Letter to the Editor: Insurance Problems--O&P’s Fault?
Regarding the "Perspective" commentary by Ralph Nobbe, CPO, in the April 2004 issue of The O&P EDGE:
Not only has the Barr Foundation been following the nationwide trend of benefit reductions, we also have been actively advocating for measures that would educate and perhaps reform the current mess of limited and nonexistent O&P benefits. Many states already do not provide Medicaid O&P benefits to patients over the age of 18.
The O&P industry would lead you to believe that the primary reason behind reduction of O&P benefits is that all states are looking for ways to reduce their state budgets. Medicaid and MediCal certainly fall into this category.
The more immediate contributing cause of third-party payers looking to cut or reduce O&P benefits is that your profession is for the most part unregulated, and unqualified providers continue to bill for O&P services.
DME, the major culprit in fraud and abuse, and the Office of Inspector General [OIG] Report of 1999 have tainted the O&P profession. Although distinctively different from the delivery of comprehensive O&P, DME has been closely aligned to O&P and will continue to be so until the national trade association, AOPA [American Orthotic & Prosthetic Association] separates DME interests from O&P.
I find it interesting that in every one of Mr. Nobbe's statements in the April article, he refers to recipients of O&P services correctly as "patients."
At the NegReg [Negotiated Rulemaking Committee] meetings, manufacturers referred to end-users as mere "consumers," not worthy of patient protection reform and mandated provider qualifications. There are those from the manufacturer/industry side and anti-regulation interests that have described receivers of O&P services as "consumers" to avoid facing the need for regulatory reform, price controls, etc.
The Barr Foundation views advocating for increased O&P benefits to a unregulated healthcare "profession" and to wealthy manufacturers who are not restricted by price controls for their mass-produced, overpriced components, as talking to a brick wall.
Until 1) every O&P provider is regulated in every state and Medicare/Medicaid establishes mandatory qualifications for providers, as is the case for every other legitimate healthcare profession; 2) DME interests are separated from O&P; and 3) price controls are activated for O&P components and supplies, as they are for other comprehensive healthcare products, your battle for credibility and increased benefits is an uphill struggle.
Providers' hard costs do exceed reimbursement levels in many cases. In the light of competitive bidding and freezes on reimbursement levels, perhaps you can convince manufacturers to reduce their costs of components and materials to you! There is not a chance of this happening, unless you are receiving big discounts for large orders. Just to survive, many smaller and independent providers may have to collectively bargain with manufacturers to receive a discount, just as the chains do.
What's so upsetting to me is that the Academy [American Academy of Orthotists & Prosthetists]--your national professional association--could be doing so much more.
AOPA, which negotiates on the profession's behalf, is deaf to the above suggestions. Worse is the apathy among your peers who choose not to advocate for making the O&P industry a legitimate, worthy, regulated healthcare profession by seeking meaningful regulation and expressing concerns for the conflicts that exist in the national associations which allegedly represent your interests.
President, Barr Foundation