Re: Reaction to the Medicare Open Forum Call yesterday
William Lifford
Description
Collection
Title:
Re: Reaction to the Medicare Open Forum Call yesterday
Creator:
William Lifford
Date:
9/13/2013
Text:
It is clear (from the Medical Director's semi-refusal to address other
issues that came up) that CMS is committed to this idea of the ECT. They
are only looking for input on the elements of the ECT, not whether the ECT
is the way to go. CMS seems to already have decided that.
I think they all have this idea that K3 level feet and knees are vastly
prescribed and that they have some unspoken internal directive to reduce
their use, beneficiaries' lifestyles be damned.
This ECT seems to be the device CMS will use to drive K3 usage down and
transform Medicare from being the best insurance for prosthetic coverage to
the least costly while delivering only okay function coverage.
It's a shame when you consider that these beneficiaries have paid into
Medicare their whole working lives... and then when they need the stability
of a C-Leg or other K3 component to preserve their quality of life as they
age, CMS will make it next to impossible to do so.
This ECT is more of a checklist of things to prove ineligibility for
high-level prosthetic fitting than to justify medical necessity.
Bill Lifford, CP
On Sep 13, 2013 9:04 AM, Anthony Gutierrez < <Email Address Redacted> > wrote:
> Beyond some bickering and stabs back and forth, my biggest take home
> message from this call was the following.
>
> O and P professionals are still suppliers and not health care specialists
> due to your financial interest in all claims.
>
> The clinical documentation document for physicians is CMS's goal of
> collecting a large amount of data of objective data about the patient. What
> this data will be used for is unclear, but they will have will have it.
>
> However, us as 'suppliers' are only able to contribute to this objective
> data set in a subjective matter with our interpretation of a K level.
>
> The vaguely described K-level system is what got us into this mess and as a
> field we need to determine a way to fix it.
>
> I issue a challenge to all practitioners to develop an extensive objective
> rubric with multiple functional assessments to make your K level
> determination as objective as possible.
>
> This takes time, a considerable amount of time, but it is a necessary step
> to turn us from suppliers into health care specialists.
>
> And dismount soap box,
>
> Tony Gutierrez CP
>
> --
> Anthony R. Gutierrez
> <Email Address Redacted>
>
>
issues that came up) that CMS is committed to this idea of the ECT. They
are only looking for input on the elements of the ECT, not whether the ECT
is the way to go. CMS seems to already have decided that.
I think they all have this idea that K3 level feet and knees are vastly
prescribed and that they have some unspoken internal directive to reduce
their use, beneficiaries' lifestyles be damned.
This ECT seems to be the device CMS will use to drive K3 usage down and
transform Medicare from being the best insurance for prosthetic coverage to
the least costly while delivering only okay function coverage.
It's a shame when you consider that these beneficiaries have paid into
Medicare their whole working lives... and then when they need the stability
of a C-Leg or other K3 component to preserve their quality of life as they
age, CMS will make it next to impossible to do so.
This ECT is more of a checklist of things to prove ineligibility for
high-level prosthetic fitting than to justify medical necessity.
Bill Lifford, CP
On Sep 13, 2013 9:04 AM, Anthony Gutierrez < <Email Address Redacted> > wrote:
> Beyond some bickering and stabs back and forth, my biggest take home
> message from this call was the following.
>
> O and P professionals are still suppliers and not health care specialists
> due to your financial interest in all claims.
>
> The clinical documentation document for physicians is CMS's goal of
> collecting a large amount of data of objective data about the patient. What
> this data will be used for is unclear, but they will have will have it.
>
> However, us as 'suppliers' are only able to contribute to this objective
> data set in a subjective matter with our interpretation of a K level.
>
> The vaguely described K-level system is what got us into this mess and as a
> field we need to determine a way to fix it.
>
> I issue a challenge to all practitioners to develop an extensive objective
> rubric with multiple functional assessments to make your K level
> determination as objective as possible.
>
> This takes time, a considerable amount of time, but it is a necessary step
> to turn us from suppliers into health care specialists.
>
> And dismount soap box,
>
> Tony Gutierrez CP
>
> --
> Anthony R. Gutierrez
> <Email Address Redacted>
>
>
Citation
William Lifford, “Re: Reaction to the Medicare Open Forum Call yesterday,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/235612.
