Fair Service: Patient Perspectives
August 2004 Issue
With Medicare and Medicaid cost-cutting, diminished reimbursements from private insurance, and other current dilemmas facing O&P practitioners and other healthcare professionals, what's happening to patients?
Although many of them are content with their care, others are disillusioned and disenchanted by the system's failure to work for them--and by other shortcomings they see.
David Green, an amputee since 1971, is a service-connected disabled veteran whose short right below-knee residual limb is extremely difficult to fit with a comfortable prosthesis. Green was fit by about ten different prosthetists, most recently by a Department of Veterans Affairs (VA) prosthetist, who tried for eight months and used 23 test sockets. "I still was not able to get a comfortable prosthesis," Green said.
Since Green had previously had success with a prosthetist not on contract with the VA, he has requested that his case--and his coverage--be transferred to this prosthetist. Despite assurances from VA personnel that this can and will be done--and despite letters to congressional representatives, senators, and VA executive leadership--Green is still waiting and receiving refusals after nearly two years. Further, he has been warned that VA appeals can take from five to seven years to resolve.
"I used to work 12-hour factory shifts," Green explained. "But since the difficulty in getting a comfortable prosthesis fit, I'm losing $192.40 every day--that's between $20,000 and $30,000 over the last two years. All I want is something to help me maximize my earnings capability in the next ten years before I retire."
This irreplaceable time continues to slip away, and with it, Green's potential for a comfortable retirement. Understand-ably, he feels helpless and frustrated, with the simple solution to his problem dangling just beyond his reach.
Prosthetists, Payers Fail
Jim DeWees, CP, BOCP, Prosthetic Center of Indiana at Bloomington, is an athletic and active 39-year-old six-year amputee. He is an avid mountain biker, snow skier, water skier, and rock climber.
"I lost my leg from frostbite, a result of a backcountry expedition in Utah that turned into a really bad situation," DeWees explained. "I fought for three months to save my foot with skin grafts and other surgeries to fix the damage, but it was unable to be fixed." DeWees then went to a prosthetist for an artificial limb. "He used the most inferior quality products that broke in a few weeks and left me stranded again with no prosthesis," said DeWees. "He really didn't seem to even care if I walked or not. He got paid for the leg and did not guarantee his work. He told me that he would have to fight with my insurance company to get a warranty-replacement new foot."
The insurance company claimed the foot had been abused. "I had been an amputee for about seven or eight weeks, and I really don't think that I was even capable of abusing a prosthesis at that point! I was barely able to walk. It was just a really ugly, discouraging experience."
Things went downhill from there--DeWees paid cash for another $14,000 leg that didn't fit and was not replaceable. The American Board for Certification in Orthotics & Prosthetics (ABC) was unable to help, he said. Another prosthetist was unable to help. DeWees tried another state--and spent another $12,000.
His disastrous experiences prompted him to apply to the California State University-Dominquez Hills O&P program in order to get his own credentials, so he could make his own prostheses and help others.
After school, his experiences as a prosthetist for major employers were also disappointing before he was able to open his own successful business in Indiana and practice by his own careful code of ethics.
Although many patients are highly satisfied with their care, with amputees like Green and DeWees reporting such experiences, it's small wonder that the O&P field overall sometimes receives a black eye, and practitioners' humanitarian motives are called into question.