Re: The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges
Jim DeWees
Description
Collection
Title:
Re: The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges
Creator:
Jim DeWees
Date:
11/11/2009
Text:
In response to the post about the Healthcare reform bill, I have a few of my own concerns, along with many other physicians and healthcare providers.
I searched the bill (using the search tool on the PDF file), and found Prosthetics listed 2 times in 1990 pages. On pages 106 and 432.
Page 106 states that O&P (along with all DME) is mandatory to be covered under the plans...what plans, I am not sure...under the Government plans, or the private health insurance companies. But, at least they are mentioned as being a benefit under THE PLAN.
On page 432 it is all about accreditation. Nowhere does it mention about individual credentials or qualifications to provide O&P, but only that the provider be accredited by some agency....PLEASE go and read these pages for yourselves and see if you can understand what they say. It first states that accreditation does not apply to those providing canes, wheelchairs, (DME stuff) including O&P...BUT the following paragraph goes into more detail about HOW and WHO people are doing accreditation applications, and how THEY will retain their provider ID numbers, until they are determined to be qualified to provide services....It is very confusing, as is ALL of this.
I don't know if this was intentional or not, but immediately following the O&P comments on page 432, they go into Bankruptcy of providers and the policies related to that....SO, I guess they are aware of this potential, and providing rules for even going bankrupt under this bill.....hmmmm...interesting.
Now, for the other parts that WILL affect us in this field. First off, take a look at the language for High Risk individuals. It first might sound good, meaning that there is a provision for people that are High Risk and cannot get healthcare insurance, or so they say. In Indiana, there is the state comprehensive health benefits for people that cannot get health insurance. All that is needed is a copy of 2 rejections from private insurance companies, and also that you do not qualify for Medicaid or Medicare. The plan (according to 2 of my patients that are on that policy) costs them about $350 a month and gets them access to medical care, doctors, therapists, and even O&P. But, many people can't even afford this, or choose to NOT have it, or don't know about it. But, the feds are now doing a program, nationwide, similar to this.
But, who is qualified or forced to be on this High Risk plan?? Well, the Secretary (of HHS) will define the conditions that qualify or determine the high risk. And, anyone that has any condition as defined by the Secretary that is high risk will be forced to be on this plan.
On page 26 of the bill, it outlines the policies that will happen if there are Insufficient funds, or over budget (and EVERY government plan is over budget and out of money...look at Medicare and Medicaid for a good example or that). But, if THIS plan goes over budget, then the Secretary will reduce benefits, establish waiting lists, and increase the premiums.
I think it would be safe to assume that MOST (if not ALL) of our patients will fall into this High Risk pool, and so we can expect to have these patients now have to WAIT for a new limb due to the budget problems or ALL government programs. We can also see a Reduced Benefit, and it will most likely be aimed at the DME benefits...it would be very easy for them to just say that the patients just don't need such expensive limbs, and reduce the benefits in that manner.
Are we going to know this at the time of service?? Or will we just do business as usual, and hope that there is money in the government program to pay us for our time and services??? And will we just be notified after delivering a limb that OOPS, we are out of money at this time, so we aren't paying you!!!. Or, will the patients be notified that since they are out of money, that the can only go to Dialysis 2 times a week instead of 3, or maybe they'll have to skip a week or 2 until they get more money in the account?? How will this work?
And, in my case, being an amputee (even though I am young...well sort of anyway, and healthy), I guess the Secretary could list the diagnosis codes for amputations as High Risk patients, because the O&P services are expensive...and so I could be listed as one of the High Risk people, and therefore MY private insurance can drop me and make me go into this pool. But, on page 30, it states that I can FIGHT against being dropped.
It states that I can fight this rescission of benefits by going to an independent party to hear the complaint, and they can decide if they can drop me or not....BUT, this independent group is under the direction of the Secretary....and so if the Secretary has defined the terms, and then is in charge of how the independent group hears my complaints about being dropped....well, I can't see this independent group going against the Secretary that wrote the definitions and also sits over this panel.
So, bottom line is I will probably be forced to give up my PRIVATE insurance that I am happy with, and end up on this Government plan, and then probably have my benefits reduced, and sitting on some waiting list for everything, and also have my premiums jacked up incredibly, and there is NO limits as to what they can raise them to.
As a prosthetist who is watching this carefully, and reading and researching this as much as possible, I do NOT see anything in here that is good for us in this field.
As an amputee and user of prosthetic devices, and also the father of a child that also needs prosthetic care, this bill scares me to death.....Thank goodness that I can make my own limbs and NOT have to wait for a blessing from the Secretary to go and get a new leg, and be able to walk again and be functional. But, heaven help the other amputees that are relying on our services and who have been able to have access to it.
But, regardless of whether or not I am defined as HIGH RISK or not, in 2 years, yes 2 YEARS, I will be forced to go to the government exchange to get my new government sanctioned care. And, for those that have business large enough that qualify for a BIG COMPANY as defined by the Secretary.
In fact, read the bill and search the words By the secretary and it comes up with 324 items that will be determined, specified, defined, ruled, implemented....... Boy, this sure gives the Secretary a lot of power to spend this $1.3 trillion dollars and the power to affect, destroy, hurt, help, benefit ALL of us!!
This bill scares me, and it should scare all of us. Read it and keep in mind how this will affect you as a person and also as a healthcare provider. I could list many more issues that are very concerning and problematic. I could spend hours writing and talking about how bad this is.
Hopefully we will all make our own minds up on this issue, and READ the bill, and not just listen to some promote it and intentionally mention how GOOD this is, or how WONDERFUL this is. READ IT!!!!! At least read pages 26, 30, 32, 40, and 106 and 432. That is enough to see these problems.
Make up your mind, talk to the physicians that send you referrals and see what THEY think about this. They are smart people, they understand how to help people and treat people. The government has NO idea how to practice medicine or help anyone. Make up your minds, call your state senators and voice your concerns. Get involved with local groups that are with you on this issue (either for or against).
I have never seen any issue so strongly dividing this nation, or causing such an outcry from the people as this bill is doing. I am strongly voicing my concerns to my congressman, who is in favor of this bill, and most likely signed his death warrant politically last week. I am trying to get in touch with my senators to talk to them about this. The Republican has already said there is NO way he can support such a bill. And the Democrat has also strongly stated that he will NOT support it either. But, since he is so close to the Clintons, and now they are involved, it will be interesting to watch how he (Evan Bayhe) moves forward...if he will cave in and vote for such a bill or not. But, I am keeping on top of his office staff and telling them on a regular basis that the people here do NOT want this bill, and how the amputees here feel about this bill.
Please don't just sit there and do nothing about this. Get involved and do whatever you feel is right to protect the patients and your businesses.
Thanks,
Jim DeWees, CP
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I searched the bill (using the search tool on the PDF file), and found Prosthetics listed 2 times in 1990 pages. On pages 106 and 432.
Page 106 states that O&P (along with all DME) is mandatory to be covered under the plans...what plans, I am not sure...under the Government plans, or the private health insurance companies. But, at least they are mentioned as being a benefit under THE PLAN.
On page 432 it is all about accreditation. Nowhere does it mention about individual credentials or qualifications to provide O&P, but only that the provider be accredited by some agency....PLEASE go and read these pages for yourselves and see if you can understand what they say. It first states that accreditation does not apply to those providing canes, wheelchairs, (DME stuff) including O&P...BUT the following paragraph goes into more detail about HOW and WHO people are doing accreditation applications, and how THEY will retain their provider ID numbers, until they are determined to be qualified to provide services....It is very confusing, as is ALL of this.
I don't know if this was intentional or not, but immediately following the O&P comments on page 432, they go into Bankruptcy of providers and the policies related to that....SO, I guess they are aware of this potential, and providing rules for even going bankrupt under this bill.....hmmmm...interesting.
Now, for the other parts that WILL affect us in this field. First off, take a look at the language for High Risk individuals. It first might sound good, meaning that there is a provision for people that are High Risk and cannot get healthcare insurance, or so they say. In Indiana, there is the state comprehensive health benefits for people that cannot get health insurance. All that is needed is a copy of 2 rejections from private insurance companies, and also that you do not qualify for Medicaid or Medicare. The plan (according to 2 of my patients that are on that policy) costs them about $350 a month and gets them access to medical care, doctors, therapists, and even O&P. But, many people can't even afford this, or choose to NOT have it, or don't know about it. But, the feds are now doing a program, nationwide, similar to this.
But, who is qualified or forced to be on this High Risk plan?? Well, the Secretary (of HHS) will define the conditions that qualify or determine the high risk. And, anyone that has any condition as defined by the Secretary that is high risk will be forced to be on this plan.
On page 26 of the bill, it outlines the policies that will happen if there are Insufficient funds, or over budget (and EVERY government plan is over budget and out of money...look at Medicare and Medicaid for a good example or that). But, if THIS plan goes over budget, then the Secretary will reduce benefits, establish waiting lists, and increase the premiums.
I think it would be safe to assume that MOST (if not ALL) of our patients will fall into this High Risk pool, and so we can expect to have these patients now have to WAIT for a new limb due to the budget problems or ALL government programs. We can also see a Reduced Benefit, and it will most likely be aimed at the DME benefits...it would be very easy for them to just say that the patients just don't need such expensive limbs, and reduce the benefits in that manner.
Are we going to know this at the time of service?? Or will we just do business as usual, and hope that there is money in the government program to pay us for our time and services??? And will we just be notified after delivering a limb that OOPS, we are out of money at this time, so we aren't paying you!!!. Or, will the patients be notified that since they are out of money, that the can only go to Dialysis 2 times a week instead of 3, or maybe they'll have to skip a week or 2 until they get more money in the account?? How will this work?
And, in my case, being an amputee (even though I am young...well sort of anyway, and healthy), I guess the Secretary could list the diagnosis codes for amputations as High Risk patients, because the O&P services are expensive...and so I could be listed as one of the High Risk people, and therefore MY private insurance can drop me and make me go into this pool. But, on page 30, it states that I can FIGHT against being dropped.
It states that I can fight this rescission of benefits by going to an independent party to hear the complaint, and they can decide if they can drop me or not....BUT, this independent group is under the direction of the Secretary....and so if the Secretary has defined the terms, and then is in charge of how the independent group hears my complaints about being dropped....well, I can't see this independent group going against the Secretary that wrote the definitions and also sits over this panel.
So, bottom line is I will probably be forced to give up my PRIVATE insurance that I am happy with, and end up on this Government plan, and then probably have my benefits reduced, and sitting on some waiting list for everything, and also have my premiums jacked up incredibly, and there is NO limits as to what they can raise them to.
As a prosthetist who is watching this carefully, and reading and researching this as much as possible, I do NOT see anything in here that is good for us in this field.
As an amputee and user of prosthetic devices, and also the father of a child that also needs prosthetic care, this bill scares me to death.....Thank goodness that I can make my own limbs and NOT have to wait for a blessing from the Secretary to go and get a new leg, and be able to walk again and be functional. But, heaven help the other amputees that are relying on our services and who have been able to have access to it.
But, regardless of whether or not I am defined as HIGH RISK or not, in 2 years, yes 2 YEARS, I will be forced to go to the government exchange to get my new government sanctioned care. And, for those that have business large enough that qualify for a BIG COMPANY as defined by the Secretary.
In fact, read the bill and search the words By the secretary and it comes up with 324 items that will be determined, specified, defined, ruled, implemented....... Boy, this sure gives the Secretary a lot of power to spend this $1.3 trillion dollars and the power to affect, destroy, hurt, help, benefit ALL of us!!
This bill scares me, and it should scare all of us. Read it and keep in mind how this will affect you as a person and also as a healthcare provider. I could list many more issues that are very concerning and problematic. I could spend hours writing and talking about how bad this is.
Hopefully we will all make our own minds up on this issue, and READ the bill, and not just listen to some promote it and intentionally mention how GOOD this is, or how WONDERFUL this is. READ IT!!!!! At least read pages 26, 30, 32, 40, and 106 and 432. That is enough to see these problems.
Make up your mind, talk to the physicians that send you referrals and see what THEY think about this. They are smart people, they understand how to help people and treat people. The government has NO idea how to practice medicine or help anyone. Make up your minds, call your state senators and voice your concerns. Get involved with local groups that are with you on this issue (either for or against).
I have never seen any issue so strongly dividing this nation, or causing such an outcry from the people as this bill is doing. I am strongly voicing my concerns to my congressman, who is in favor of this bill, and most likely signed his death warrant politically last week. I am trying to get in touch with my senators to talk to them about this. The Republican has already said there is NO way he can support such a bill. And the Democrat has also strongly stated that he will NOT support it either. But, since he is so close to the Clintons, and now they are involved, it will be interesting to watch how he (Evan Bayhe) moves forward...if he will cave in and vote for such a bill or not. But, I am keeping on top of his office staff and telling them on a regular basis that the people here do NOT want this bill, and how the amputees here feel about this bill.
Please don't just sit there and do nothing about this. Get involved and do whatever you feel is right to protect the patients and your businesses.
Thanks,
Jim DeWees, CP
_________________________________________________________________
Bing brings you maps, menus, and reviews organized in one place.
<URL Redacted>
********************
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
Jim DeWees, “Re: The U.S. House Passes Healthcare Reform: Mixed Bag for O&P Emerges,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 25, 2024, https://library.drfop.org/items/show/230961.
