Thursday, May 19, 2022

Medicare Documentation Templates

Wil Haines

Hello Colleagues and Guests,

I missed the call yesterday regarding the documentation templates for
doctors working with prosthetic patients. From what I am hearing, not
much has changed from the first call.

I posted a marked-up version of my attempt to sort this stuff out after
listening in on the first conference call. I also sent a copy to
Medicare. Granted, there will be controversy over the use of ambulating
versus walking. But my take is that walking leaves no room for
interpretation. Dealing with CMS, this seems to be an important point.
If interested, you can view the mark-up at, then
documents, then CMS, then CMS Proposed Prosthetic Documentation Template

If CMS takes the approach that I hear they are moving toward, the
pre-prosthetic costs involved with making a determination as to whether
someone is a candidate for a prosthesis will be significant for the
healthcare system. It will also delay the prosthetic rehabilitation of
amputees by a significant number of weeks, or months. I don’t want to
speculate on what those costs might be, but I’ll bet they will exceed
the cost of providing a preparatory prosthesis by a pretty good margin.
And then, when it is all said and done, the prosthetic prescription will
still be written in most cases. The list of specialized medical
professionals involved in this is also significant. Then, when you look
at the pre-prosthetic conditions of many of our patients when first
seen, these tests will need to be repeated as time goes on. Is it not
typical that patients present at our office with less than optimal
strength and balance, following an amputation? From my perspective, that
is more the rule than the exception. But given the opportunity to walk
again, many of those same individuals, given a motive to get back to
walking, will often greatly exceed the expectations of medical

Given the range of medical conditions that bring patients to the point
of amputation, I suppose CMS would rather that patients be left in a
wheelchair and be dependent upon caregivers for the rest of their lives.
This too would add significant medical costs to the healthcare system by
increasing the need for hospitalizations and treatments due to
inactivity, pressure sores, contractures, etc., etc.. In my mind, those
involved with the policy making for CMS prosthetic care have little
experience with amputees. Most able bodied folks have automobiles or
other modes of transportation that takes them a short distance to the
convenience store for needed supplies. They (we) could walk and not need
the car, but because we choose to use the car for whatever the reason,
does that mean we can no longer walk when we want to? Of course not.
Because we can walk, does that mean we should no longer have access to
the automobile for such a trip? I don’t think so. That analogy should be
played out by CMS. A prosthesis, as well as a wheelchair, scooter,
moped, or whatever is nothing more than a tool to be used for our
convenience when we so choose. Storing energy as an amputee is not only
a sensible thing to do, it is also an important thing to do given the
fact that it takes more energy to walk with a prosthesis. As we get
older, we lose muscle tone and overall strength. Eventually, all of us
have to store our energy for use when it is most important to us. So if
CMS would just put the crooks in jail who are abusing the system and let
the 99% who are not crooks go on taking care of prosthetic patients in
an appropriate manner, the world would be a much better place for all of
us. My guess is that the physicians who are involved in all of this
would give CMS a standing ovation if that were to happen.

In the meantime, we need to be active in giving feedback to CMS
regarding what, when, and how amputees are to receive the prosthetic
care that is often needed and medically necessary and justified for
their continued quest to meld back into society in one manner or
another. I’ll close with one more story that I read in a very
interesting book. A person who was recently given a prosthesis was asked
what was the most important part of getting the prosthesis and getting
out of a wheelchair. The answer should give all of us pause. The person
said that being able to ‘hug’ someone at standing level again was the
most important part of getting a new prosthesis. How’s that for a lesson
in psychology. There is truly something significant about one’s self
esteem. Unfortunately, those of us in the healthcare profession
sometimes get calloused about the truly, often withheld, important
things in a patient’s life.

Please, tell CMS what you think about the documentation for prosthetic care.

Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123


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