With all due respect, to ACA’s recent post and announcement of A newly launched attempt of advocacy re: patient’s access to “hi-tech” component rehabilitation, their goal maybe better served and received, if they partnered first with AOPA to advocate for state regulation of the O&P “profession” and manufacturer qualifcations for reimbursement to Medicare/Medicaid.
Mandatory benefits for any prosthetic components,hitech or otherwise, will be a hard goal to achieve and retain when basically anyone, with no regard to qualification, can fabricate fit and adjust comprehensive O&P devices to patients in 40 of 50 states.
ACA says:
“elimination of coverage for these devices by certain insurance companies is just the tip of the iceberg. Excluding prosthetics from insurance policies and limiting coverage by imposing unrealistic annual and lifetime caps are quickly becoming the rule, and not the exception, in the insurance industry.”
TB reply:
In my opinion insurance companies and Medicare /Medicaid providers are implementing these exclusions as the result of discovering that the delivery of O&P is for the most part unregulated and has no oversight to better protect the patient. That coupled with the extremely high cost of rehabilitation mostly driven by the providers cost of components and supplies Has resulted in elimination and limitation of coverage’s.
ACA says:
“the need to show that the care received from well-trained, professional individuals, along with the use of appropriate technology, improves outcomes and prevents secondary conditions. This is an exciting but daunting long-term project that requires the help and support of every single person living with the loss or absence of a limb, as well as those who care for”.
TB reply:
Very long term until the profession of O&P is regulated like any other legitimate health care profession and cost of manufactured prosthetic components and goods are properly analyzed considering today’s technology to produce.
Would not ACA’s initiative to show that the care received is from well-trained, professional individuals be better served by alignment to the Academy than the industry?
Not only do patients need and deserve the strongest guarantees of competence and qualified delivery, so do the third party payers and lawmakers.
Until that can be better assured, thru mandatory regulation and education degrees in O&P, state board oversight of providers and affordable access to components, amputees will continue to be subject to the elimination and limitation of coverage for these devices.Dont forget this is not a one time cost for prosthetic rehabilitation, but one that often occurs every 3.4 years!
Have mamufactures given any thought to ACA’s President Paddy Rossbach plea to them last spring, to reduce the cost of goods in light of elimination of prosthetic coverage,implementation of competitive bidding, price freezes,etc.
Good day,
Tony Barr
—–Original Message—–
From: Orthotics and Prosthetics List [mailto:[email protected]] On Behalf Of Leslie Duncan
Sent: Thursday, June 10, 2004 8:28 AM
To: [email protected]
Subject: [OANDP-L] ACA – representing beneficiaries – is part of workgroup that also includes manufacturers of myoelectric/computerized devices…
The ACA has announced that it is leading the development of a “National Action Plan for Access Among Individuals with Limb Loss.” As part of this initiative, ACA – representing beneficiaries – is part of workgroup that also includes manufacturers of myoelectric/computerized devices and AOPA.
Together, we are working to reverse “certain imprudent policies regarding coverage of these devices”, as detailed in a recent letter to practitioners that included a bibliography to provide “empirical evidence that they can provide to payors to justify the provision of state-of-the-art devices.”
ACA (http://www.amputee-coalition.org/aca_advocacy.html) and AOPA
(http://www.aopanet.org) have posted this letter on their web sites to ensure that it is available for all practitioners
It is important for us to educate insurance companies about the scope of this issue by placing it in context. Not every amputee requires these devices. A significant number of the 1.2 million amputees living in the US have trans-tibial or lower amputations, and therefore do not use microprocessor or myoelectric components.
However, elimination of coverage for these devices by certain insurance companies is just the tip of the iceberg. Excluding prosthetics from insurance policies and limiting coverage by imposing unrealistic annual and lifetime caps are quickly becoming the rule, and not the exception, in the insurance industry. With these changes, amputees are now facing a national health crisis as insurers place them at risk for myriad secondary health conditions resulting from the sedentary lifestyle that naturally arises out of inadequate prosthetic coverage.
We need to show that the care received from well-trained, professional individuals, along with the use of appropriate technology, improves outcomes and prevents secondary conditions. This is an exciting but daunting long-term project that requires the help and support of every single person living with the loss or absence of a limb, as well as those who care for them.
Paddy Rossbach, RN
President & CEO, Amputee Coalition of America
Leslie Duncan, MIS
Manager, Information Services
Amputee Coalition of America
900 East Hill Ave., Suite 285
Knoxville, TN 37915-2568
888-267-5669 ext. 8115
Fax 865-525-7917
[email protected]
www.amputee-coalition.org
September 25, 2003
