The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) issued the following press statement about the public comment meeting on the draft Local Coverage Determination (LCD) for Lower Limb Prostheses and a subsequent meeting at the U.S. Department of Health and Human Services (HHS):
NAAOP had a strong presence at yesterday’s public comment meeting in Linthicum, Maryland, that was hosted by the medical directors of the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and at a subsequent meeting in the HHS secretary’s office in Washington DC.
The public comment meeting, which took place to address the draft LCD for Lower Limb Prostheses, included 200 individuals with amputations from around the United States as well as hundreds of other concerned individuals in the room and participating by teleconference. NAAOP General Counsel Peter Thomas, JD, who has bilateral lower-limb amputations, brought the audience to its feet early on when he said, “This draft policy makes it more difficult for patients seeking to walk again after the loss of a limb when it should be encouraging patients to push themselves through the difficult rehabilitation process to become ambulatory. It will lead to added costs to Medicare as more individuals with limb loss simply give up, remain in a wheelchair, or become long-term residents of nursing homes.”
NAAOP President David McGill, JD, spoke about the draft LCD from his perspective as someone who has a transfemoral amputation, when he noted that “the elimination of the concept of ‘potential’ when assessing an amputee’s functional level creates an artificial ceiling that many amputees will never be able to break through.” He also asked the DME MAC medical directors “to not sacrifice the physical and emotional well-being of amputees on the altar of administrative or economic efficiency,” concluding, “surely our right to mobility is worth more than that.”
NAAOP Vice President Jim Rogers, CPO, also a speaker at the meeting, later described the day’s events as “heartfelt, emotional, and deeply humbling.” He added, “At no other time in the history of our profession have we come together, patients, clinicians, educators, and allied health professionals, at one time with one voice in support of those we serve. We upheld the right of amputees to access modern technology; we attacked the imposition of barriers to that care and we argued that the O&P professional is indeed qualified-and perhaps the most qualified professional-to accurately evaluate the amputee and determine the best treatment plan.”
NAAOP live-tweeted the event and gave people the opportunity to watch some of the proceedings in real time via Periscope. Ashlie White, NAAOP secretary and director of social media, stated, “I believe this is the first time in the history of the O&P profession that any organization has provided live video access to a Medicare public meeting.” White further noted that she thinks it increasingly likely that live streaming tools like the one used by NAAOP will give all licensed and certified practitioners and patients the ability to be a part of Medicare and DME MAC processes more directly.
NAAOP Immediate Past President Paul Prusakowski, CPO/L, FAAOP, observed that “[b]y listening in on the meeting by phone and following the updates online minute-by-minute, it was clear that this event represented one of the most significant moments in the history of our profession. The passionate testimonies by both diverse professionals and the people who rely upon our care clearly struck both emotional and intellectual chords that resonated far beyond the four walls of that room and underscored the significant role that our profession plays as part of the rehabilitation team in restoring the lives of the patients we all serve.”
George Breece, executive director of NAAOP, added, “We were gratified to hear that the U.S. Department of Veterans Affairs [VA] will also oppose this proposal, calling for it to be rescinded. They understand the impact this restrictive policy will have on all amputees using prosthetic limbs, including veterans and those with private insurance. This is not just a Medicare issue and we are grateful to the VA for taking such a strong stand and protecting access to appropriate prostheses for its veteran amputees.”
Later in the day, McGill and Thomas participated in a meeting with high-ranking officials from the Centers for Medicare & Medicaid Services, including Acting Director Andrew Slavitt and Acting Principal Deputy Administrator Patrick Conway, MD, MSc. McGill and Thomas were satisfied that senior Medicare officials understand the issues and share serious concerns with the policy proposed by Medicare’s contractors, the DME MACs.
“Administrator Slavitt specifically stated that Medicare officials would be speaking with the DME MAC medical directors to talk about this policy,” noted Thomas, labeling the willingness of CMS’ central office to get involved a “positive sign.” McGill added, “It was encouraging to hear Acting Administrator Slavitt state that his team ‘is very personally engaged’ on this issue, and it is clear that he and Dr. Conway have devoted significant time and attention to the concerns raised by NAAOP, the O&P Alliance, the Amputee Coalition, and many other stakeholders.”
While Thomas termed the day’s events “historic,” he cautioned that much work remains to be done. “We’re not yet at the finish line,” he said. “It is imperative that as many people as possible submit comments to this proposed LCD before the August 31 deadline.” McGill agreed, pointing out that “comments made at the public meeting yesterday, while powerful, are not part of the official record the DME MAC medical directors will review when assessing their next steps with this draft LCD. That would be impossible because literally none of the medical directors took notes during the three hours of public comments. We implore all NAAOP members and anyone else interested in making their voice heard to utilize the formal written comment submission process before the end of the day Monday.