Medicare Should Follow the VA’s Lead
June 2016 Issue
The Centers for Medicare & Medicaid Services (CMS) seems to be focusing a significant amount of energy on undermining the expeditious delivery of appropriate prosthetic devices to many of its Medicare beneficiaries with amputations. Instead, I suggest that CMS embarks on a more positive agenda by taking a lead from the U.S. Department of Veterans Affairs (VA). Since 2010, the VA has allocated up to $8 million annually toward its Adaptive Sports Grant (ASG) Program to fund the expansion and establishment of programs nationwide that encourage veterans and service members with disabilities, including those with limb loss, to participate in a variety of adaptive sports as part of a multifaceted rehabilitative effort. CMS could adopt a similar initiative for its Medicare beneficiaries with amputations by funding local, regional, and national programs that support increased activity levels among our civilians with amputations.
VA studies have documented that participating in adaptive sports benefits veterans with disabilities. Numerous physical and social benefits have been reported, including reductions in stress and decreased dependence on antidepressant and pain medications. While I concede that significant differences exist between typical veterans with limb loss and average Medicare beneficiaries with limb loss, I also think that many benefits could be realized if CMS encourages its beneficiaries with limb loss to participate in a variety of locally organized activities that include adaptive sports.
The United States Olympic Committee led the VA's initial ASG Program efforts. So why couldn't Medicare involve a national organization, such as the YMCA and its network of about 2,700 facilities across the United States, to spearhead a similar civilian effort? Grants could be awarded to the YMCA at a national level, with mini-grants filtered down to local facilities.
Farfetched? Medicare already offers to reimburse up to $1,940 per beneficiary per year (2015 rates) for physical or occupational therapy (PT and OT) when deemed to be medically necessary. Why not commit an equal amount per year for beneficiaries with limb loss who do not qualify for or need PT or OT and use that money to fund programs that promote group interactions, positive lifestyle choices, and enhanced activity levels for Medicare beneficiaries with limb loss? These grants could be used to encourage Medicare beneficiaries with limb loss to participate in a variety of educational, supportive, and sports-related activities at their local YMCAs, while promoting more healthy and active lifestyles.
Because a model for such a program already exists within the VA, it should be fairly straightforward to create an equivalent civilian program funded by CMS. If successful, such an effort might lead to positive outcomes for tens of thousands of civilians with limb loss across the country while helping put the "care" back in Medicare.
Peter Seaman, CLP, provides compassionate patient care at Master's Orthotics & Prosthetics, Silverdale, Washington. He can be reached at .