Thursday, May 23, 2024

O&P Profession and the Patient Defeated at Neg Reg

Anthony T. Barr

The Barr Foundation wishes to reiterate its concerns as the Negotiated Rulemaking Committee meetings came to an end July 14, 2003

The below are closing remarks made and submitted to my fellow committee members prior to the last scheduled meeting, to again formally disclose our position and in hopes of encouraging a “last ditch effort” to the committee to reach consensus.

We consider that a low priority has been accorded to consumer/beneficiary representation at these hearings. Absent from the discussion and participants were any national disability organizations to represent the interests of the hundreds of thousands of the millions of handicapped individuals who require orthotic devices in order to be able to function in everyday life;

The American Diabetes Association: the CDC indicates that in addition to the current 2 million amputees in this country, 82,000 people have diabetes-related leg and foot amputations each year as a consequence of their disease. Over 150,000 Americans suffer limb loss every year who require qualified prosthetic rehabilitation;

The American Stroke Association: statistics show there are 700,000 people a year who have a stroke, many of who require an orthoses to provide function and independency to their lives.

The March of Dimes and Roosevelt Warm Springs Institute for Rehabilitation: suggest that up to 250,000 U.S. polio survivors may have post-polio syndrome;

Multiple Scoliosis Awareness Foundation: estimate 350,000 cases of MS in the United States and that number is expected to increase by 10,000 new cases each year;

Spina Bifida of America: report approximately 70,000 people in the U.S. have been diagnosed with Spina Bifida, many of who (like our alternate member) wear orthoses.

The Barr Foundation fails to understand why AOTA’s legal counsel asserts that “if the orthotics and prosthetics industry were to succeed in reaching it’s goals… this would significantly restrict the ability of occupational therapists to obtain Medicare payment.” We have never heard an argument from the O&P groups in favor of reducing OT services. We have, however, heard the OT’s presentation in which they said their splints involved mostly low-temperature plastics. We fear some of the suggested changes to current regulations will encourage more manufacturers and suppliers to provide orthoses and prostheses without regard to qualification. So, we ask CMS to continue requiring a minimum of a five year life span for O&P services. We believe this is not only cost-effective for the federal government, but better assures beneficiaries of receiving durable braces and artificial limbs which provides them with some recourse should problems arise.We do not believe APTA’s claims of their membership being adequately trained to provide all orthotic and prosthetic services. We have reviewed their testing guide book in which disciplines such as cardiology and oncology are covered along with orthotics and prosthetics. We praise them for considering how these conditions might affect the therapy they provide their patients. However, we would no sooner see them as primary care givers to treat our heart or cancer ailments than we would to treat our O&P needs.

The Barr Foundation believes the only reason APTA introduced state and federal legislation regarding O&P is because they, themselves, doubt their assertion that “qualified equals licensed.” We believe Congress deliberately intended “qualified” to have meaning regarding the type of PT or OT who might provide O&P services. We also believe (whether we agree or not) that Congress did not add that modifier to “physician” with equal deliberation.

We restate our position “that any allied health professional who seeks qualification for Medicare and/or Medicaid reimbursement under Section 427 of BIPA 2000 should be required to demonstrate his/her competency based on education, training and experience by undertaking and successfully passing an objective and psychometrically sound examination that properly addresses the provision of prosthetic and certain orthotic services.”

After reviewing Section 2.B. of the Application for DMEPOS Suppliers we are convinced that CMS currently recognizes the differences between “licenses, certifications, and registrations” and “orthotic personnel,” “prosthetic personnel” and “occupational therapist/physical therapist.” We applaud CMS for making those distinctions and encourage them to continue doing so.

We remind the O&P profession that they are a largely unlicenced profession and had this one opportunity to resolve and upgrade their practices to a legitimate healthcare profession in the eyes of CMS and Medicare. All 21 members of this Committee have failed to “do the right thing” for the patient in legitimizing the delivery of qualified O&P services.

We believe the therapy groups knew the O&P groups would break ranks in not reaching agreement among themselves. Non-consensus will not yield accountable and meaningful regulation but will continue to split the profession and confuse the patient and the insurers over qualification issues.

Maintaining the status quo is not acceptable to the Barr Foundation.

The volume of distress calls to our organization, from lost and frustrated patients unable to receive qualified services and affordable coverage, will continue to escalate if a ruling isn’t justly and expeditiously concluded. Over the past 10 months while we have been attending the Neg Reg meetings, state Medicaid programs and private insurers have continued to eliminate or drastically reduced O&P benefits generated by the fraud and abuse brought about by unqualified providers in a generally unregulated healthcare profession.

Yet another major concern to our organization is that if the current ABC and BOC education and training criteria, now recognized by law, are not maintained as “minimum standards, ” they could be lowered in the future thus exposing the beneficiaries to lower standards of patient care.

Finally, patient safety was not the overall purpose of the legislation in spite of every committee member having said so at the beginning of these hearings.

Via the Rulemaking Committee, we were charged with establishing WHO is qualified to provide WHICH O&P devices in WHAT sort of facilities in order to receive payment.

The productivity and comfort of millions of Americans are at stake.

We should not fail them in a post Neg Reg effort to educate CMS,whom is now soley responsible for a recommendation of proposed rule that will directly effect all patients requiring custom prosthetics and orthotics.


Anthony T. Barr


E-mail: [email protected]


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