In response to my comments about AOPA meetings I received the following reply:
I hear what you are saying, Bracedude. What AOPA is doing with HCFA is
just a band-aid. The Balanced Budget Act (BBA) of a couple of years ago
created the SNF PPS system (and did a lot of other bad stuff). It is now
the law. HCFA’s job is to implement it. HCFA can’t circumvent the entire
law passed by Congress, but they can bend it a little. That’s why they
have asked us to identify the higher priced services. Based on the
information we received from our members, we have been clear with HCFA from
the beginning that SNF PPS is bad for patient care. That SNFs will deny
access to needed prosthetic and orthotic services, and that’s wrong.
More important that what HCFA is considering is what we have been trying to
do in Congress. Like I said, SNF PPS is the law. If we want to exempt O&P
(and we do), Congress is the place to do it. Both Houses of Congress are
now considering “fixes” to the BBA. AOPA has been working with them on
language to exclude O&P since before this session started.
If any of you want to help, write to your Senator and tell him/her how this
provision is hurting patient care. Write to your Representative and tell
him/her the same thing. AOPA members can find guidelines on writing members
of congress on our website at
http://www.opoffice.org/members/governmentrelations/grassrootslobbyingto
Bracedude reply to Bob follows:
Dear Bob, I believe that the exclusion of these “higher priced items”from the
PPS fuels fraud and abuse. The OIG has spent a lot of time looking into body
jacket expenditures. I have to believe one of the key reasons this device has
been abused is because it is a big ticket item. Certainly the lack of
requirements for credentialed practitioners has let every slick talking
salesman with a brace in his trunk to sell contribute to the problem. I
believe the pitch that needs to be made to HCFA is that by limiting providers
to qualified individuals that could lose their Medicare and ABC certification
they will reduce the abuses of the program. The dollar value of the device
is NOT the criteria to use when distinguishing which items should and
shouldn’t be covered in a SNF.
The dollar value argument could be made to support exactly the opposite
position that AOPA is taking. Potentially, if Medicare pays $5,000 for one
prosthesis to make one nursing home resident ambulatory they could make 8.3
residents ambulatory with $600 AFO’s. OK so the .3 guy didn’t walk so well
but you get my point.
