The perfect O&P storm
Wil
Description
Collection
Title:
The perfect O&P storm
Creator:
Wil
Date:
1/25/2013
Text:
Hello Colleagues and Guests,
Based upon recent posts, it looks like the perfect O&P storm is
approaching and may already be here. So here goes again.
For starters, I've posted the proposed competitive bidding list that I
received today for your review. It can be found at OP-Repository.org,
then Documents, then CMS. Many of us have not paid much attention to
this, but I believe it is very important for the future of O&P. Here's
why. We are apparently asleep at the switch. Let me explain. I will only
use one code on this list, but I could keep most of you up all night
discussing the rest of them without any difficulty. Some of you know
that. L-Code 0120, Soft cervical collar. There was a day when a soft
cervical collar was federally controlled and could not be dispensed
without a prescription from a physician. That's hard to believe isn't
is? Now for the stories.
A harmless soft cervical collar is now considered a commodity because it
does not take any professional expertise to apply. I believe this is
true. It does not take any professional expertise to swallow a
prescribed pill or capsule either, but some are controlled and can only
be purchased upon the order of a physician. Why? Well, you know the
answer for that. In my opinion, that harmless cervical collar should
also be controlled by a physician. On more than one occasion, someone
has wondered into a hospital or physician's office wearing a soft
cervical collar, only to discover that they have a potentially serious
odontoid fracture. I have personally seen this happen. Because injuries
or fractures in the cervical region are almost always more dangerous
than some in lower spinal areas, where is the common sense that now
allows a cervical collar to be purchased off-the-shelf without physician
supervision or knowledge? Was this perhaps suggested by trial lawyers?
Maybe it was the same ones that represented the fellow who used his lawn
mower as a hedge trimmer.
Most of you don't know this, but I was sued for $20,000,000.00 a few
years ago. The charge was wrongful death. Even though this was a
frivolous lawsuit, there was nothing frivolous about it at the time. It
involved a wheelchair, a solid drop-in seat, and a seatbelt. The
seatbelt was applied by the maintenance man at the nursing home on the
order of a therapist. We had sold a dozen sets of E&J seatbelts to the
nursing home at their request. The short statement by the plaintiff
attorney was, you should have known better. The suit never went to
trial because the insurance company would not allow it and told us we
were on our own if we wanted a jury trial. Shortly after the suit was
settled for little money, we lost our liability insurance. The siblings
who sued had never ever been to the nursing home to visit their 30 plus
year old sibling who had severe spastic CP. You can likely guess what
the cause of death was.
This brings me to the problem we are having getting the names of those
at CMS who are responsible, along with their written and signed clinical
notes, for making the denial decisions for CMS and who are also
overriding the decisions of the prescribing physicians. From my
perspective, not only is this an important part of the patient's medical
record, it is also a piece of information that we will need if we are
ever sued for denying appropriate O&P care that harms a Medicare or
Medicaid recipient, based upon a CMS denial as not being medically
necessary. Today, I saw a post where prosthetic liners are being denied
as not medically necessary. Knowing how easy it is for things to
disappear in government when it's convenient, I suggest that each of us
give this serious consideration. I can already visualize a denied
prosthetic liner, a later life threatening infection, and a potential
lawsuit that would likely make 20 million seem like pocket change. Are
you getting the picture? Folks this should be serious stuff for us.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
Based upon recent posts, it looks like the perfect O&P storm is
approaching and may already be here. So here goes again.
For starters, I've posted the proposed competitive bidding list that I
received today for your review. It can be found at OP-Repository.org,
then Documents, then CMS. Many of us have not paid much attention to
this, but I believe it is very important for the future of O&P. Here's
why. We are apparently asleep at the switch. Let me explain. I will only
use one code on this list, but I could keep most of you up all night
discussing the rest of them without any difficulty. Some of you know
that. L-Code 0120, Soft cervical collar. There was a day when a soft
cervical collar was federally controlled and could not be dispensed
without a prescription from a physician. That's hard to believe isn't
is? Now for the stories.
A harmless soft cervical collar is now considered a commodity because it
does not take any professional expertise to apply. I believe this is
true. It does not take any professional expertise to swallow a
prescribed pill or capsule either, but some are controlled and can only
be purchased upon the order of a physician. Why? Well, you know the
answer for that. In my opinion, that harmless cervical collar should
also be controlled by a physician. On more than one occasion, someone
has wondered into a hospital or physician's office wearing a soft
cervical collar, only to discover that they have a potentially serious
odontoid fracture. I have personally seen this happen. Because injuries
or fractures in the cervical region are almost always more dangerous
than some in lower spinal areas, where is the common sense that now
allows a cervical collar to be purchased off-the-shelf without physician
supervision or knowledge? Was this perhaps suggested by trial lawyers?
Maybe it was the same ones that represented the fellow who used his lawn
mower as a hedge trimmer.
Most of you don't know this, but I was sued for $20,000,000.00 a few
years ago. The charge was wrongful death. Even though this was a
frivolous lawsuit, there was nothing frivolous about it at the time. It
involved a wheelchair, a solid drop-in seat, and a seatbelt. The
seatbelt was applied by the maintenance man at the nursing home on the
order of a therapist. We had sold a dozen sets of E&J seatbelts to the
nursing home at their request. The short statement by the plaintiff
attorney was, you should have known better. The suit never went to
trial because the insurance company would not allow it and told us we
were on our own if we wanted a jury trial. Shortly after the suit was
settled for little money, we lost our liability insurance. The siblings
who sued had never ever been to the nursing home to visit their 30 plus
year old sibling who had severe spastic CP. You can likely guess what
the cause of death was.
This brings me to the problem we are having getting the names of those
at CMS who are responsible, along with their written and signed clinical
notes, for making the denial decisions for CMS and who are also
overriding the decisions of the prescribing physicians. From my
perspective, not only is this an important part of the patient's medical
record, it is also a piece of information that we will need if we are
ever sued for denying appropriate O&P care that harms a Medicare or
Medicaid recipient, based upon a CMS denial as not being medically
necessary. Today, I saw a post where prosthetic liners are being denied
as not medically necessary. Knowing how easy it is for things to
disappear in government when it's convenient, I suggest that each of us
give this serious consideration. I can already visualize a denied
prosthetic liner, a later life threatening infection, and a potential
lawsuit that would likely make 20 million seem like pocket change. Are
you getting the picture? Folks this should be serious stuff for us.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
Citation
Wil, “The perfect O&P storm,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/234607.
