O&P Reacts Negatively to Medicare Reform Bill

The Medicare reform legislation passed November 25 will have a negative impact on the O&P field, said the American Orthotic & Prosthetic Assn. (AOPA). "AOPA is troubled by the overall outcome of the Medicare package," the association said November 26.

The legislation includes a Medicare payment freeze for all orthotic and prosthetic services for the next three years as well as a competitive bidding program for "off-the-shelf" orthotic devices. "The impact of a bad political strategy on the part of the durable medical equipment industry (DME), combined with mixed messages sent to lawmakers by groups purportedly representing O&P interests was lessened somewhat by the intensive lobbying efforts of AOPA.," the organization stated.

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.

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." AOPA succeeded in limiting competitive bidding to 'off-the-shelf' orthotic devices rather than all non-custom-fabricated orthotic services, as proposed in the original legislation," the association said.

"This indeed is a painful blow to O&P," said AOPA President Keith Cornell, CP, BOCO, FAAOP. "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. 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 said. "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."

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.

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.

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O&P Reacts Negatively to Medicare Reform Bill

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