When it comes to the big picture, the O&P industry is a small player
in swaying key legislative decisions. The industry accounts for less than 1% of
Medicare expenditures. While it is not expected that the major O&P
organizations agree 100% of the time, in the past few years they have fostered
an understanding that it is crucial to remain coordinated and organized when
promoting key legislative principals. The industry simply can not afford to
have different points of view from such a small field.
Affordable Care Act
The
Affordable Care Act passed by Congress and signed into law in
March 2010 is clearly the piece of legislation that will continue to have the
biggest affect on the industry moving forward.
© 2010 iStockphoto Dwight Nadig/Getty Images, Inc./Image Source |
“Our key interest in this past legislative cycle has been health
care reform,” Kendra Calhoun, president and chief executive officer of the
Amputee Coalition of America (ACA) explained to O&P Business
News. “With the new Republican-controlled house, there is talk of
repeal or defunding portions of the health care reform bill. I can not really
predict what the bill is going to look like going forward.”
According to Tom Fise, executive director of the American Orthotic and
Prosthetic Association (AOPA), the industry did reasonably well in avoiding
major cuts as a result of the bill.
Kendra Calhoun |
“The one negative thing that occurred for us is something that
occurred for relatively every subdivision of providers, which was the
productivity adjustment reducing the fee schedule amount,” Fise explained.
“Estimates are at approximately 1% per year.”
The fee schedule that was published reflects this decrease. There is
virtually a flat fee schedule for O&P going into 2011, Fise said.
“That is a negative, but one that was spread across the roughly
$500 billion’s worth of Medicare cuts that was part of the bill,” he
said.
The medical device tax, embedded in the Affordable Care Act, imposes a
2.3% excise tax on the sale and import of Class I, II and III medical devices
beginning in 2013. According to Fise, the tax is still on the road to
implementation. Fise suspected that there will be efforts to repeal or modify
it.
“It came about in an unusual way,” Fise explained. “In
the final hours, as the bill was being voted on in the House, the provision was
changed and that is how we ended up with a tax for nearly all devices. There
are some potential exemptions as it pertains to O&P that we will be
exploring.”
Injured and Amputee Veterans Bill of Rights
The Injured and Amputee Veterans Bill of Rights, (HR 5428) is
a bill that has yet to be passed by the 111th Congress as of press time.
Currently, the House has passed the bill, but it has yet to be passed by the
Senate.
“It is an important bill and I think it will be hard for anyone to
be opposed to it,” Fise said.
The bill ensures that veterans are aware of their rights to care,
including the right to have their care provided by a medical center other than
the Veterans Affairs centers. In the House, the bill was combined with the
Women Veterans Bill of Rights. There were some concerns expressed about that
bill, but ultimately all concerns were laid to rest and approved by the House.
According to Fise, there is talk of separating the two bills so the
Injured and Amputee Bill of Rights could be voted on its own merits, but that
has yet to happen.
Tom Fise |
“My confidence level is high because we have good people working on
that bill and it is a good cause,” Calhoun said. “I don’t have a
crystal ball, but I can say the ACA will support it.”
If the bill does not pass in the 111th Congress, then there will be an
effort to pass it in the 112th. If this bill is not passed by the Senate before
they adjourn, then the whole process must start over again.
“It would be as if the House vote to approve this bill did not
happen — you have to get both Houses in the same Congress to approve the
bill,” Fise said. “It would be a lot easier at this point, because
one House has voted already. If that does not happen, there will be an effort
to start over again in the new Congress.”
New relationships
Calhoun admitted that 2011 could potentially be a challenging
legislative year due to the large turnover in the House.
“It is going to be challenging in Congress because of the new
Congress — not because Republicans own the majority — but because it
is a different challenge than a democratically controlled Congress. There was
so much turnover and so many new people,” she said. “Politics is like
health care — it is all about relationships. You spend a lot of time on
these relationships and then you have to start all over.”
Despite being unfamiliar with the players involved, the industry’s
core principals and messages still need to be heard.
“We have to fight a bigger uphill battle and we have to make our One voiceThere are many individuals called upon throughout the year to contact “AOPA has geared up significantly on the legislative side in the Each week, AOPA has a call with ACA. The idea behind this constant
“It is a matter of having to stay on top of it,” Liberman-Lampear has gone to Capitol Hill four times throughout the “We have to talk to representatives with one voice,” Medicare O&P Improvements ActO&P organizations and industry leaders need to maintain their clear Through the O&P Improvements Act (HR 2479) Medicare would not For the first time, the bill would also link payment to the “The bill has potential because it would cut down on fraud and The Federal O&P Parity BillThe Federal O&P There have been parity laws established in 19 states. If an insurance “We will be lobbying for the adoption of as much of that For Liberman-Lampear’s state, Michigan, passing a state parity bill “It has been tough,” Liberman-Lampear explained. “It was Calhoun agreed that the due to the limited amount of knowledge on the “We had some stalling out in parity in 2010 but we will be back at Looking ahead in 2011Looking ahead in 2011, state laws, particularly related to Medicaid are The ACA, in order to be heard, turned to the media to discuss a timely “We were concerned about the way amputees were being treated while The ACA wanted to develop a more effective and respectful process when “I received an e-mail about how one amputee was treated and then Instead of waiting for the language to be implemented and enacted, the “We received press coverage around the country and the TSA called There will also be a resolution in 2011 to name the month of April Limb “We start from the big mega issues like the Affordable Care Act and
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