Re: Specific Rx for Prosthesis
tony barr
Description
Collection
Title:
Re: Specific Rx for Prosthesis
Creator:
tony barr
Date:
12/21/2004
Text:
Although I am not a prosthetist colleague to whom Al directed his post, and
since you haven't heard from me in awhile, this is an interesting question
Al Pike has posed and hope you will include it in the general list serve
discussion.
A Patient's Perspective
We shouldn't continue to minimize the physician's responsibity in the
evaluation and prescription process and responsibility factors of the
equation while at he same time adamantly oppose licensed physical therapists
from prescribing O&P services .
There is a reference in the Federal Registry where there is thought being
considered to allow physician assistants ,nurses,etc to write prescriptions
of O&P services. Wouldn't supporting exemption from patients require a
physicians prescription for comprehensive O&P devices set dangerous
precedent here?
As part of the Barr Foundation funding requirements, we ask applicants to
include not only coverage denial letters from viable resources, but also a
physician's Rx for a prosthesis.
Any doctor can provide them.
If most of you would agree that most physicians do not possess the skills
or training to make O&P treatment assessment,
it would seem reasonable to me that the first step in the process of
achieving proper prosthetic rehabilitation that needs reform (outside of a
patient receiving proper surgical care in removing the limb) is the
prescription process.
Judging from the written prescriptions I have personally seen, they are
mostly Rx limited to Right B/K Prosthesis or Left Artificial limb I had
one labeled Fake leg and most misspelled the word prosthesis let
alone had language as to the specific components to use in the Rx. I am sure
you all have had similar experiences and could share ?
The problem of general physicians writing Rxs, whom have no knowledge of O&
P corrective treatment, nor the current technology utilized for
rehabilitation for patients whom have initial acute conditions and
require replacement items, is formidable.
This is why you should encourage that only properly trained physicians
should evaluate and prescribe not eliminate the requirement and the
prescribing physician not get entirely paid until he see the patient with
his prosthesis as a follow up visit!! This delay of full payment until the
follow-up would also provide him an opportunity of seeing today's technology
and take more pride in the quality of his own work, amputation and the
benefits of his patient receiving proper prosthetic rehabilitation.
To support eliminating the physicians evaluation and prescription
interactions for acute treatment is a time bomb ready to explode the door
open to even less qualified sources to write prescriptions.
Could not some replacement components whether orthotic or prosthetic, be
improperly prescribed for a particular patient because of his or her
activity level? Would a College Park replacement foot be appropiate
replacement for a sach or a C-Leg be a appropiate replacement for a
prosthesis worn by a wheel chair bound patient ?
Could not a replacement component not properly matched to the patient be
harmful to his/her rehabilitation?
Why can't a general physician refer the patient requiring O&P treatment, to
a physician specifically trained in neuromuscular disorders and have them
write the prescription and do a follow up after it has been fitted ??
It's a common occurrence in other treatments. Why not O&P ?
We have to fix the problem, not eliminate it.
Since everyone seems to be in full agreement that the need for full
involvement of physician is necessary in all aspects of a patients medical
care, and the physician groups represented at Neg Reg admitted to a minimum
of 50% of the responsibility to assure their patients to receive proper O&P
treatment , I would suggest you consider taking it a few steps further in
your suggestions to CMS, and beyond what seems to be the current policy for
any physician to be able to evaluate and prescribe O&P services.
The proposed rule being developed by CMS would make the face to face
physician visit a requirement for every single physician written order and
thus a precursor to every interaction a Medicare beneficiary would have with
their orthotist and/or prosthetist for services. In clinical practice today
many referrals take place though correspondence and other documentation,
including a written prescription, and do not require an office visit if in
the judgment of the physician it is not necessary.
Under the proposed rule, a Medicare beneficiary could not receive benefits
or coverage for an O or P service billed under any prescription from a
physician unless the beneficiary completed an actual physician office visit
to obtain it. If the proposed requirement is instituted and enforced,
beneficiaries would be required to complete a physician visit for even the
simplest of adjustments and/or supplies (such as socks or suspension
sleeves). Secondarily, the proposed rule prohibits the physician from
charging for the visit that the beneficiary would need in order to receive
the prescription. Taking the proposed rule to its administrative
conclusion; the Medicare beneficiary on their way to their orthotist and/or
prosthetist must first arrange a visit to their physician (for free or
potentially out of pocket) in order to write a prescription and validate
their need to see their orthotist and/or prosthetist for services.
We continue to support and operate under present Medicare policy which
requires clinical documentation, communication with the referring physician
and a valid detailed prescription written by a physician. We also
acknowledge that the proposed rule could create beneficiary access issues
and our concern is specifically for those individuals who are past acute
medical need and are in essence an experienced wearer. Faced with an
orthotic or prosthetic issue, which may develop into an acute medical issue
if left unattended, a physician face-to-face visit requirement may over
burden the referral process for many of these Medicare beneficiaries. We
have always and will continue to support the need for a physician's
prescription, but we also believe it is up to the referring physician to
decide if a face to face visit with their patient is necessary to write a
prescription. Currently, if the physician is uncomfortable with the
communication with their patient and/or the prosthetist or orthotist, or has
any other concerns in generating a written order, he/she will often request
that the patient set up an appointment to insure their instructions. It is
for these reasons that we resist the additional requirement for a physician
visit in addition to having a valid physician order.
Lets not forget that anybody, regardless of lack of certification or
license, can still provide O&P services today and be reimbursed by
Medicare/Medicaid. While this profession remains unregulated and discussion
continue as to what is DME and what is comprehensive O&P lets make at least
one party accountable or be made partially accountable, the licensed
physician writing the Rx.
I would like to thank Al Kritter CPO and Dr. Sidney Fishman for providing me
with some of the above information.
However, my opinions statements and conclusions are my own.
Tony Barr
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of <Email Address Redacted>
Sent: Tuesday, December 21, 2004 8:14 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Specific Rx
Dear prosthetist colleagues:
How specific and detailed are the prescriptions you are receiving for
prostheses? I recall getting prescriptions on an Rx pad that read Leg
prosthesis
and signed by a physician.
On the generic prescriptions do you follow up with the physician for more
detail or do you find many physicians not versed in prosthetic component
selection?
How many write your own detailed prosthesis prescription for the physician's
signature?
Thanks for any insight you can provide on today's prostheses prescription
procedures.
Al Pike, CP
since you haven't heard from me in awhile, this is an interesting question
Al Pike has posed and hope you will include it in the general list serve
discussion.
A Patient's Perspective
We shouldn't continue to minimize the physician's responsibity in the
evaluation and prescription process and responsibility factors of the
equation while at he same time adamantly oppose licensed physical therapists
from prescribing O&P services .
There is a reference in the Federal Registry where there is thought being
considered to allow physician assistants ,nurses,etc to write prescriptions
of O&P services. Wouldn't supporting exemption from patients require a
physicians prescription for comprehensive O&P devices set dangerous
precedent here?
As part of the Barr Foundation funding requirements, we ask applicants to
include not only coverage denial letters from viable resources, but also a
physician's Rx for a prosthesis.
Any doctor can provide them.
If most of you would agree that most physicians do not possess the skills
or training to make O&P treatment assessment,
it would seem reasonable to me that the first step in the process of
achieving proper prosthetic rehabilitation that needs reform (outside of a
patient receiving proper surgical care in removing the limb) is the
prescription process.
Judging from the written prescriptions I have personally seen, they are
mostly Rx limited to Right B/K Prosthesis or Left Artificial limb I had
one labeled Fake leg and most misspelled the word prosthesis let
alone had language as to the specific components to use in the Rx. I am sure
you all have had similar experiences and could share ?
The problem of general physicians writing Rxs, whom have no knowledge of O&
P corrective treatment, nor the current technology utilized for
rehabilitation for patients whom have initial acute conditions and
require replacement items, is formidable.
This is why you should encourage that only properly trained physicians
should evaluate and prescribe not eliminate the requirement and the
prescribing physician not get entirely paid until he see the patient with
his prosthesis as a follow up visit!! This delay of full payment until the
follow-up would also provide him an opportunity of seeing today's technology
and take more pride in the quality of his own work, amputation and the
benefits of his patient receiving proper prosthetic rehabilitation.
To support eliminating the physicians evaluation and prescription
interactions for acute treatment is a time bomb ready to explode the door
open to even less qualified sources to write prescriptions.
Could not some replacement components whether orthotic or prosthetic, be
improperly prescribed for a particular patient because of his or her
activity level? Would a College Park replacement foot be appropiate
replacement for a sach or a C-Leg be a appropiate replacement for a
prosthesis worn by a wheel chair bound patient ?
Could not a replacement component not properly matched to the patient be
harmful to his/her rehabilitation?
Why can't a general physician refer the patient requiring O&P treatment, to
a physician specifically trained in neuromuscular disorders and have them
write the prescription and do a follow up after it has been fitted ??
It's a common occurrence in other treatments. Why not O&P ?
We have to fix the problem, not eliminate it.
Since everyone seems to be in full agreement that the need for full
involvement of physician is necessary in all aspects of a patients medical
care, and the physician groups represented at Neg Reg admitted to a minimum
of 50% of the responsibility to assure their patients to receive proper O&P
treatment , I would suggest you consider taking it a few steps further in
your suggestions to CMS, and beyond what seems to be the current policy for
any physician to be able to evaluate and prescribe O&P services.
The proposed rule being developed by CMS would make the face to face
physician visit a requirement for every single physician written order and
thus a precursor to every interaction a Medicare beneficiary would have with
their orthotist and/or prosthetist for services. In clinical practice today
many referrals take place though correspondence and other documentation,
including a written prescription, and do not require an office visit if in
the judgment of the physician it is not necessary.
Under the proposed rule, a Medicare beneficiary could not receive benefits
or coverage for an O or P service billed under any prescription from a
physician unless the beneficiary completed an actual physician office visit
to obtain it. If the proposed requirement is instituted and enforced,
beneficiaries would be required to complete a physician visit for even the
simplest of adjustments and/or supplies (such as socks or suspension
sleeves). Secondarily, the proposed rule prohibits the physician from
charging for the visit that the beneficiary would need in order to receive
the prescription. Taking the proposed rule to its administrative
conclusion; the Medicare beneficiary on their way to their orthotist and/or
prosthetist must first arrange a visit to their physician (for free or
potentially out of pocket) in order to write a prescription and validate
their need to see their orthotist and/or prosthetist for services.
We continue to support and operate under present Medicare policy which
requires clinical documentation, communication with the referring physician
and a valid detailed prescription written by a physician. We also
acknowledge that the proposed rule could create beneficiary access issues
and our concern is specifically for those individuals who are past acute
medical need and are in essence an experienced wearer. Faced with an
orthotic or prosthetic issue, which may develop into an acute medical issue
if left unattended, a physician face-to-face visit requirement may over
burden the referral process for many of these Medicare beneficiaries. We
have always and will continue to support the need for a physician's
prescription, but we also believe it is up to the referring physician to
decide if a face to face visit with their patient is necessary to write a
prescription. Currently, if the physician is uncomfortable with the
communication with their patient and/or the prosthetist or orthotist, or has
any other concerns in generating a written order, he/she will often request
that the patient set up an appointment to insure their instructions. It is
for these reasons that we resist the additional requirement for a physician
visit in addition to having a valid physician order.
Lets not forget that anybody, regardless of lack of certification or
license, can still provide O&P services today and be reimbursed by
Medicare/Medicaid. While this profession remains unregulated and discussion
continue as to what is DME and what is comprehensive O&P lets make at least
one party accountable or be made partially accountable, the licensed
physician writing the Rx.
I would like to thank Al Kritter CPO and Dr. Sidney Fishman for providing me
with some of the above information.
However, my opinions statements and conclusions are my own.
Tony Barr
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of <Email Address Redacted>
Sent: Tuesday, December 21, 2004 8:14 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Specific Rx
Dear prosthetist colleagues:
How specific and detailed are the prescriptions you are receiving for
prostheses? I recall getting prescriptions on an Rx pad that read Leg
prosthesis
and signed by a physician.
On the generic prescriptions do you follow up with the physician for more
detail or do you find many physicians not versed in prosthetic component
selection?
How many write your own detailed prosthesis prescription for the physician's
signature?
Thanks for any insight you can provide on today's prostheses prescription
procedures.
Al Pike, CP
Citation
tony barr, “Re: Specific Rx for Prosthesis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/224082.
