LAS VEGAS – Many issues that will decide the future of health care in the United States are currently under debate at the national level. However, there are many critical health care decisions that have yet to be determined at the state level, and the outcome of such debates will have a major impact on the O&P profession, said a speaker here.
Thomas F. Fise, JD, executive director of the American Orthotic & Prosthetic Association (AOPA), illustrated this point by discussing a proposed cut in the state of Nevada related to Medicaid eligibility that would have been extremely detrimental to the O&P profession.
“The outgoing governor in Nevada proposed changes to the Medicaid program that would eliminate O&P care for those over the age of 21 [years],” Fise said at the 2011 American Orthotic & Prosthetic National Assembly. “Fortunately, through several months of successful lobbying efforts and a strong coordinated effort by O&P providers in Nevada, the passage of those detrimental cuts was prevented.”
To fight legislative battles at the state level, O&P providers must obtain certain resources. The most crucial resource, according to Fise, is the patient.
“When you lobby about the Medicaid payment structure, the legislators only see dollar signs,” Fise said. “But when your patients come in, they see things differently.”
According to Fise, resources such as AOPA and The Amputee Coalition Association will help coordinate those efforts. In order to mount an effort to prevent cuts, O&P practitioners must increase education efforts.
“Generally, the states do not care about downstream costs. They want to cut the money today,” Fise said.
AOPA provided O&P providers in Nevada a sample letter which they could send to their state legislators.
“Have the patients send the letters,” Fise added. “Give them the tools to defend their own care. Most of them would have lost their coverage, if this provision went into effect.”
In the Nevada case, those letters resulted in face-to-face meetings with state legislators. AOPA provided talking points to O&P representatives as to why cutting Medicaid for amputees would likely be detrimental to not only the patients, but also the overall economy. According to Fise, without O&P care, patients would be less independent, less likely to keep or find a job and ultimately unable to provide tax revenues for the state.
O&P patients losing their Medicaid coverage is a story that grabs people’s attention, Fise said.
“However it worked out, whatever force it was, after the new governor was sworn into office, he said eligibility for Medicaid coverage would not be changed,” he said. “Were any of the things we did the cause for it? We do not know. You make the best arguments you can and you hope you have a good result. We did in this instance.”
There have been efforts in several states to reduce or eliminate O&P treatment for Medicaid patients. We all know that proper O&P treatment can help patients avoid more costly conditions such as obesity, diabetes, depression and limited mobility. AOPA was able to activate article placement and advertising in newspapers and a billboard in Carson City for all the legislators to see.
While we have some limited data that documents costly effects without early O&P intervention, we really do not have enough documentation at the national level that could strengthen our case. All payers, legislators and policymakers are going to demand greater documentation on the cost-effectiveness of certain treatment programs and devices.
— Thomas V. DiBello, CO, FAAOP
President, American Orthotic and Prosthetic Association