Medicare Bill a 'Mixed Bag' for O&P The landmark Medicare reform and prescription drug
bill passed by the Senate November 25 is a "mixed bag" for O&P,
according to the National Association for the Advancement of
Orthotics & Prosthetics (NAAOP). Although some aspects are
unfavorable to O&P, "There are clearly some important victories
in the bill," NAAOP said.
However, the American Orthotic & Prosthetic Association
(AOPA) said the legislation will have a negative impact on the
O&P field. "AOPA is troubled by the overall outcome of the
Medicare package," the Association said November 26.
The Senate passed the legislation by a vote of 54-44. The House
of Representatives passed the bill November 22 by a vote of
220-215.
Three-Year Payment Freeze Imposed
Medicare payments for orthotic and prosthetic services will now
be frozen at 2003 levels for 2004, 2005, and 2006. This provision
will cost the field $1.2 billion over the next ten years, according
to AOPA. "Lobbying efforts by AOPA resulted in reducing the freeze
period from five years to three years," the association noted.
"On behalf of providers of orthotics and prosthetics services,
AOPA is disappointed that Medicare reform has resulted in a
three-year payment freeze," said Tyler Wilson, executive director.
"Imposing 2003 payment levels for the next three years is certainly
not a way to ensure that Medicare beneficiaries receive the best
treatment utilizing the latest technologies that our industry has
to offer. Unfortunately the O&P industry got whacked because
various lobbying groups in our field failed to embrace AOPA's
reasonable message on Capitol Hill, thereby presenting a disunified
voice and allowing Medicare dollars to be pulled away from our
specialty," he continued.
NAAOP, however, added, "It is important to note that a
Senate-passed tax bill in late May would have frozen the entire
O&P fee schedule for ten years. Thanks in part to the efforts
of NAAOP, this provision was removed from the final tax bill. In
addition, the fee freeze under the Medicare bill continues through
2008 for certain items of DME, clearly indicating a separation
between treatment of DME and professional O&P care."
Competitive Bidding to be Implemented
Following the payment freeze, Medicare will begin to implement
in 2007 a competitive bidding program for virtually all DME and
only "off-the-shelf" orthotic devices. Payments determined by
competitive bidding will replace Medicare fee schedule
payments.
Both AOPA and NAAOP credited their efforts in helping to confine
the scope of competitive bidding. "Off-the-shelf" orthotics
represents a much narrower definition than what was proposed by the
original Senate-passed bill in June, said NAAOP.
That bill included all non-custom-fabricated orthotic services,
noted AOPA, adding, "This legislation officially recognizes that
the provision of O&P services required trained practitioners to
fabricate and fit O&P devices to patients."
NAAOP said, "The inclusion of this definition should be
considered a major victory, since most orthotics and all
prosthetics will not be subject to a nationwide system of Medicare
competitive bidding at anytime in the near future."
Quality Standards to be Established
A highlight of the Medicare legislation is that Medicare will
establish quality and accreditation requirements for the provision
and payment of orthotic and prosthetic services--a position AOPA
advocated strongly, the association pointed out.
"This provision appears to trump' the protracted Negotiated
Rulemaking dispute in favor of the position that all O&P care
must be provided by healthcare professionals certified/accredited
in the practice of orthotics and prosthetics," said NAAOP. "The
provision will need to be analyzed further to understand its full
implications, i.e. its impact on the failed Negotiated Rulemaking
[NegReg] process, but it appears to be very favorable to NAAOP's
position on the issue of the definition of a qualified
provider.'"
Also, under the bill, O&P was spared application of a
provision mandating a cut in reimbursement for the top five
utilized DME items in 2005. "This also represents an extremely
positive outcome for O&P," NAAOP pointed out.
"Overall, the bill marks a fundamental shift toward private
insurance as a model for the provision of Medicare benefits and
prescription drugs," said NAAOP. "It also enacts myriad reforms to
other provider payment systems as well as the CMS [Centers for
Medicare & Medicaid Services]regulatory system," NAAOP
added.
"The three-year payment freeze followed by competitive bidding
for off-the-shelf' orthotic devices is an additional burden for an
industry that already has experienced arduous reimbursement
problems," said AOPA President Keith Cornell, CP, BOCO, FAAOP.
"After several years of continued private sector contract pressures
and increasing labor, material, and administrative costs, we find
ourselves challenged now more than ever to meet patient, payer, and
industry expectations.
"This bill should serve as a rallying point for the industry,"
Cornell continued. "Although I am pleased AOPA was able to mitigate
the effects of the bill, I cannot recall a more powerful precedent
to require the various lobbying groups to speak with one
voice."
Efforts by Physical Therapists to Encroach on O&P
Defeated
"In a final positive note, AOPA was successful in defeating a
proposal that would have permitted physical therapists to prescribe
and provide a variety of services, including O&P services, to
Medicare beneficiaries," the association said. Instead, lawmakers
called for a Medicare Payment Advisory Commission (MedPAC) study to
analyze the proposal. "AOPA will continue to fight this type of
expansion into the O&P field over the next two years while this
study is being conducted," the organization stated.
For additional information, contact Walter Gorski, AOPA
director of legislative affairs: 571.431.0876, ext. 209;wgorski@aopanet.org; or Peter
Thomas, NAAOP general counsel, or Dustin May, legislative director,
Powers Pyles Sutter and Verville PC, 800.622.6740;www.oandp.com/naaop 
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