Policy Forum 2013: What’s at Stake for O&P?

Exclusive live coverage from The O&P EDGE [caption id="" align="alignnone" width="350"] Kirk concludes his discussion at the AOPA Policy Forum. Policy Forum photographs courtesy of AOPA.[/caption] "We are faced with the challenge of going up on the Hill and making our presence known," American Orthotic & Prosthetic Association (AOPA) President Tom Kirk, PhD, told the approximately 100 attendees who gathered March 12-13 for the 2013 AOPA Policy Forum held at L'Enfant Plaza Hotel, Washington DC. "We are here so that we can visit with, educate, and ask Congress for some help" to make "progress toward the goal of helping people who can't help themselves." The "we" Kirk referred to was the group comprising O&P practitioners and administrators, manufacturer representatives, consumers, and O&P association leaders who, on March 12, were briefed on key issues and how to lobby effectively when meeting with Congress members and their staffs during the more than 350 appointments scheduled for the following day. Specifically at issue were ten talking points: Discuss the need for a moratorium on new Medicare audits until the Centers for Medicare & Medicaid Services (CMS) promulgates a new, fairer standard, and for Medicare to recognize partial payments in fairness to providers. Ask Congress members to cosponsor and pass the Medicare Orthotic and Prosthetic Improvements Act when it is re-introduced in the 113th session of Congress. Among other things, this bill would prohibit Medicare from reimbursing unlicensed providers in states that have enacted licensure laws, and force CMS to implement a 13-year-old federal statute that Medicare only pays qualified providers. Ask Congress members to cosponsor and pass the Insurance Fairness for Amputees Act when it is re-introduced in the 113th session of Congress. Highlight the importance of the U.S. Department of Health and Human Services (HHS) clarifying the inclusion of O&P as essential health benefits in its directives to states as they select their benchmark plans operating within their state from which to model their state health insurance exchange under the Affordable Care Act. Provide facts about O&P and competitive bidding, and discuss how efforts to expand competitive bidding beyond off-the-shelf orthotics to include other O&P devices would be detrimental to patient care. Ask Congress members to cosponsor and pass the Injured and Amputee Veterans Bill of Rights when it is re-introduced in the 113th session of Congress. Discuss the need for and request funds be provided for O&P outcomes-based research/evidence-based practice. Discuss the need for and request short-term competitive grants to support prosthetic education. Highlight concerns regarding the U.S. Department of Veterans Affairs (VA) O&P procurement reform. Discuss the VA Office of Inspector General (OIG) audit report on the acquisition of prostheses, which was released March 2012. Speaking Up for O&P Time for questions was allotted after each of the dozen afternoon sessions. The recurring theme was the impact of CMS and Medicare audits on the O&P profession. Stories were told about layoffs, businesses closing, Medicare audits delaying payments for months, and claims being denied repeatedly, each time for a different reason, and then being overturned on all of the reasons. "Tell us how to play the game, and then we'll play the game appropriately because we're in this to take care of people," said one attendee. "It's difficult because a lot of people at CMS are in their government buildings writing all of these regulations and don't really know how it plays out on the ground," said Laura Holland, health staffer to Senator John Cornyn (R-TX). She added that Congress people are in a better position to help if the O&P profession and industry share their stories and request specific actions. It also came to light that at least a handful of years have passed since O&P had a bill or partial bill attain Congressional approval, prompting a question about the prospects of one of these bills passing this year. "For our fair insurance bill, I don't know if it will pass this year," said Amputee Coalition President and CEO Kendra Calhoun, "but I know if we don't keep introducing it, it will never pass. We have...to be consistent [with our efforts]. I wouldn't lose heart." This, in essence, is the purpose of the Policy Forum: to keep coming back to Washington DC and make sure the voice of the O&P profession is heard. "If you keep coming back, [Congress] might realize there is something about it," said AOPA Executive Director Thomas Fise, JD. However, equally important, and perhaps more so, said many Policy Forum speakers is taking the message home. It was suggested that to forward the O&P message, members of congress should be invited to patient care facilities to witness the behind-the-scenes workings and meet the patients—their constituents. Sending a thank-you note for the Washington DC visit was another strategy suggested to get back on the Congressional radar. Carrying the Message Works [caption id="" align="alignnone" width="300"] Policy Forum speakers Dennis Clark and Duckworth.[/caption] On a positive note, AOPA Lobbyist Catriona Macdonald, Linchpin Strategies, Washington DC, announced during her Tuesday afternoon presentation that Senator Richard Durbin (D-IL) introduced two bills to the Senate to fund prosthetics research and education: Senate Bill (S.)521, the Wounded Warrior Research Enhancement Act, and S.522, the Wounded Warrior Workforce Enhancement Act. (Editor's note: To read about these bills, see " Senate Bills Introduced to Fund O&P Research and Education " in our news section.) In addition, Tuesday morning speaker Representative Tammy Duckworth (D-IL), an Iraq war veteran who underwent bilateral lower-limb amputations in 2004 as a result of her service, and Tuesday afternoon speaker Representative Brett Guthrie (R-KY) authored a draft "sign-on" letter to HHS Secretary Kathleen Sebelius that was circulated during the House visits, expressing concern that efforts to reduce fraud and abuse in Medicare claims for prosthetics may be harming access to care for the most vulnerable Medicare beneficiaries. Duckworth and Guthrie also will be circulating a similar letter addressed to their colleagues in the House of Representatives urging them to "sign on" and add their names as a signatories on the letter to Sebelius. According to AOPA, several Congress members have already added their name as a result of the Policy Forum visits. "It's up to us to work together," Guthrie said.

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