Colleagues and Guests:
I applaud Chris for his well done and honest piece of work. For the most
part, I have never been shy about dolling out my thoughts, although this
has not served me well in some cases. But here goes again. I can well
remember the frustration that I had with L-Codes back in the day; yes,
back in the day. It was amazing to me that a SACH foot, as I recall, was
reimbursed at a much higher rate than a Greisinger relatively speaking
cost-wise. Even back in those days, Medicare would not budge or give
consideration to a single practitioner’s analysis. Everything had to be
done by committee, not by some misinformed single practitioner. But, the
truth is that there were more SACH feet being provided than Greisingers.
So the moral of this story was and still is, if it ain’t broke don’t fix
it. I have had several conversations with very knowledgeable
practitioners over the years regarding the fee versus cost crisis that
has so unfairly worked against both our profession and third party
payers like Medicare. Our profession grew, in many cases, without regard
for the costs involved. You might say, we had lost-leaders. In
orthotics, for example, if you were doing spinal work, you typically
were doing very well. On the other hand, it your practice primarily
concentrated on lower limb work, you were a victim of a system that
operated without regard to cost. To this day, there are L-Codes that
would force you into bankruptcy if your practice was primarily focused
upon the area where these codes prevailed and you were honest about your
work and billing. Now, at the bottom of the slope, where is the logic in
all of this?
Since day one of Medicare, our profession has been caving in to a song
that has been played over and over and over by our leadership. That song
is titled, “It’s The Best We Could Do.” Sounds a lot like politics to
me. While we should be thankful to some of our larger O&P corporations
and organizations who have had the resources to negotiate successfully
in our behalf in many cases, we should also recognize that we were
always on an accounting slippery slope and the bottom of that slope is
now here. As one of my friends in the field proclaims, “there is just no
juice left to squeeze.”
If CMS applied the same finance rules to O&P that they apply to their
own government offices, we would not be where we are today, in a mess.
That is true because accounting has little grey and, for the most part,
it is black and white as it should be. Furthermore, there is little to
no logic in the DMEPDAC system other than obvious politics at play. So
until those issues are corrected, I believe there is little hope that
comprehensive O&P care can survive within the CMS system? That is a
strong statement, but nonetheless one that I believe. In a round-about
way, Chris is right on target with his analysis.
Sooner or later; obviously later at this point in time, someone
somewhere will have to take a look at O&P services and come to grips
with the dilemma that we are now in. Otherwise, many folks with
physically challenging problems will end up on the short end of the
stick and largely be without the professional O&P resources that have
been available for the past several years. Worse yet, the costs for
those services will undoubtedly skyrocket, leaving many unable to afford
the O&P care that is needed. In the meantime, it does not take a rocket
scientist to visually see the inconsistencies that prevail throughout
our profession when it comes to services and their related fees. CMS
recognizes the problem, but they are seemingly clueless about how to go
about solving it. Their answer seems to lie largely in the
off-the-shelf, minimal adjustment, etc., thought train. By the way, just
what is the definition of minimal adjustment? It is an amusing term
that simply illustrates the grasping-for-straws by those who are trying
to slow down a derailed O&P train. But in actuality, this only makes
things worse and sets the stage for even more abuse. On the other hand,
if no adjustments are needed for O&P devices, why do they exist on the
CMS docket and are considered a covered CMS item? Can a person go to
Walmart, purchase an off-the-shelf device and turn it in to CMS? If the
answer is no, then why do these devices still exist as covered items
within CMS? Is it to make a pathway for the folks who are now
advertising on television that proclaim if you have back, knee, or
foot/ankle pain and you are on Medicare, you may be eligible for a “pain
relieving” brace at little or no cost to you? And, those devices will be
provided by their accredited personnel and delivered to your doorstep.
Frankly, this is mind boggling. We have CMS auditors chasing O&P
practitioners and physicians all over the country with news that their
documentation does not meet the CMS standards for medical necessity and
then we have these folks on television who are seemingly telling CMS
that they are smarter than the folks at CMS.
An old-timer from Indiana was returning from a duck hunting trip. He had
bagged three. An auditor (oops I mean game warden) was sitting on a hill
looking down and saw the three ducks in the back of the fellow’s truck
and promptly pulled him over. He asked the old-timer if he had an
Indiana hunting license and the answer was no, but these ducks were not
from Indiana. The game warden proceeded to spread the legs of the first
duck and declared that indeed the duck was from Ohio. When asked, the
old-timer presented a valid Ohio duck hunting license. The warden then
took a look at the south end of the second duck and declared the duck
was from Kentucky. When asked, the old-timer presented a valid Kentucky
duck hunting license. Furious, the warden then examined the 3rd duck on
the south end and promptly declared the duck was from Illinois. When
asked, the old-timer presented a valid Illinois duck hunting license.
Finally, the exasperated game warden asked the old-timer just where he
was from. At that point the old-timer got out of his truck, pulled his
pants and drawers down, and bent over. He then said to the game warden,
“you tell me, you’re the expert.”
Merry Christmas, God’s Blessing to each and everyone, and Happy New
Year! And, thank you Chris for taking a stand.
Wil Haines, CPO
Bionic Solutions
Avon, IN
On 12/19/2014 3:49 PM, Chris Wells CP,LP wrote:
> Hello colleagues, I am continually amazed at our profession and how we bring
> trouble to our own door step. I am not going to mention any names only give
> a recent discussion with a supplier. I was referred a Pt that had severe LE
> weakness due to multiple issues needing bilateral AFOs (lightweight) to
> ambulate. After trying a couple of prefabricated devices I was unable to
> control her Rt LE recurvautum with an AFO alone and discussed with the Pt
> the need to change to a KAFO. She understood but was very concerned with
> weight as due to her syndrome she fatigues quickly. After trying to come up
> with the best plan of care for her I came across a newer device in a
> magazine that I had never used but knew that the lower leg section weighed
> less than 1 lb. I ordered all necessary components and applied them to the
> Pt. She was very pleased, as was I, on the drastic improvement it made in
> her life, immediately ( I like the product). The Pt complied with all my
> request to return to the Dr. for documentation. As I was getting ready to
> put together the detailed Rx I thought how do I code this thing. I first
> went to the PDAC website and what do you know it was useless. Then I went to
> the manufacturer website and still no info. I finally called the company and
> asked if they had any suggestions, which they stated “we have a list of what
> practitioners have had success using “. Once I received the fax I laughed at
> the combination of custom and prefab codes put together in the first section
> then in the other section below it states other have had success with . and
> gave a list of all custom components, and let me state there is not one
> thing that is custom about this device other than contouring the uprights to
> the Pt’s thigh and knee; which I do to any OTS KO I fit.
>
>
>
> I know Medicare reps watch this site and my question to you is: why aren’t
> you complying with your own suggestions and making these manufacturers
> provide you with the device and assigning L codes prior to them being
> allowed on the market; and secondly your priority list on who is audited is
> flawed. You have the larger companies as the least likely to be audited but
> these are the companies do the majority of the abuse NOT the small
> established mom and pop companies; and to those who are saying I am blasting
> Hanger, not so. There are some very good Hanger offices out there. Those of
> you practitioners that are crying about unfair treatment need to look in the
> mirror and realize some of you are responsible for the downfall of our
> profession! I know there are several great practitioners and companies out
> there that are fighting the good fight and not getting the reimbursement
> they deserve and it is due to fraud and abuse that I see so frequently.
>
>
>
> There is no quick fix but I try to do what is right for the Pt within the
> letter of the law no matter how senseless it seems and it will not improve
> until some of you are put out of business because of your abusive ways. So I
> say bring on the audits and prepayment reviews. I hope it shuts some of you
> down. I apologize for the grammatical errors, I make legs and braces (sorry
> NUPOC “orthotics”) for a living and I hope I still have an industry in the
> future.
>
>
>
> Have a Merry Christmas
>
>
>
> Chris Wells CPO,LPO
>
> Frustrated with us not them
>
>
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