US-Politics: Competitive Bidding for Prosthetics

[Wayne Renardson]

Mr. Allen sent this to OANDP-L for the attention of practitioners. It
strikes me as a consumer I have a vested interest in the outcome of
this legislation. If only the lowest bid received will be the main
criteria that decides what rig I will wear or use, well, it don't take
a weatherman to know which way this wind blows (apologies to Bob
Dylan).  

Mr. Allen is happy to reply to questions:  <MAllenCPO at AOL.COM> 

He included a list of each member of the House committees formulating
this legislation so if you plan to write, I suggest you contact him
for the congressional committee member in your location.   

BTW, does anyone know where ACA stands or what they are doing re: this
issue?  No doubt advocating for us.....

Wayne Renardson
------------------------------

                     CALL TO ACTION ”ROUND TWO!

EXEMPT ORTHOTICS AND PROSTHETICS FROM COMPETITIVE 
BIDDING 

NAAOP thanks those listserv members for their advocacy efforts in 
responding to our first Call to Action announced on May 15, 2002. This e- 
mail is our second effort designed to keep the pressure on Congress.  During 
the Congressional recess, which begins today and lasts until June 2, 2002, WE 
ASK THAT YOU CONTACT THE MEMBERS OF CONGRESS LISTED 
BELOW WHILE THEY ARE IN THEIR HOME STATES and emphasize 
the message to TOTALLY Exempt O &P from Medicare competitive bidding.      

As you may recall, two major committees in the House of Representatives are 
expected to pass Medicare reform legislation that will include some orthotics 
and prosthetics in a competitive bidding system for durable medical 
equipment.  Fortunately, this legislation, which was scheduled to be 
considered in the House of Representatives this week, has been postponed 
until after Memorial Day recess. A vote will likely occur in early to mid-June.  
At this time, however, it is still likely that some form of competitive bidding 
for O&P will be included in the legislation.       

Under this proposal, O&P practitioners would be required to bid on the basis 
of price for particular O&P care. With price, not quality, as the number one 
concern, NAAOP believes that professional standards of care would be 
degraded, quality of care would suffer dramatically, and patients would loose 
access to the practitioner of their choice.      

If this provision is included in the House committee bills, the O&P field will 
face an uphill battle to remove the provision from the legislation as it moves to 
the Senate. THIS IS WHY YOUR CONTINUED ACTION IS NEEDED.  
Below is a list of the Republican members on the Energy and Commerce and 
the Ways and Means committees.  It has become apparent that committee 
Democrats will not be involved with the drafting or passage of this legislation.      

[please forgive all CAPS]

IF YOU PRACTICE ( or use prosthetics ed:) IN A STATE WITH A 
MEMBER ON ONE OF THE COMMITTEE ROSTERS LISTED BELOW, 
PLEASE CALL THE NUMBER LISTED AND ASK TO BE CONNECTED 
TO THE DISTRICT OFFICE. LEAVE YOUR OPINION, FAX A LETTER 
TO THE DISTRICT OFFICE, OR FIND OUT WHEN EVENTS ARE 
BEING HELD WITH THE REPRESENTATIVE SO THAT YOU CAN 
TELL THEM PERSONALLY WHY O&P SHOULD BE TOTALLY 
EXEMPT FROM MEDICARE COMPETITIVE BIDDING.      

Use the talking points listed below for some sample arguments describing why 
O &P should be totally exempt from Medicare competitive bidding.     

Thank you for your continued efforts, 

Mike Allen, CPO, FAAOP, President National Association for the 
Advancement of Orthotics and Prosthetics (NAAOP) 
--------------------- 

O&P Care Should Be Totally Exempt from Medicare Competitive Bidding 
because:   

*Maintaining Professional Care Professional orthotic and prosthetic care 
consists of highly specialized and individualized clinical services involving the 
design and development of anatomically customized devices.  Professional O 
&P care is provided by clinicians with extensive training in the treatment of 
patients requiring orthoses (orthopedic braces) and prostheses (artificial 
limbs). Orthoses and prostheses should not be competitively bid because it will 
have the effect of eliminating the clinical component of care at the expense of 
the patient;    

*When Price Impacts Quality: When price becomes the sole and determining 
factor in securing Medicare referrals, the range and quality of professional 
services provided to the patient is sacrificed in order to put forth a low bid.  
Because professional O&P care is a labor intensive service, quality of care will 
suffer as providers search for ways to cut corners and costs so they can make 
ends meet. Some orthotic suppliers will likely hire unqualified orthotic fitters 
with no training in anatomy, physiology, pathology, manual muscle testing or 
observational gait analysis and set them loose on unsuspecting patients who 
may assume they are clinicians.  When low-ball bidders provide substandard 
care, competitive bidding may actually cost Medicare more than the current 
system due to increased patient visits, replacements necessitated by ill-fitting 
orthoses and prostheses, and the cost of related medical complications. 
Competitive bidding for professional services will foster a race to the bottom, 
not a race for the best outcome;    

* Competitive Bidding for O&P is Premature. Imposing competitive bidding 
on any professional O&P care is certainly ill-advised, but it is also premature.    

Medicare's Polk County competitive bidding demonstration project did not 
include any O&P services and the San Antonio demo, which did include some 
non-customized orthotics will not conclude until December 2002.  The impact 
on quality and access of competitive bidding on the orthoses included in the 
San Antonio demo is simply not fully known;   

* Professional O&P Care is Customized to Each Patient, not Generic. All 
prostheses and most orthoses are custom designed to address the specific 
anatomical and functional needs of each patient. Even pre-fabricated orthoses 
should not be subject to competitive bidding because the professional 
judgment of the O&P clinician is still needed to determine whether a 
prefabricated orthoses will suffice or whether a custom fabricated orthoses is 
necessary. Low-ball bidders will likely not possess the professional judgment 
necessary to make this important assessment;    

*Competitive Bidding Eliminates Choice: Medicare beneficiaries under the 
competitive bidding system will be restricted in the provider of their choice. 
Long-standing relationships between beneficiaries and familiar providers will 
be interrupted causing disruption in service and dissatisfaction for patients. 
Government-run competitive bidding may significantly undermine the ability of 
independent, community-based providers to keep their doors open;   

*Encourage Innovation ”The efforts to advance professional O&P care by 
clinicians, entrepreneurs, and researchers through the development of 
innovative clinical techniques and components to improve the functional 
abilities of people with disabilities will be significantly curtailed if there is not 
an adequate funding stream to award innovation.     

This debate is not about a distinction between pre-fabricated orthotics and 
custom orthotics; the real question is the level of clinical services provided to 
the patient. Implicit in the physician's order are the requisite clinical services 
needed to deliver a positive patient outcome and the fee for this clinical care is 
already included in the Medicare billing codes.  Medicare only overpays for 
pre-fabricated orthotics when there is no clinical care provided (i.e., where the 
pre-fabricated orthoses is drop-shipped or simply provided to the patient for 
self-fitting), and this is the inevitable result of competitive bidding of O&P 
care.     

For these reasons, I urge you to support a total exemption for O&P from 
Medicare competitive bidding.    

WAYS AND MEANS COMMITTEE--REPUBLICANS 

HOUSE ENERGY AND COMMERCE COMMITTEE -REPUBLICANS   

Visit our web site at <www.oandp.com/naaop>

Come share YOUR view! Government Relations is what WE do!