The landmark Medicare reform and prescription drug bill passed by the Senate November 25 is a "mixed bag" for O&P, according to the National Association for the Advancement of Orthotics & Prosthetics (NAAOP). Although some aspects are unfavorable to O&P, "There are clearly some important victories in the bill," NAAOP said. However, the American Orthotic & Prosthetic Association (AOPA) said the legislation will have a negative impact on the O&P field. "AOPA is troubled by the overall outcome of the Medicare package," the Association said November 26. The Senate passed the legislation by a vote of 54-44. The House of Representatives passed the bill November 22 by a vote of 220-215. Three-Year Payment Freeze Imposed Medicare payments for orthotic and prosthetic services will now be frozen at 2003 levels for 2004, 2005, and 2006. This provision will cost the field $1.2 billion over the next ten years, according to AOPA. "Lobbying efforts by AOPA resulted in reducing the freeze period from five years to three years," the association noted. "On behalf of providers of orthotics and prosthetics services, AOPA is disappointed that Medicare reform has resulted in a three-year payment freeze," said Tyler Wilson, executive director. "Imposing 2003 payment levels for the next three years is certainly not a way to ensure that Medicare beneficiaries receive the best treatment utilizing the latest technologies that our industry has to offer. Unfortunately the O&P industry got whacked because various lobbying groups in our field failed to embrace AOPA's reasonable message on Capitol Hill, thereby presenting a disunified voice and allowing Medicare dollars to be pulled away from our specialty," he continued. NAAOP, however, added, "It is important to note that a Senate-passed tax bill in late May would have frozen the entire O&P fee schedule for ten years. Thanks in part to the efforts of NAAOP, this provision was removed from the final tax bill. In addition, the fee freeze under the Medicare bill continues through 2008 for certain items of DME, clearly indicating a separation between treatment of DME and professional O&P care." Competitive Bidding to be Implemented Following the payment freeze, Medicare will begin to implement in 2007 a competitive bidding program for virtually all DME and only "off-the-shelf" orthotic devices. Payments determined by competitive bidding will replace Medicare fee schedule payments. Both AOPA and NAAOP credited their efforts in helping to confine the scope of competitive bidding. "Off-the-shelf" orthotics represents a much narrower definition than what was proposed by the original Senate-passed bill in June, said NAAOP. That bill included all non-custom-fabricated orthotic services, noted AOPA, adding, "This legislation officially recognizes that the provision of O&P services required trained practitioners to fabricate and fit O&P devices to patients." NAAOP said, "The inclusion of this definition should be considered a major victory, since most orthotics and all prosthetics will not be subject to a nationwide system of Medicare competitive bidding at anytime in the near future." Quality Standards to be Established A highlight of the Medicare legislation is that Medicare will establish quality and accreditation requirements for the provision and payment of orthotic and prosthetic services--a position AOPA advocated strongly, the association pointed out. "This provision appears to trump' the protracted Negotiated Rulemaking dispute in favor of the position that all O&P care must be provided by healthcare professionals certified/accredited in the practice of orthotics and prosthetics," said NAAOP. "The provision will need to be analyzed further to understand its full implications, i.e. its impact on the failed Negotiated Rulemaking [NegReg] process, but it appears to be very favorable to NAAOP's position on the issue of the definition of a qualified provider.'" Also, under the bill, O&P was spared application of a provision mandating a cut in reimbursement for the top five utilized DME items in 2005. "This also represents an extremely positive outcome for O&P," NAAOP pointed out. "Overall, the bill marks a fundamental shift toward private insurance as a model for the provision of Medicare benefits and prescription drugs," said NAAOP. "It also enacts myriad reforms to other provider payment systems as well as the CMS [Centers for Medicare & Medicaid Services]regulatory system," NAAOP added. "The three-year payment freeze followed by competitive bidding for off-the-shelf' orthotic devices is an additional burden for an industry that already has experienced arduous reimbursement problems," said AOPA President Keith Cornell, CP, BOCO, FAAOP. "After several years of continued private sector contract pressures and increasing labor, material, and administrative costs, we find ourselves challenged now more than ever to meet patient, payer, and industry expectations. "This bill should serve as a rallying point for the industry," Cornell continued. "Although I am pleased AOPA was able to mitigate the effects of the bill, I cannot recall a more powerful precedent to require the various lobbying groups to speak with one voice." Efforts by Physical Therapists to Encroach on O&P Defeated "In a final positive note, AOPA was successful in defeating a proposal that would have permitted physical therapists to prescribe and provide a variety of services, including O&P services, to Medicare beneficiaries," the association said. Instead, lawmakers called for a Medicare Payment Advisory Commission (MedPAC) study to analyze the proposal. "AOPA will continue to fight this type of expansion into the O&P field over the next two years while this study is being conducted," the organization stated. For additional information, contact Walter Gorski, AOPA director of legislative affairs: 571.431.0876, ext. 209;wgorski@aopanet.org; or Peter Thomas, NAAOP general counsel, or Dustin May, legislative director, Powers Pyles Sutter and Verville PC, 800.622.6740;www.oandp.com/naaop
The landmark Medicare reform and prescription drug bill passed by the Senate November 25 is a "mixed bag" for O&P, according to the National Association for the Advancement of Orthotics & Prosthetics (NAAOP). Although some aspects are unfavorable to O&P, "There are clearly some important victories in the bill," NAAOP said. However, the American Orthotic & Prosthetic Association (AOPA) said the legislation will have a negative impact on the O&P field. "AOPA is troubled by the overall outcome of the Medicare package," the Association said November 26. The Senate passed the legislation by a vote of 54-44. The House of Representatives passed the bill November 22 by a vote of 220-215. Three-Year Payment Freeze Imposed Medicare payments for orthotic and prosthetic services will now be frozen at 2003 levels for 2004, 2005, and 2006. This provision will cost the field $1.2 billion over the next ten years, according to AOPA. "Lobbying efforts by AOPA resulted in reducing the freeze period from five years to three years," the association noted. "On behalf of providers of orthotics and prosthetics services, AOPA is disappointed that Medicare reform has resulted in a three-year payment freeze," said Tyler Wilson, executive director. "Imposing 2003 payment levels for the next three years is certainly not a way to ensure that Medicare beneficiaries receive the best treatment utilizing the latest technologies that our industry has to offer. Unfortunately the O&P industry got whacked because various lobbying groups in our field failed to embrace AOPA's reasonable message on Capitol Hill, thereby presenting a disunified voice and allowing Medicare dollars to be pulled away from our specialty," he continued. NAAOP, however, added, "It is important to note that a Senate-passed tax bill in late May would have frozen the entire O&P fee schedule for ten years. Thanks in part to the efforts of NAAOP, this provision was removed from the final tax bill. In addition, the fee freeze under the Medicare bill continues through 2008 for certain items of DME, clearly indicating a separation between treatment of DME and professional O&P care." Competitive Bidding to be Implemented Following the payment freeze, Medicare will begin to implement in 2007 a competitive bidding program for virtually all DME and only "off-the-shelf" orthotic devices. Payments determined by competitive bidding will replace Medicare fee schedule payments. Both AOPA and NAAOP credited their efforts in helping to confine the scope of competitive bidding. "Off-the-shelf" orthotics represents a much narrower definition than what was proposed by the original Senate-passed bill in June, said NAAOP. That bill included all non-custom-fabricated orthotic services, noted AOPA, adding, "This legislation officially recognizes that the provision of O&P services required trained practitioners to fabricate and fit O&P devices to patients." NAAOP said, "The inclusion of this definition should be considered a major victory, since most orthotics and all prosthetics will not be subject to a nationwide system of Medicare competitive bidding at anytime in the near future." Quality Standards to be Established A highlight of the Medicare legislation is that Medicare will establish quality and accreditation requirements for the provision and payment of orthotic and prosthetic services--a position AOPA advocated strongly, the association pointed out. "This provision appears to trump' the protracted Negotiated Rulemaking dispute in favor of the position that all O&P care must be provided by healthcare professionals certified/accredited in the practice of orthotics and prosthetics," said NAAOP. "The provision will need to be analyzed further to understand its full implications, i.e. its impact on the failed Negotiated Rulemaking [NegReg] process, but it appears to be very favorable to NAAOP's position on the issue of the definition of a qualified provider.'" Also, under the bill, O&P was spared application of a provision mandating a cut in reimbursement for the top five utilized DME items in 2005. "This also represents an extremely positive outcome for O&P," NAAOP pointed out. "Overall, the bill marks a fundamental shift toward private insurance as a model for the provision of Medicare benefits and prescription drugs," said NAAOP. "It also enacts myriad reforms to other provider payment systems as well as the CMS [Centers for Medicare & Medicaid Services]regulatory system," NAAOP added. "The three-year payment freeze followed by competitive bidding for off-the-shelf' orthotic devices is an additional burden for an industry that already has experienced arduous reimbursement problems," said AOPA President Keith Cornell, CP, BOCO, FAAOP. "After several years of continued private sector contract pressures and increasing labor, material, and administrative costs, we find ourselves challenged now more than ever to meet patient, payer, and industry expectations. "This bill should serve as a rallying point for the industry," Cornell continued. "Although I am pleased AOPA was able to mitigate the effects of the bill, I cannot recall a more powerful precedent to require the various lobbying groups to speak with one voice." Efforts by Physical Therapists to Encroach on O&P Defeated "In a final positive note, AOPA was successful in defeating a proposal that would have permitted physical therapists to prescribe and provide a variety of services, including O&P services, to Medicare beneficiaries," the association said. Instead, lawmakers called for a Medicare Payment Advisory Commission (MedPAC) study to analyze the proposal. "AOPA will continue to fight this type of expansion into the O&P field over the next two years while this study is being conducted," the organization stated. For additional information, contact Walter Gorski, AOPA director of legislative affairs: 571.431.0876, ext. 209;wgorski@aopanet.org; or Peter Thomas, NAAOP general counsel, or Dustin May, legislative director, Powers Pyles Sutter and Verville PC, 800.622.6740;www.oandp.com/naaop