Letter to the Editor: Insurance Problems--O&P’s Fault?Regarding the "Perspective" commentary by Ralph Nobbe, CPO,
in the April 2004 issue of The O&P EDGE:
Not only has the Barr Foundation been following the nationwide
trend of benefit reductions, we also have been actively advocating
for measures that would educate and perhaps reform the current mess
of limited and nonexistent O&P benefits. Many states already do
not provide Medicaid O&P benefits to patients over the age of
18.
The O&P industry would lead you to believe that the primary
reason behind reduction of O&P benefits is that all states are
looking for ways to reduce their state budgets. Medicaid and
MediCal certainly fall into this category.
The more immediate contributing cause of third-party payers
looking to cut or reduce O&P benefits is that your profession
is for the most part unregulated, and unqualified providers
continue to bill for O&P services.
DME, the major culprit in fraud and abuse, and the Office of
Inspector General [OIG] Report of 1999 have tainted the O&P
profession. Although distinctively different from the delivery of
comprehensive O&P, DME has been closely aligned to O&P and
will continue to be so until the national trade association, AOPA
[American Orthotic & Prosthetic Association] separates DME
interests from O&P.
I find it interesting that in every one of Mr. Nobbe's
statements in the April article, he refers to recipients of O&P
services correctly as "patients."
At the NegReg [Negotiated Rulemaking Committee] meetings,
manufacturers referred to end-users as mere "consumers," not worthy
of patient protection reform and mandated provider
qualifications. There are those from the manufacturer/industry side
and anti-regulation interests that have described receivers of
O&P services as "consumers" to avoid facing the need for
regulatory reform, price controls, etc.
The Barr Foundation views advocating for increased O&P
benefits to a unregulated healthcare "profession" and to wealthy
manufacturers who are not restricted by price controls for their
mass-produced, overpriced components, as talking to a brick
wall.
Until 1) every O&P provider is regulated in every state and
Medicare/Medicaid establishes mandatory qualifications for
providers, as is the case for every other legitimate healthcare
profession; 2) DME interests are separated from O&P; and 3)
price controls are activated for O&P components and supplies,
as they are for other comprehensive healthcare products, your
battle for credibility and increased benefits is an uphill
struggle.
Providers' hard costs do exceed reimbursement levels in many
cases. In the light of competitive bidding and freezes on
reimbursement levels, perhaps you can convince manufacturers to
reduce their costs of components and materials to you! There is not
a chance of this happening, unless you are receiving big discounts
for large orders. Just to survive, many smaller and independent
providers may have to collectively bargain with manufacturers to
receive a discount, just as the chains do.
What's so upsetting to me is that the Academy [American Academy
of Orthotists & Prosthetists]--your national professional
association--could be doing so much more.
AOPA, which negotiates on the profession's behalf, is deaf
to the above suggestions. Worse is the apathy among your peers who
choose not to advocate for making the O&P industry a
legitimate, worthy, regulated healthcare profession by seeking
meaningful regulation and expressing concerns for the conflicts
that exist in the national associations which allegedly represent
your interests.
Tony Barr
President, Barr Foundation 
Table Of Contents - August 2004
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