Have had several requests to post responses re: attorney requesting opinion,
repairs/replacement parts costs, etc.
Here they are:
you could try Ottobock reimbursement department because they may have
documentation. Their email is [email protected]
at [email protected]
As a long time practitioner and full time expert in prosthetics, PLEASE be
careful. Testifying is NOT an enjoyable event. The opposing attorney will
not be pleasurable either in deposition or on the stand. They will find any
weak area of you or your practitioner and will be relentless. I am not
trying to solicit business but as a practitioner, telling you from my
experiences. Stick with what you do, offer good care and treatment and leave
the legal stuff to the experts.
I have done a few of these over the years and follow Medicare guidelines for
5 year replacement and frequency of soft goods like liners socks act. Use
your clinical justifications for medical necessity as it stand today if the
patient is a K3 MPK candidate.
I make a spreadsheet with the current price and add a 3% per year and keep
adding the frequency until I hit average life expectancy. As far as parts
wearing out I use the manufactures warrantee period and for worker’s
compensation include extended warranties so the knee can have the same time
frame as the complete replacement in five years. Hope this helps
Hopefully you’re getting paid for your research and obtained information. I
know the time it takes to research & provide. Unless, of course, you are
assisting one of your own patients.
I hope you charge for this as once you give info like this you need to be
able to back it up. You are not required to provide this info. I only do
so when paid to as much time and research is needed to properly provide such
info.
I sure hope they are paying you a hefty fee for your help. That being said,
anytime you give away your costs you are giving someone somewhere the
opportunity to de-value your expertise and service. That is proprietary and
an unwise disclosure, especially if it’s going into a court record. They
won’t be buying one at cost, so don’t quote it at cost. For #1, Give them
Medicare allowable L codes, all the L codes in the whole thing, Medicare
rules on mechanical life, and manufacturer brochures on warranty, M&R. You
didn’t provide them with an OPINION. You gave them an aggregate of past
patient experience based on best practices, Medicare allowables, Medicare
rules and manufacturer warranty, maintenance & repairs. Don’t let them trip
you up.remember the Miranda warning.”anything you say can and will be used
against you”. For #2, it’s mechanical/electronic equipment. As such it is
normal for wear and tear to require maintenance and repair, just like a car,
pump, motor, iPhone, etc. Don’t forget to mention variables in the time
table like K level, weight changes, revision surgeries, etc. For #3, that’s
just listing the parts of a MPK prosthesis, like you would for a VA
Estimate/request for PO. Be thorough, you’re acting as a paid expert. All
in my humble opinion and hoping to help you maintain your business. And,
cover your bases, get paid before you do all this justification work. It’s
going to take you 2 to 4 hours. I hope this doesn’t sound too bossy and
that it helps,
Have a Super Day!
If this is part of a lifecare plan, the way I have done them is as follows:
1. Facts that support opinion? Clinical experience. Period. A
microprocessor could last 20 years. Or 2 months, or anything in between.
Activities of Daily living could change, weight could change, all variables
with no predictability regarding specifics.
The knees are repaired under warranty for 3 years. After 5, they won’t be
considered for repair for any reason. Therefore, replacement will be
between 3 and 5 years, typically, depending on activity. Same analogy as a
car. If your car has all repairs for free done, and then after 5 years no
repairs under any circumstances, how long would you guess the car would last
before needing replacement? Probably 3-5 years, right?
2. Statement is leg, motors and other parts need replacement for the
following reasons: normal wear and tear, change in physiological condition
(weight loss, gain, atrophy, etc. all very usual and ordinary with the
amputee population), or, prosthesis, is lost, irreparably damaged, or
stolen.
3. Don’t know why the attorney’s want this. Again, question 2 would seem
to reasonably answer for question 3 as well.
this sounds like a typical court case looking for settlement costs trying
to factor in replacement frequency yada yada. I wouldn’t put too much effort
into this is probably not any “hard data or research”- all you need to do is
have another practitioner attest to the recommendations on frequency and
replacement and put the burden back on them you shouldn’t have to prove
anything to them – we are the prosthetists and are the experts- just have
another prosthetists or even two attest to the general recommendations and
guidelines based on clinical experience that you already provided – that’s
it let them challenge it if they want-and/or find someone else to
disapprove it. Attorneys have a good way of wasting our time for their own
benefit. Hope this helps
We base our replacements on the manufacturers warranty. If it’s not covered
after 3 years-that’s when it needs replacement.
I know that professors at O & P schools get subpoenaed to testify that info
and provide samples (they are paid to do so, BTW). Reach out to your local
O & P school to discuss.
I would suggest that you go to the manufacturer for help.
Those questions can be answered based on your professional experience and do
not require another source to validate. Your prosthetic practitioners are
the source so use your experience to validate the questions posed to your
business.
If your practice has little experience in fitting MPK’s than let the
attorney as there are many folks that can provide that information in our
industry.
Most of the info the lawyer is requesting is better answered by an economist
with your input. Be careful as the opposing lawyer will be looking to rip
you apart. My wife a CPO learned this lesson.
Typically these requests are for a lifecare plan in terms of prosthetic
costs as well as expert testimony. There are specialists within our
industry who do this. One is John Michael. I suggest you reach out to
him.
Hello from progressive prosthetics of the Midwest! I have had this happen
several times with patients and Ottobock has been very helpful with form
letters etc.
Michelle Jones
Progressive Prosthetic & Orthopedic Services, Inc.
380 Cleveland Place
Virginia Beach, VA 23462
Phone: (757) 456-5501
Fax: (757) 671-7525
Email: [email protected]
