Re: The most honest response to date
Tony Barr
Description
Collection
Title:
Re: The most honest response to date
Creator:
Tony Barr
Date:
5/13/2005
Text:
Not our weekly salute but couldn't resist a post:
NOMA/Reductions/Price Freezes/Parity Laws/Etc.
Who's Responsible / Who's to Blame ?
Want some honesty from a mere patient's perspective?
Perhaps we should look first at the 'why' to determine 'whom' is responsible
for NOMAs encroachment into specialized O&P and the reductions taking place
in the Medicare/Medicaid arena..
The real reason that there is newfound interest in legislative advocacy for
proper O&P coverage is that there have been some clear shots across the
bow by the insurance industry to exclude or severely limit O&P benefits
from their policies.
Take for example that Anthem and Aetna have decided that all myoelectric
arms and computer knees are investigation and have no added benefit.
United Health Care has decided to limit coverage next year to a total of
$2500 annual benefit for prosthetics.
The ACA has partnered with AOPA to fund a PAC to attempt to put together an
effort of the industry and patient organizations to push legislation to
mandate O & P insurance coverage on a state and national basis or mandate
parity laws in states where there is no regulation nor requirement of even a
certification credential !!
Insurance coverage issues and licensure for prosthetists (as for
nursing/medicine) is a state issue, and licensure ( with mandatory
educational standards ) would be a benefit for amputees.
It is fortunate that ACA appears to be doing something on the lines of
supporting meaningful advocacy.
I believe their new born enthusiasm to support advocacy issues may be
attributed to AOPA 's perception that supporting parity is more digestible
to them and the industry than supporting O & P regulation in all 50
states.
My question is, how do you better assure quality services are delivered
and maintain the credibility of parity legislation when basically anyone can
still provide O&P services without regard to qualification in 40 of 50
states ?
The ACA needs to be sure that it s own organization and amputees are not
being exploited for the greater good of the pocket books of the power
brokers of the industry.
The issues with Anthem and Aetna may be that the industry lacks the
objective research to support the claims of the manufactures for many of
these products. Maybe Anthem and Aetna are not seeing the advertised results
with the patients fit with some of these devices, I know I can say that for
the C-legs .
The amputees still speak the adverting literature, but I don't see it in the
gaits they walk. The C-leg has become a household word do to the partnering
of Otto Bock, Hanger, and the ACA. But what about the Adaptive K nee from
Endolite that came first, is third generation, wireless, and has seven
independent adjustment modes to the C-legs one.
Where is the independent comparative testing of these two systems to the
S-N-S that shows that one is superior to the other and documents the cost
benefit of the new systems?
I am also well aware of many $75, 000 Utah Arms that are sitting in closets
and insurance companies have had to shell out money again for less costly
body powered systems that are more user friendly.
If the IG were pointed in the right direction they would find many cases
like this to build a case for Anthem and Aetna .
The O&P industry would lead you to believe that the primary reason behind
reduction of O&P benefits is that all states are looking for ways to reduce
their state budgets. Medicaid and MediCal certainly fall into this category.
The more immediate contributing cause of third party payers looking to cut
or reduce O&P benefits is that your profession is on the most part
unregulated and unqualified providers continue to bill for O&P services.
You carry red flags on your white jackets with certification credentials.
DME, the major culprit of fraud and abuse, and OIG Report of 1999 has
tainted the O&P profession. Although distinctively different from the
delivery of comprehensive O&P,DME has been closely aligned to O&P and will
remain to be so until the national trade industry (AOPA) separates DME
interests from O&P. NOMA members are also members to a trade industry
representing DME interests,NOMA interests and the profession of O&P
interests. How can that be effective for satisfying the needs of all and
maintaining proper reimbursement. Not possible.
This thinking on behalf of lawmakers is the alignment of DME to O&P is
natural since they have learned from AOPA whom is the legislative
voice, for both. AOPA was delegated federal legislative negotiations years
ago by the professional association , the Academy. I applaud their efforts
to go at it themselves.
At the Neg Reg meetings manufactures referred the end users as mere
consumers, not worthy of patient protection reform and mandating provider
qualifications.
There are those from the manufacture/industry side and anti regulation
interests, that have equated receivers of O&P services as consumers to elude
to the lack of need of regulatory reform, price controls ,etc.
You cant have it both ways !
Medical, in an effort to restructure their state budgets, will no doubt soon
be following suit of many other states in eliminating O&P benefits all
together.
Apathy among O&P providers is a deterrent for reform.
The Barr Foundation equates advocating for increased O&P benefits to a
unregulated health care providers and for benefit of already well
heeled manufactures whom are not restricted in price controls, for their
mass produced overpriced components, as talking to a brick wall.
The O&P profession is very much still in the making and has lost
significant ground during these economic times.
The profession not the industry should lead the crusade to :
1) support legislation that would make sure every O&P provider is regulated
in every state and Medicare/Medicaid establishes mandatory qualifications
for providers as is for every other legitimate health care provider,
2) DME and NOMA interests are separated from the delivery of comprehensive
O&P
3) Every state support and obtain parity legislation in every regulated
state making it mandatory for health care providers to have proper O&P
benefits.
4 ) Price controls are activated for O&P component and supplies as are
other comprehensive health care products
Until which time these goals are achieved the profession's fight for
credibility and increased benefits will continue to be an uphill struggle.
2005 O&P Policy Forum (9 CECs)
The upcoming O&P Policy Forum comes at a pivotal time. The O&P profession
needs to pull together and work to advance our collective interests. Some
of the issues that need attention include: preventing an extension of the
Medicare payment freeze, defeating efforts by physical therapists (PTs) to
prescribe and provide O&P services, seeking alternatives to crushing
Medicare audit tactics and allowing practitioners to bill Part B for
services provided to patients in a skilled nursing facility.
O&P Professional Speaks Out
We [as practitioners] have to do everything we can to protect
reimbursement. Our expenses and overhead will continue to rise and
accreditation will only become more complicated. Attending the O&P Policy
Forum is the first critical step in this process.
-Ted Trower, CPO, A-S-C Orthotics & Prosthetics
June 21: Participants will receive private briefings from key lawmakers and
policymakers and receive lobbying training from expert lobbyists.
Lobby training from expert lobbyiests representing who?
How many at the attending the Forum will lobby to regulate the profession
and separate the delivery of comprehensive O&P from NOMA and DME ??
I agree with Mr. Keith Monroe, Prosthetic Resident Fargo North Dakota,
With all due respect, and as a new member to this profession, I suggest
before we start throwing stones at others, we clean the windows on our own
glass house.
NOMA/Reductions/Price Freezes/Parity Laws/Etc.
Who's Responsible / Who's to Blame ?
Want some honesty from a mere patient's perspective?
Perhaps we should look first at the 'why' to determine 'whom' is responsible
for NOMAs encroachment into specialized O&P and the reductions taking place
in the Medicare/Medicaid arena..
The real reason that there is newfound interest in legislative advocacy for
proper O&P coverage is that there have been some clear shots across the
bow by the insurance industry to exclude or severely limit O&P benefits
from their policies.
Take for example that Anthem and Aetna have decided that all myoelectric
arms and computer knees are investigation and have no added benefit.
United Health Care has decided to limit coverage next year to a total of
$2500 annual benefit for prosthetics.
The ACA has partnered with AOPA to fund a PAC to attempt to put together an
effort of the industry and patient organizations to push legislation to
mandate O & P insurance coverage on a state and national basis or mandate
parity laws in states where there is no regulation nor requirement of even a
certification credential !!
Insurance coverage issues and licensure for prosthetists (as for
nursing/medicine) is a state issue, and licensure ( with mandatory
educational standards ) would be a benefit for amputees.
It is fortunate that ACA appears to be doing something on the lines of
supporting meaningful advocacy.
I believe their new born enthusiasm to support advocacy issues may be
attributed to AOPA 's perception that supporting parity is more digestible
to them and the industry than supporting O & P regulation in all 50
states.
My question is, how do you better assure quality services are delivered
and maintain the credibility of parity legislation when basically anyone can
still provide O&P services without regard to qualification in 40 of 50
states ?
The ACA needs to be sure that it s own organization and amputees are not
being exploited for the greater good of the pocket books of the power
brokers of the industry.
The issues with Anthem and Aetna may be that the industry lacks the
objective research to support the claims of the manufactures for many of
these products. Maybe Anthem and Aetna are not seeing the advertised results
with the patients fit with some of these devices, I know I can say that for
the C-legs .
The amputees still speak the adverting literature, but I don't see it in the
gaits they walk. The C-leg has become a household word do to the partnering
of Otto Bock, Hanger, and the ACA. But what about the Adaptive K nee from
Endolite that came first, is third generation, wireless, and has seven
independent adjustment modes to the C-legs one.
Where is the independent comparative testing of these two systems to the
S-N-S that shows that one is superior to the other and documents the cost
benefit of the new systems?
I am also well aware of many $75, 000 Utah Arms that are sitting in closets
and insurance companies have had to shell out money again for less costly
body powered systems that are more user friendly.
If the IG were pointed in the right direction they would find many cases
like this to build a case for Anthem and Aetna .
The O&P industry would lead you to believe that the primary reason behind
reduction of O&P benefits is that all states are looking for ways to reduce
their state budgets. Medicaid and MediCal certainly fall into this category.
The more immediate contributing cause of third party payers looking to cut
or reduce O&P benefits is that your profession is on the most part
unregulated and unqualified providers continue to bill for O&P services.
You carry red flags on your white jackets with certification credentials.
DME, the major culprit of fraud and abuse, and OIG Report of 1999 has
tainted the O&P profession. Although distinctively different from the
delivery of comprehensive O&P,DME has been closely aligned to O&P and will
remain to be so until the national trade industry (AOPA) separates DME
interests from O&P. NOMA members are also members to a trade industry
representing DME interests,NOMA interests and the profession of O&P
interests. How can that be effective for satisfying the needs of all and
maintaining proper reimbursement. Not possible.
This thinking on behalf of lawmakers is the alignment of DME to O&P is
natural since they have learned from AOPA whom is the legislative
voice, for both. AOPA was delegated federal legislative negotiations years
ago by the professional association , the Academy. I applaud their efforts
to go at it themselves.
At the Neg Reg meetings manufactures referred the end users as mere
consumers, not worthy of patient protection reform and mandating provider
qualifications.
There are those from the manufacture/industry side and anti regulation
interests, that have equated receivers of O&P services as consumers to elude
to the lack of need of regulatory reform, price controls ,etc.
You cant have it both ways !
Medical, in an effort to restructure their state budgets, will no doubt soon
be following suit of many other states in eliminating O&P benefits all
together.
Apathy among O&P providers is a deterrent for reform.
The Barr Foundation equates advocating for increased O&P benefits to a
unregulated health care providers and for benefit of already well
heeled manufactures whom are not restricted in price controls, for their
mass produced overpriced components, as talking to a brick wall.
The O&P profession is very much still in the making and has lost
significant ground during these economic times.
The profession not the industry should lead the crusade to :
1) support legislation that would make sure every O&P provider is regulated
in every state and Medicare/Medicaid establishes mandatory qualifications
for providers as is for every other legitimate health care provider,
2) DME and NOMA interests are separated from the delivery of comprehensive
O&P
3) Every state support and obtain parity legislation in every regulated
state making it mandatory for health care providers to have proper O&P
benefits.
4 ) Price controls are activated for O&P component and supplies as are
other comprehensive health care products
Until which time these goals are achieved the profession's fight for
credibility and increased benefits will continue to be an uphill struggle.
2005 O&P Policy Forum (9 CECs)
The upcoming O&P Policy Forum comes at a pivotal time. The O&P profession
needs to pull together and work to advance our collective interests. Some
of the issues that need attention include: preventing an extension of the
Medicare payment freeze, defeating efforts by physical therapists (PTs) to
prescribe and provide O&P services, seeking alternatives to crushing
Medicare audit tactics and allowing practitioners to bill Part B for
services provided to patients in a skilled nursing facility.
O&P Professional Speaks Out
We [as practitioners] have to do everything we can to protect
reimbursement. Our expenses and overhead will continue to rise and
accreditation will only become more complicated. Attending the O&P Policy
Forum is the first critical step in this process.
-Ted Trower, CPO, A-S-C Orthotics & Prosthetics
June 21: Participants will receive private briefings from key lawmakers and
policymakers and receive lobbying training from expert lobbyists.
Lobby training from expert lobbyiests representing who?
How many at the attending the Forum will lobby to regulate the profession
and separate the delivery of comprehensive O&P from NOMA and DME ??
I agree with Mr. Keith Monroe, Prosthetic Resident Fargo North Dakota,
With all due respect, and as a new member to this profession, I suggest
before we start throwing stones at others, we clean the windows on our own
glass house.
Citation
Tony Barr, “Re: The most honest response to date,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/224919.
