CHICAGO — Inviting local congressional representatives into an O&P practice is the most effective way orthotists and prosthetists can demonstrate the need for professional O&P care, according to a presenter at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, here.
“You have to become more of an activist, and you don’t have to come to Washington to do it,” Peter Rosenstein, executive director of the American Academy or Orthotists and Prosthetists (AAOP), said. “You need to invite them to your practice and show them what you do. There is nothing better for them than a picture with you and a patient getting services provided. Once they do that, you have connected them to the profession and the patient. So when they go back and there is a vote, they will understand a little bit better what they are voting on. That is the most effective thing you can do.”
Rosenstein said the O&P Alliance, comprising five leading O&P national organizations, is looking for sponsors to introduce legislation, drafted by the AAOP to “amend title XVIII of the Social Security Act to recognize orthotic and prosthetic suppliers as independent professional providers of medical care for Medicare beneficiaries, to improve the Medicare administrative appeals process, and for other purposes,” according to a draft of the legislation.
“We want, on the House side, Republicans as lead sponsors, and Democrats as lead sponsors on the Senate side,” in line with the majority in each house, Rosenstein said.
He also spoke about the Medicare sustainable growth rate and the “doc fix,” the patchwork attempts to prevent an automatic cut to physician Medicare reimbursement. A permanent solution to repeal the payment formula, which is currently being discussed in Congress, would cost approximately $150 billion. The O&P Alliance wants to ensure the cost does not come on the backs of O&P providers.
Rosenstein also spoke of bundling services, the practice of paying hospitals a flat fee for a group of related services, such as an inpatient surgical stay and subsequent rehabilitation, thus making the hospital, rather than CMS or Medicare, responsible for paying the service providers.
“It now is something Congress is looking at this week. They believe if they actually do some bundling experiments now, they will get $100 billion out of this $150 billion,” he said.
The Alliance recently sent a letter to Congress that requested the exemption of complex O&P care from bundling, he said.
“Including O&P in bundling totally changes the relationship between the patient and the prosthetist or orthotist because the Medicare patient would no longer have the ability to choose the person they want as their caregiver. There are a number of Congress people who resonated with it. We believe there will be a certain exemption for that,” Rosenstein said.
He also spoke about Recovery Audit Contractor (RAC) audits and the difficulties practitioners face in not only appealing audits, but also awaiting payment for successful appeals. He stressed the importance of getting patients more involved and active in their own care, particularly in their role with their primary care physicians. He said the Amputee Coalition has a meeting with CMS in the next few weeks to talk about this issue.
“You get a lot further if you are the patient than if you are the provider,” he said.
Despite the rocky political climate, Rosenstein remains optimistic about the future of O&P.
“I think things are going to get better. We are going through the most dramatic change that health care has gone through since they started Medicare and Medicaid. The Affordable Care Act and its concept, which is to guarantee that everybody who comes to you will have insurance, is a good thing. Thirty million more people will have insurance, and that has to benefit you, once it is worked out.”— by Carey Cowles
For more information:
Rosenstein P. Future political climate for health care. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. Feb. 26-March 1, 2014. Chicago.
Disclosure: Rosenstein is executive director of the AAOP.