt of advocacy re: patient's access to hi-tech component
rehabilitation, their goal maybe better served and received, if they
partnered first with AOPA to advocate for state regulation of the O&P
profession and manufacturer qualifcations for reimbursement to
Medicare/Medicaid.
Mandatory benefits for any prosthetic components,hitech or otherwise, will
be a hard goal to achieve and retain when basically anyone, with no regard
to qualification, can fabricate fit and adjust comprehensive O&P devices to
patients in 40 of 50 states.
ACA says:
elimination of coverage for these devices by certain insurance companies is
just the tip of the iceberg. Excluding prosthetics from insurance policies
and limiting coverage by imposing unrealistic annual and lifetime caps are
quickly becoming the rule, and not the exception, in the insurance
industry.
TB reply:
In my opinion insurance companies and Medicare /Medicaid providers are
implementing these exclusions as the result of discovering that the
delivery of O&P is for the most part unregulated and has no oversight to
better protect the patient. That coupled with the extremely high cost of
rehabilitation mostly driven by the providers cost of components and
supplies
Has resulted in elimination and limitation of coverage's.
ACA says:
the need to show that the care received from well-trained, professional
individuals, along with the use of appropriate technology, improves outcomes
and prevents secondary conditions. This is an exciting but daunting
long-term project that requires the help and support of every single person
living with the loss or absence of a limb, as well as those who care for.
TB reply:
Very long term until the profession of O&P is regulated like any other
legitimate health care profession and cost of manufactured prosthetic
components and goods are properly analyzed considering today's technology to
produce.
Would not ACA's initiative to show that the care received is from
well-trained, professional individuals be better served by alignment to the
Academy than the industry?
Not only do patients need and deserve the strongest guarantees of competence
and qualified delivery, so do the third party payers and lawmakers.
Until that can be better assured, thru mandatory regulation and education
degrees in O&P, state board oversight of providers and affordable access to
components, amputees will continue to be subject to the elimination and
limitation of coverage for these devices.Dont forget this is not a one time
cost for prosthetic rehabilitation, but one that often occurs every 3.4
years!
Have mamufactures given any thought to ACA's President Paddy Rossbach plea
to them last spring, to reduce the cost of goods in light of elimination of
prosthetic coverage,implementation of competitive bidding, price
freezes,etc.
Good day,
Tony Barr
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Leslie Duncan
Sent: Thursday, June 10, 2004 8:28 AM
To: <Email Address Redacted>
Subject: [OANDP-L] ACA - representing beneficiaries - is part of workgroup
that also includes manufacturers of myoelectric/computerized devices...
The ACA has announced that it is leading the development of a National
Action Plan for Access Among Individuals with Limb Loss. As part of this
initiative, ACA - representing beneficiaries - is part of workgroup that
also includes manufacturers of myoelectric/computerized devices and AOPA.
Together, we are working to reverse certain imprudent policies regarding
coverage of these devices, as detailed in a recent letter to practitioners
that included a bibliography to provide empirical evidence that they can
provide to payors to justify the provision of state-of-the-art devices.
ACA ( <URL Redacted>) and AOPA
( <URL Redacted>) have posted this letter on their web sites to
ensure that it is available for all practitioners
It is important for us to educate insurance companies about the scope of
this issue by placing it in context. Not every amputee requires these
devices. A significant number of the 1.2 million amputees living in the US
have trans-tibial or lower amputations, and therefore do not use
microprocessor or myoelectric components.
However, elimination of coverage for these devices by certain insurance
companies is just the tip of the iceberg. Excluding prosthetics from
insurance policies and limiting coverage by imposing unrealistic annual and
lifetime caps are quickly becoming the rule, and not the exception, in the
insurance industry. With these changes, amputees are now facing a national
health crisis as insurers place them at risk for myriad secondary health
conditions resulting from the sedentary lifestyle that naturally arises out
of inadequate prosthetic coverage.
We need to show that the care received from well-trained, professional
individuals, along with the use of appropriate technology, improves outcomes
and prevents secondary conditions. This is an exciting but daunting
long-term project that requires the help and support of every single person
living with the loss or absence of a limb, as well as those who care for
them.
Paddy Rossbach, RN
President & CEO, Amputee Coalition of America
Leslie Duncan, MIS
Manager, Information Services
Amputee Coalition of America
900 East Hill Ave., Suite 285
Knoxville, TN 37915-2568
888-267-5669 ext. 8115
Fax 865-525-7917
<Email Address Redacted>
www.amputee-coalition.org
September 25, 2003
launched attempt of advocacy re: patient's access to hi-tech component
rehabilitation, their goal maybe better served and received, if they
partnered first with AOPA to advocate for state regulation of the O&P
profession and manufacturer qualifcations for reimbursement to
Medicare/Medicaid.
Mandatory benefits for any prosthetic components,hitech or otherwise, will
be a hard goal to achieve and retain when basically anyone, with no regard
to qualification, can fabricate fit and adjust comprehensive O&P devices to
patients in 40 of 50 states.
ACA says:
elimination of coverage for these devices by certain insurance companies is
just the tip of the iceberg. Excluding prosthetics from insurance policies
and limiting coverage by imposing unrealistic annual and lifetime caps are
quickly becoming the rule, and not the exception, in the insurance
industry.
TB reply:
In my opinion insurance companies and Medicare /Medicaid providers are
implementing these exclusions as the result of discovering that the
delivery of O&P is for the most part unregulated and has no oversight to
better protect the patient. That coupled with the extremely high cost of
rehabilitation mostly driven by the providers cost of components and
supplies
Has resulted in elimination and limitation of coverage's.
ACA says:
the need to show that the care received from well-trained, professional
individuals, along with the use of appropriate technology, improves outcomes
and prevents secondary conditions. This is an exciting but daunting
long-term project that requires the help and support of every single person
living with the loss or absence of a limb, as well as those who care for.
TB reply:
Very long term until the profession of O&P is regulated like any other
legitimate health care profession and cost of manufactured prosthetic
components and goods are properly analyzed considering today's technology to
produce.
Would not ACA's initiative to show that the care received is from
well-trained, professional individuals be better served by alignment to the
Academy than the industry?
Not only do patients need and deserve the strongest guarantees of competence
and qualified delivery, so do the third party payers and lawmakers.
Until that can be better assured, thru mandatory regulation and education
degrees in O&P, state board oversight of providers and affordable access to
components, amputees will continue to be subject to the elimination and
limitation of coverage for these devices.Dont forget this is not a one time
cost for prosthetic rehabilitation, but one that often occurs every 3.4
years!
Have mamufactures given any thought to ACA's President Paddy Rossbach plea
to them last spring, to reduce the cost of goods in light of elimination of
prosthetic coverage,implementation of competitive bidding, price
freezes,etc.
Good day,
Tony Barr
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Leslie Duncan
Sent: Thursday, June 10, 2004 8:28 AM
To: <Email Address Redacted>
Subject: [OANDP-L] ACA - representing beneficiaries - is part of workgroup
that also includes manufacturers of myoelectric/computerized devices...
The ACA has announced that it is leading the development of a National
Action Plan for Access Among Individuals with Limb Loss. As part of this
initiative, ACA - representing beneficiaries - is part of workgroup that
also includes manufacturers of myoelectric/computerized devices and AOPA.
Together, we are working to reverse certain imprudent policies regarding
coverage of these devices, as detailed in a recent letter to practitioners
that included a bibliography to provide empirical evidence that they can
provide to payors to justify the provision of state-of-the-art devices.
ACA ( <URL Redacted>) and AOPA
( <URL Redacted>) have posted this letter on their web sites to
ensure that it is available for all practitioners
It is important for us to educate insurance companies about the scope of
this issue by placing it in context. Not every amputee requires these
devices. A significant number of the 1.2 million amputees living in the US
have trans-tibial or lower amputations, and therefore do not use
microprocessor or myoelectric components.
However, elimination of coverage for these devices by certain insurance
companies is just the tip of the iceberg. Excluding prosthetics from
insurance policies and limiting coverage by imposing unrealistic annual and
lifetime caps are quickly becoming the rule, and not the exception, in the
insurance industry. With these changes, amputees are now facing a national
health crisis as insurers place them at risk for myriad secondary health
conditions resulting from the sedentary lifestyle that naturally arises out
of inadequate prosthetic coverage.
We need to show that the care received from well-trained, professional
individuals, along with the use of appropriate technology, improves outcomes
and prevents secondary conditions. This is an exciting but daunting
long-term project that requires the help and support of every single person
living with the loss or absence of a limb, as well as those who care for
them.
Paddy Rossbach, RN
President & CEO, Amputee Coalition of America
Leslie Duncan, MIS
Manager, Information Services
Amputee Coalition of America
900 East Hill Ave., Suite 285
Knoxville, TN 37915-2568
888-267-5669 ext. 8115
Fax 865-525-7917
<Email Address Redacted>
www.amputee-coalition.org
September 25, 2003
Citation
tony barr, “Re: ACA - representing beneficiaries - is part of workgroup that also includes manufacturers of myoelectric/computerized devices...,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/223154.
