Congressional Action On Durable Medical Equipment Could Jeopardize Patient Care For Amputees And Other Disabled Medicare Beneficiaries

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Rehabilitation / Physical Therapy
Article Date: 12 Jun 2008 - 5:00 PDT

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Many Americans, even Medicare beneficiaries, may not be aware that Congress is working hard on revisions to the Medicare law. It's a tough job and a huge challenge to assure that this is done fairly in its impact on patients. While the major impetus is to try to avoid an across-the-board cut to Medicare physician fee payments slated to take effect as of July 1, among the other proposals being considered is the possibility of delaying Medicare's ongoing process to implement a competitive bidding program for durable medical equipment (DME). Under the Congressional rules, all costs to Medicare involved in delaying competitive bidding on the selling of medical equipment like hospital beds, wheelchairs, and oxygen, will have to come from elsewhere in the Medicare system. A spokesperson for DME suggested in Congressional testimony that there be a broad cut to the Medicare DME fee schedule to pay for the delay on competitive bidding - in essence that DME suppliers, being those who will benefit from the delay in competitive bidding, ought to be the ones to pay for it.

Recently, however, the discussions have taken an alarming turn. DME suppliers are the only ones who would benefit from a delay in competitive bidding, but some are suggesting that other Medicare suppliers should help cover the costs through reductions in their fee schedule, including the orthotic and prosthetic (O&P) field. The consequence of such a proposal would mean fee cuts to patient care facilities that provide care to America's amputees and other disabled individuals. This has prompted grave concerns about access to those O&P facilities providing care and restoring mobility to these patients, many of whom are Medicare beneficiaries.

"Americans have been heartened to see that veterans returning from Iraq and Afghanistan are benefiting from the tremendous improvements that are now available for those who have lost a limb, or have impaired mobility due to limb injuries," said Brad Ruhl, President of the American Orthotic and Prosthetic Association. "This proposed change is incomprehensible... prosthetics and orthotics are NOT included in competitive bidding, and it would be profoundly unfair for Congress to pay for a delay in competitive bidding by reducing Medicare payments to amputees and other disabled seniors, including disabled veterans and disabled children who are well-served under the current O&P fee schedule."**

Ironically, this week hundreds of amputees converge on Washington for an annual legislative day conducted by the Amputee Coalition of America (ACA), and plan to ask members of Congress to enact a prosthetic parity bill to assure that all insurers provide the identical coverage for amputee care that is provided for all other medical and surgical conditions. Some insurers have limited coverage to one replacement limb per life, or very meager amounts on how much they will spend for replacement limbs. It is an anomaly to have some in Congress talking about balancing the budget for what they wish to do to help DME, on the backs of these amputees.

"Orthotics and prosthetics have already gotten the short end in prior fee cuts and freezes, so we have lost significant ground to inflation in recent years," says James Kaiser, CP, LP, of Scheck and Siress, a chain of prosthetic and orthotic patient care facilities in the Midwest. "If there is a new round of Medicare cuts to help pay for this totally unrelated DME competitive bidding delay, the approximately 20% of O&P patient care facilities that are already on the edge will close, severely damaging patient access and choice, and assuring longer delays for these Medicare amputees and other disabled patients at the fewer, more crowded facilities that would remain open to serve them."

AOPA, based in Alexandria, Virginia, is the largest non-profit organization dedicated to helping orthotic and prosthetic businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. The association was founded when needs of returning veterans in the aftermath of World War I required a national organization to address the educational and research requirements of the industry.

**This refers to veterans with non-service connected injuries who are covered by Medicare and disabled children covered under Medicare and Medicaid. In addition, it would affect all private managed care contracts that pay based upon a percentage of the Medicare fee schedule.

American Orthotic and Prosthetic Association (AOPA)