A recurring theme during the 2014 American Orthotic & Prosthetic Association (AOPA) Policy Forum was that the messenger matters.
“It’s the boots on the ground that can change the day and the way the policymakers can [learn about] what you do and I do every day, the good and the bad…,” AOPA President Anita Liberman-Lampear, MA, said in her opening remarks at the April 2–3 event, which was held at the Renaissance Hotel, Washington DC.
Liberman-Lampear welcomes Policy Forum attendees with her opening remarks. Photographs courtesy of Laura Fonda Hochnadel.
More than 100 O&P practitioners, industry and association representatives, and consumers from across the country were in attendance. They were joined by 12 O&P students, whose expenses were underwritten by the National Commission on Orthotic and Prosthetic Education (NCOPE) and the members of the O&P Alliance. Upward of 300 Congressional appointments were also scheduled so attendees could advocate and lobby for AOPA and O&P-related issues.
AOPA lobbyist Catriona Macdonald, president of Linchpin Strategies, Washington DC, opened the first briefing session. “I can’t tell you how important it is that you take the time to come here to talk to members of Congress and their staff and that you do the same thing and follow up with them when they are at home,” she said, before offering guidelines on how to approach the Congressional appointments the following day. Among those guidelines were to first address “white hat issues,” such as bills that have no budgetary implications, before addressing those issues that are more difficult, require more work on their part, and are more directly related to your practice’s finances. She also advised individuals to be aware of the committees that the Congress people with whom they are meeting sit on and to focus advocacy efforts on issues that pass through their committees, if any. “[C]ongressional offices are going to pay the most attention to and be inclined to be the most helpful on issues that go through the committees that they sit on, because that is where their expertise is and that is where they feel they have the most power to be helpful,” Macdonald said. In other cases, she said, it might be appropriate to start the visit with a thank you for past help. Such as, “Thank you for the money that [O&P] got for DOD [U.S. Department of Defense] research.”
This year, the following eight talking points were on the agenda:
- Request support for Part B-Recovery Audit Contractor (RAC) audit legislation. Included in this talking point was proposed legislation that was drafted by the O&P Alliance and the National Association for the Advancement of Orthotics & Prosthetics (NAAOP), the Ensuring Beneficiary Access to Orthotics and Prosthetics Act of 2014. Among other things, the bill seeks to reform the appeals process and the RACs, and explicitly states that O&P clinical notes are part of the record for purposes of determining medical necessity.
- Ask Congress members to cosponsor and pass the Medicare Orthotic and Prosthetic Improvements Act, House Resolution (H.R.) 3112. This bill would prohibit Medicare from reimbursing unlicensed providers in states that have enacted licensure laws; force the Centers for Medicare & Medicaid Services (CMS) to implement a 14-yearold federal statute that Medicare only pays qualified providers; limit deemed accrediting bodies to those experienced in O&P and which meet criteria set forth in Section 427 of the Benefits Improvement and Protection Act of 2000 (BIPA); and adapt a revised payment system for O&P that links practitioner qualifications with the level of complexity of the O&P care provided.
- Ask Congress members to cosponsor and pass the Insurance Fairness for Amputees Act, H.R. 3020. The bill does not mandate health insurance providers to provide O&P coverage, but if the insurer chooses to do so, then the benefits must be on par with general medical and surgical benefits.
- Provide facts about O&P and competitive bidding, and discuss how efforts to expand competitive bidding beyond off-the-shelf (OTS) orthoses to include other O&P devices would be detrimental to patient care. Further, when OTS orthoses were included in competitive bidding, the definition stated that they are used with minimal self-adjustment, but CMS recently adopted an expanded definition of OTS orthoses to include adjustments made by a beneficiary, caretaker, or supplier. This has resulted in CMS classifying many devices as OTS orthoses even though they do not meet the statutory definition.
- Ask Congress members to cosponsor and pass the Injured and Amputee Veterans Bill of Rights, H.R. 3408, which requires every U.S. Department of Veterans Affairs (VA) O&P clinic to post a list of rights that injured and amputee veterans have under this bill—rights that will grant veterans the ability to obtain O&P technology that meets their needs, select a practitioner of their choice, and obtain a second opinion for treatment decisions.
- Request support for Section 322 of the Comprehensive Veterans Health and Benefits and Military Pay Restoration funding for short-term competitive grants to universities to launch O&P practitioner education programs.
- Tell Congress members that you endorse Congress’ initial determination that O&P needs to be exempted from any post-acute care bundling. Congress has already provided clear indication, by virtue of how it excluded most O&P services and items from the competitive bidding program, that this patient choice and provider relationship needs to be protected.
- Restore due process rights and proper Administrative Law Judge (ALJ) timeframes.
NAAOP General Counsel Peter Thomas, provides an overview of the various Medicare auditors and their roles.
Mobility Saves
Tom Fise, JD, AOPA executive director, followed Liberman- Lampear’s remarks with what he called good news. “Finally we do have proof. Medicare data demonstrates that O&P care and O&P interventions are cost effective,” he said. “We’ve known it in hearts…[s]o we now have that [data] and we’ve done some things to convey that information around….” Fise was referring to the the July 2013 Dobson DaVanzo report, commissioned by AOPA and the Amputee Coalition, which provides a retrospective analysis of Medicare claims that details the value of O&P services among Medicare beneficiaries. The report results indicate that even with the added costs of the interventions themselves, within a short time, overall healthcare costs were ultimately decreased among those who had received lower-limb orthoses, and the healthcare costs were comparable among those who had received spinal orthoses or lower-limb prostheses.
Fise urged attendees to get this message out to third-party payers, referral sources, and policymakers. To this extent, he said that AOPA started a program to do the same, called Mobility Saves. “Mobility saves time and money,” he said. “Mobility saves lives and money.”
Attendees learn about a new AOPA awareness project called Mobility Saves.
A Mobility Saves logo is under development, a website is under construction, and press releases are in process, Fise said. The awareness project will also include a PowerPoint slide deck tailored to referral sources, third-party payers, and O&P providers. In addition, public service announcements, a video news release, and B-roll video footage are planned and patient testimonials will be conveyed.
Breaking News
Breaking news was relayed by Joseph McTernan, AOPA director of coding and reimbursement services, and Brian J. Looser, assistant vice president of federal public affairs for McGuireWoods Consulting, Washington DC. McTernan addressed recent input from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) in which they expanded the definition of minimal self-adjustment to include bending, trimming, molding, shaping and introduced the term “substantial modification” as a way to define custom- fitted orthoses (See talking point 4). The day of the Policy Forum, AOPA sent a letter to Laurence Wilson, director of the Chronic Care Policy Group with CMS’ Office of Clinical Standards and Quality, requesting withdrawal of that bulletin and the resulting Local Coverage Determinations due to statutory failings. Additionally, “the latest domino” fell at 9:30 that morning, McTernan said, when the Medicare Pricing, Data Analysis, and Coding contractor (PDAC) released a statement that due to the change in policy and the definition change of OTS orthoses, as well as the expanded definition of custom-fitted orthoses, it was going to go back and reverify the products on its code classification list and decide if they are OTS, custom fitted, or whether they can be both.
Looser’s news addressed the temporary pause of provider-driven ALJ hearings. Specifically, Representatives Tammy Duckworth (D-IL) and Todd Rokita (R-IN) signed off on a letter to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius stating that Medicare audits be suspended “until an appropriate, timely, and statutorily required system providing due process to providers is restored” (See talking point 8).
As with other issues, attendees were urged to call attention to both of these matters during their Congressional visits.
For more information about Policy Forum and these issues, visit the AOPA website, access the Legislative & Regulatory pull-down menu, and scroll down to Policy Forum.
