Re: Medicare & new prostheses
Tony Barr
Description
Collection
Title:
Re: Medicare & new prostheses
Creator:
Tony Barr
Date:
11/16/2005
Text:
Good to see this discussion .
Here is my spin to Kim's excellent comments.
KR
Your predicament illustrates a level of Medicare's malfeasance rampant in
all DMERC regions. This cancer continues to grow, confound, and suffocate
this profession. Unless we can collectively establish effective protocol to
address such deficiencies, we will not survive as a profession with our
dignity intact.
Far too many conscientious practitioners are being held hostage by a
perplexing moral dilemma. Do the right thing for the patient by taking huge
monetary loss or suffer the heartbreak of financial expediency saying there
is nothing I can do. As professionals this is an untenable position which
is happening all too often and we must find a way to stop it.
TB
Why third party payers are pulling out of prosthetic coverage or raising
co-pays beyond affordability ?
1) Private insurance companies, Medicare, Medicaid, are thinking
prosthetic and orthotic devices are part of DME (Durable Medical Equipment)
manufactured and provided by unregulated sources and fitted by unregulated
providers.DME suppliers are the major source of fraud and abuse taking place
in the health care system.
Many are both represented by the same national trade industry lobbying for
better higher reimbursements . Lots of luck !
2) Prosthetists and orthotist practitioners dont require a state license nor
education nor formal training in 40 states of 50 states to legally hang a
shingle , evaluate patients fabricate and deliver comprehensive O&P
(prosthetic and orthotic devices) and get paid .There is no accountability
to a provider in a unregulated state.*
3) Unlike most all other specialized health care products, no price
controls exist on prosthetic components , supplies or services so its what
the market will bear (what you will bear as a every 3-5 year continuing
expense for a lifetime )
4) Too many unscrupulous providers (credentialed and uncredentialled)
oversubscribe costly and more profit margined components and supplies , for
patients that have good coverage, that dont necessarily require them.Ex:
I've seen too many amputees sitting in wheel chairs with C-Legs.
KR
Professional organizations such as AOPA, AAOP, ABC, or BOC have failed to
forcefully address this issue for fear of alienating certain dues paying
constituency. Some such as ABC claim to have a cannon of ethics, but
reality reveals a toothless watch dog that is neither ready, willing, nor
able to take appropriate action or sanctions
TB
Nice to blame professional associations but it is really up to the members
to have the leadership address the priorities. Any professional membership
is as effective as its memebrs. I agree there is no accountability or
oversight by any .This is a strong and a good argument for state and
federal regulation.
ABC and BOC provide no accountability or oversight. They are not membership
associations and have no members .
The By-Laws /Cannons condone cross credentialing and stay silent on
regulation .
Example :Cross Credentialing
ABC Certified Prosthetist/Orthotists in good standing have major concerns
on how the prosthetic and orthotic profession is allowing certified
practitioners in one discipline practice the other discipline without proper
supervision or certification in that discipline. With the state of scrutiny
our profession is currently experiencing, It seems that we would be in our
(ABC's) best interest, not to allow this to continue. The ABC Cannons of
Ethical Conduct should include in it's language something to the effect that
individuals who are currently certified in one discipline are not permitted
to practice the other discipline until full certification in that specific
discipline is achieved. The only exception to this would be if the
non-certified individual in under direct supervision by a qualified
practitioner stationed at that facility.
I am amazed at how many private O&P facilities allow non-certified
practitioners provide care to patients via certification in the opposite
discipline with out direct supervision. You may not be aware of current
policies at the VA which now stipulate that all VA prosthetic labs need to
be ABC or BOC certified as well as have the appropriate certified
practitioner providing care to veterans. In addition, contracting policy
stipulates that contracted facilities must have a full time certified staff
member stationed at that specific facility, supervising a non-certified
practitioner. In instances where contracted facilities do not have the
appropriate certified/supervised practitioner's), a contracted provider with
the appropriate certification's) should be selected.
ABC should take action...in specific instances where a practitioner is
certified in one discipline and actively participating in a residency
program for the other discipline or when a practitioner is certified in one
discipline and has completed their residency in the opposite and awaiting
to pass the appropriate exam...and enforce via a revision of the Cannon's of
Ethical Conduct, those single disciplined ABC Practitioners practicing the
opposite discipline without direct supervision. The penalty should include a
fine combined with suspension or warning of suspension of the current
credential until which time the opposite certification is achieved.
You as a profession, by allowing such practices to occur, are in essence
saying to the medical community at large that we as a credentialing body,
allow less that optimal care to patients we see by allowing non-certified
practitioners provide care to patients via the opposite credential.
The analogy I use to best describe what is happening here is...Would you
recommend or send your mother or neighbor to a licensed or certified
electrician to do plumbing work for them?
This situation is specific to single credentialed ABC practitioners and not
students who are currently enrolled or who have completed their residency
nor is it in reference to those practitioners who have never been
certified by ABC and who vicariously call themselves an Orthotist or
Prosthetist.
On the topic of facility accreditation as a means of Medicare payment, isn't
the industry including ABC pushing for Accreditation ?
I believe to become accredited as an ABC facility you must have certified
staff on the premises in the discipline that they do. If that is true than
how can they still support cross over while lobbying for accreditation. If
Medicare adopts facility accreditation we need to make sure that they
require that the facility have a certified practitioner on staff for each
discipline they provide. I really prefer licensure , since facility
accreditation is a joke anyway.
In Florida, Hanger recently blocked the direct supervision language (by
challenging the language with their attorney) the board unanimously passed
at the last board meeting. This is the second or third time they keep
challenging , forcing the board to hold another work shop to discuss the
language and to take another vote.
Then by law they have another 30 day period to challenge , tying it up
again.
They like the language that says direct supervision means the licensed
practitioner is in the building . We all know what that means. They can
use anyone they want to see patients without actually having to see the
patient if the licensed person is in the building. Additionally, who can
prove they are in the building? The other big point here is that
unsuspecting patients that pay for a service, thinking they are receiving
care by a licensed person are in many cases receiving care by a technician
in the back room. Someone with no formal education or even a certification.
I feel as licensed professionals you should have a fiduciary responsibility
to provide the care that is paid for.
There has been tremendous fraud because of this loop hole rule. Some
companies are billing for prosthetics when there are no licensed persons on
staff. The people seeing the patients say there is a licensed person on the
premises and some guys sell their credentials as clinical supervisors and
say they were in the building when the care happened but they actually may
be the clinical supervisor of up to 5 or 6 labs, to these shady O and P
companies.
I am not accusing exclusively Hanger of those practices but this is a bad
rule.
KR
Licensure is a valiant attempt and a step in the right direction at the
state level, but it is presently limited and feeble and has yet to
universally address and resolve federal problems.
TB
In 1996 the Barr Foundation helped get a federal O&P regulation bill drafted
by Fla Congressman Robert Wexler. The William G. Barr Amputee Protection
Act
The criteria was basically that anyone whom requested reimbursement for
performing comprehensive O&P services from Medicare/Medicaid for
beneficiaries, be duly certified by ABC or BOC in that particularly allied
health care science. AOPA opposed it. The Academy did not support it since
it let AOPA do their legislative lobbying at that time.
The bill never got out of committee since there was no support by either the
trade industry nor professional association.
Imp glad now because I don't believe mandatory certification is the answer.
I believe the Academy will soon be calling their own shots for the
PROFESSION and not industry interests.
But once again any professional organization is a effective as its members
.For the most part the apathy of it's members and O&P practitioners in
general is rampant and pitifull.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Here is my spin to Kim's excellent comments.
KR
Your predicament illustrates a level of Medicare's malfeasance rampant in
all DMERC regions. This cancer continues to grow, confound, and suffocate
this profession. Unless we can collectively establish effective protocol to
address such deficiencies, we will not survive as a profession with our
dignity intact.
Far too many conscientious practitioners are being held hostage by a
perplexing moral dilemma. Do the right thing for the patient by taking huge
monetary loss or suffer the heartbreak of financial expediency saying there
is nothing I can do. As professionals this is an untenable position which
is happening all too often and we must find a way to stop it.
TB
Why third party payers are pulling out of prosthetic coverage or raising
co-pays beyond affordability ?
1) Private insurance companies, Medicare, Medicaid, are thinking
prosthetic and orthotic devices are part of DME (Durable Medical Equipment)
manufactured and provided by unregulated sources and fitted by unregulated
providers.DME suppliers are the major source of fraud and abuse taking place
in the health care system.
Many are both represented by the same national trade industry lobbying for
better higher reimbursements . Lots of luck !
2) Prosthetists and orthotist practitioners dont require a state license nor
education nor formal training in 40 states of 50 states to legally hang a
shingle , evaluate patients fabricate and deliver comprehensive O&P
(prosthetic and orthotic devices) and get paid .There is no accountability
to a provider in a unregulated state.*
3) Unlike most all other specialized health care products, no price
controls exist on prosthetic components , supplies or services so its what
the market will bear (what you will bear as a every 3-5 year continuing
expense for a lifetime )
4) Too many unscrupulous providers (credentialed and uncredentialled)
oversubscribe costly and more profit margined components and supplies , for
patients that have good coverage, that dont necessarily require them.Ex:
I've seen too many amputees sitting in wheel chairs with C-Legs.
KR
Professional organizations such as AOPA, AAOP, ABC, or BOC have failed to
forcefully address this issue for fear of alienating certain dues paying
constituency. Some such as ABC claim to have a cannon of ethics, but
reality reveals a toothless watch dog that is neither ready, willing, nor
able to take appropriate action or sanctions
TB
Nice to blame professional associations but it is really up to the members
to have the leadership address the priorities. Any professional membership
is as effective as its memebrs. I agree there is no accountability or
oversight by any .This is a strong and a good argument for state and
federal regulation.
ABC and BOC provide no accountability or oversight. They are not membership
associations and have no members .
The By-Laws /Cannons condone cross credentialing and stay silent on
regulation .
Example :Cross Credentialing
ABC Certified Prosthetist/Orthotists in good standing have major concerns
on how the prosthetic and orthotic profession is allowing certified
practitioners in one discipline practice the other discipline without proper
supervision or certification in that discipline. With the state of scrutiny
our profession is currently experiencing, It seems that we would be in our
(ABC's) best interest, not to allow this to continue. The ABC Cannons of
Ethical Conduct should include in it's language something to the effect that
individuals who are currently certified in one discipline are not permitted
to practice the other discipline until full certification in that specific
discipline is achieved. The only exception to this would be if the
non-certified individual in under direct supervision by a qualified
practitioner stationed at that facility.
I am amazed at how many private O&P facilities allow non-certified
practitioners provide care to patients via certification in the opposite
discipline with out direct supervision. You may not be aware of current
policies at the VA which now stipulate that all VA prosthetic labs need to
be ABC or BOC certified as well as have the appropriate certified
practitioner providing care to veterans. In addition, contracting policy
stipulates that contracted facilities must have a full time certified staff
member stationed at that specific facility, supervising a non-certified
practitioner. In instances where contracted facilities do not have the
appropriate certified/supervised practitioner's), a contracted provider with
the appropriate certification's) should be selected.
ABC should take action...in specific instances where a practitioner is
certified in one discipline and actively participating in a residency
program for the other discipline or when a practitioner is certified in one
discipline and has completed their residency in the opposite and awaiting
to pass the appropriate exam...and enforce via a revision of the Cannon's of
Ethical Conduct, those single disciplined ABC Practitioners practicing the
opposite discipline without direct supervision. The penalty should include a
fine combined with suspension or warning of suspension of the current
credential until which time the opposite certification is achieved.
You as a profession, by allowing such practices to occur, are in essence
saying to the medical community at large that we as a credentialing body,
allow less that optimal care to patients we see by allowing non-certified
practitioners provide care to patients via the opposite credential.
The analogy I use to best describe what is happening here is...Would you
recommend or send your mother or neighbor to a licensed or certified
electrician to do plumbing work for them?
This situation is specific to single credentialed ABC practitioners and not
students who are currently enrolled or who have completed their residency
nor is it in reference to those practitioners who have never been
certified by ABC and who vicariously call themselves an Orthotist or
Prosthetist.
On the topic of facility accreditation as a means of Medicare payment, isn't
the industry including ABC pushing for Accreditation ?
I believe to become accredited as an ABC facility you must have certified
staff on the premises in the discipline that they do. If that is true than
how can they still support cross over while lobbying for accreditation. If
Medicare adopts facility accreditation we need to make sure that they
require that the facility have a certified practitioner on staff for each
discipline they provide. I really prefer licensure , since facility
accreditation is a joke anyway.
In Florida, Hanger recently blocked the direct supervision language (by
challenging the language with their attorney) the board unanimously passed
at the last board meeting. This is the second or third time they keep
challenging , forcing the board to hold another work shop to discuss the
language and to take another vote.
Then by law they have another 30 day period to challenge , tying it up
again.
They like the language that says direct supervision means the licensed
practitioner is in the building . We all know what that means. They can
use anyone they want to see patients without actually having to see the
patient if the licensed person is in the building. Additionally, who can
prove they are in the building? The other big point here is that
unsuspecting patients that pay for a service, thinking they are receiving
care by a licensed person are in many cases receiving care by a technician
in the back room. Someone with no formal education or even a certification.
I feel as licensed professionals you should have a fiduciary responsibility
to provide the care that is paid for.
There has been tremendous fraud because of this loop hole rule. Some
companies are billing for prosthetics when there are no licensed persons on
staff. The people seeing the patients say there is a licensed person on the
premises and some guys sell their credentials as clinical supervisors and
say they were in the building when the care happened but they actually may
be the clinical supervisor of up to 5 or 6 labs, to these shady O and P
companies.
I am not accusing exclusively Hanger of those practices but this is a bad
rule.
KR
Licensure is a valiant attempt and a step in the right direction at the
state level, but it is presently limited and feeble and has yet to
universally address and resolve federal problems.
TB
In 1996 the Barr Foundation helped get a federal O&P regulation bill drafted
by Fla Congressman Robert Wexler. The William G. Barr Amputee Protection
Act
The criteria was basically that anyone whom requested reimbursement for
performing comprehensive O&P services from Medicare/Medicaid for
beneficiaries, be duly certified by ABC or BOC in that particularly allied
health care science. AOPA opposed it. The Academy did not support it since
it let AOPA do their legislative lobbying at that time.
The bill never got out of committee since there was no support by either the
trade industry nor professional association.
Imp glad now because I don't believe mandatory certification is the answer.
I believe the Academy will soon be calling their own shots for the
PROFESSION and not industry interests.
But once again any professional organization is a effective as its members
.For the most part the apathy of it's members and O&P practitioners in
general is rampant and pitifull.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Tony Barr, “Re: Medicare & new prostheses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/225724.
