STLtoday - Pinning blame on patients for costs won't lead to

Doug Ervine, Republican State Rep for the Health Insurance industry here in the great state of MO, thinks that people would take better care of themselves if they had to pay out of pocket more. Mary Jo Feldstein thinks otherwise.

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Videos about Amputation and Amputees

The Care Digest Volume 2 Issue 2

The Care Digest Vol 2 Issue 2 (6-26-08) - Upload a Document to Scribd

Read this document on Scribd: The Care Digest Vol 2 Issue 2 (6-26-08)

Congratulations Shawn!

Congratulations to Shawn McAdams, C.P., for passing his board exams and becoming an ABC Certified Orthotist. The American Board for Certification in Prosthetics and Orthotics offers the highest certification in the profession, requiring a four-year bachelors degree, training in the fabrication of prosthetic and orthotic devices, a graduate certificate like the one Shawn earned from Northwestern Medical School in Chicago, and finally a year-long residency each for orthotics and prosthetics.

While most states require professional certification and licensure for doctors, therapists, nurses, and hairdressers, currently only eleven require that prosthetists and orthotists get certified and licensed. Illinois does, but Missouri doesn't. Still, all of P & O Care's practitioners on both sides of the river have graduated from Northwestern University, and our residents work under proper supervision until they pass their boards.

Congressional Action On Durable Medical Equipment Could Jeopardize Patient Care For Amputees And Other Disabled Medicare Beneficiaries

Many Americans, even Medicare beneficiaries, may not be aware that Congress is working hard on revisions to the Medicare law.

Under the Congressional rules, all costs to Medicare involved in delaying competitive bidding on the selling of medical equipment like hospital beds, wheelchairs, and oxygen, will have to come from elsewhere in the Medicare system. A spokesperson for DME suggested in Congressional testimony that there be a broad cut to the Medicare DME fee schedule to pay for the delay on competitive bidding - in essence that DME suppliers, being those who will benefit from the delay in competitive bidding, ought to be the ones to pay for it.

Recently, however, the discussions have taken an alarming turn. DME suppliers are the only ones who would benefit from a delay in competitive bidding, but some are suggesting that other Medicare suppliers should help cover the costs through reductions in their fee schedule, including the orthotic and prosthetic (O&P) field. The consequence of such a proposal would mean fee cuts to patient care facilities that provide care to America's amputees and other disabled individuals. This has prompted grave concerns about access to those O&P facilities providing care and restoring mobility to these patients, many of whom are Medicare beneficiaries.

"Americans have been heartened to see that veterans returning from Iraq and Afghanistan are benefiting from the tremendous improvements that are now available for those who have lost a limb, or have impaired mobility due to limb injuries," said Brad Ruhl, President of the American Orthotic and Prosthetic Association. "This proposed change is incomprehensible... prosthetics and orthotics are NOT included in competitive bidding, and it would be profoundly unfair for Congress to pay for a delay in competitive bidding by reducing Medicare payments to amputees and other disabled seniors, including disabled veterans and disabled children who are well-served under the current O&P fee schedule."**

Ironically, this week hundreds of amputees converge on Washington for an annual legislative day conducted by the Amputee Coalition of America (ACA), and plan to ask members of Congress to enact a prosthetic parity bill to assure that all insurers provide the identical coverage for amputee care that is provided for all other medical and surgical conditions. Some insurers have limited coverage to one replacement limb per life, or very meager amounts on how much they will spend for replacement limbs. It is an anomaly to have some in Congress talking about balancing the budget for what they wish to do to help DME, on the backs of these amputees.

"Orthotics and prosthetics have already gotten the short end in prior fee cuts and freezes, so we have lost significant ground to inflation in recent years," says James Kaiser, CP, LP, of Scheck and Siress, a chain of prosthetic and orthotic patient care facilities in the Midwest. "If there is a new round of Medicare cuts to help pay for this totally unrelated DME competitive bidding delay, the approximately 20% of O&P patient care facilities that are already on the edge will close, severely damaging patient access and choice, and assuring longer delays for these Medicare amputees and other disabled patients at the fewer, more crowded facilities that would remain open to serve them."

AOPA, based in Alexandria, Virginia, is the largest non-profit organization dedicated to helping orthotic and prosthetic businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. The association was founded when needs of returning veterans in the aftermath of World War I required a national organization to address the educational and research requirements of the industry.

**This refers to veterans with non-service connected injuries who are covered by Medicare and disabled children covered under Medicare and Medicaid. In addition, it would affect all private managed care contracts that pay based upon a percentage of the Medicare fee schedule.

An Arm or a Leg is Not a Luxury!

Check out this power point presentation about prosthetic parity from the Missouri Coalition for People with Limb Loss. The coalition willl be raising support from now until the 2009 legislative session begins in January.

An Arm or a Leg is Not a Luxury! - Upload a doc

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Pistorius on Talk of the Nation

Yesterday, while I was driving around between hospitals, physician offices, and nursing homes, I got to listen to Oscar Pistorius taking calls and being interviewed by Neil Conan on Talk of the Nation. It was really interesting to get his own perspective on how one test could show he had an unfair advantage and others could confirm he did not.

Evidently, the first test measured the volume of oxygen he used on a straight-of-way after accellerating, but there were several problems with this method. First, volume of oxygen use measures aerobic energy, whereas the 400m dash is mostly an anaerobic sprint. Second, Pistorius is at his greatest disadvantage to able-bodied sprinters when he is accellerating right out of the blocks and going around the two turns in his race.

Oscar also tells a funny story about the first time he ran with his J-shaped Cheetah feet, but I won't spoil it for you.

Columnist Reverses His Take on Pistorius

Opinion writer for the NY Times George Vecsey has changed his mind about Olympic hopeful Oscar Pistorius. In his piece today entitled, "A Ruling on the Side of Opportunity," Vecsey writes,

"While I still have doubts about the implications of these springy lower limbs — both in magnifying speed and affecting other runners — I find myself applauding the narrow one-case judgment of the court.

"It feels better to be on the side of hope and opportunity — particularly since the three-person arbitration team backed it up, unanimously."

Double Amputee Can Run in Olympics!

The now-famous double BK amputee from South Africa, Oscar Pistorius, has won his appeal today before the world's highest court for athletics, the Court of Arbitration for Sport. This clears him to compete in Beijing this summer with able bodied sprinters in his best event, the 400m, so long as he qualifies with a time of at least 45.95 seconds.

Earlier today, Pistorius said, “I am thrilled with the panel’s findings and hope that it silences many of the crazy theories that have been circulating in recent months about my having an unfair advantage.”

“My focus throughout this appeal has been to ensure that disabled athletes be given the chance to compete and compete fairly with able-bodied athletes. I look forward to continuing my quest to qualify for the Olympics.”

Amputee Coalition of America Calls for Prosthetic Parity

From O&P Business News, Online Exclusive
April 15, 2008

In the face of drastically reduced health insurance coverage for prosthetic care, the Amputee Coalition of America (ACA), a national non-profit educational and advocacy organization representing amputees, is calling for federal legislation requiring health insurance companies to cover prosthetic care on par with other essential medical care.

A bill creating the Prosthetic Parity Act, HR 5615, has been introduced in the House. The bill was authored by Rep. Robert Andrews (D-NJ), with Reps. George Miller (D-CA), Todd Platts (R-PA), Mario Diaz-Balart (R-FL), and Lincoln Diaz-Balart (R-FL) signing on as original co-sponsors.

“The introduction in the House of Representatives of the Prosthetic Parity Act is a tremendous positive development. Many of the two million amputees in the United States are deprived of meaningful coverage for prosthetic care by their health insurers, which potentially places a greater burden on society. This proposed legislation would require health insurers to cover prosthetic care on par with their coverage of other essential medical care,” said Paddy Rossbach, president and chief executive officer of the ACA.

“Increasingly we’ve seen health insurers drastically limit coverage for prosthetic care by imposing unrealistically low dollar caps and restrictions, even limiting coverage to one prosthesis per lifetime,” Rossbach added. “Federal legislation is needed to close the insurance coverage gap.”

There are an estimated two million individuals living with limb differences or loss in the United States, including 70,000 under the age of 18.

According to a recent poll by the ACA, among respondents with private health insurance, 24% had experienced a reduction in prosthetic coverage over the past three years. Four percent had their coverage eliminated entirely.

“For less than 25 cents per month in health insurance premiums, amputees will get the care they need to get back to work and live independent, productive lives. The cost to the health care system if this is not done far exceeds that of providing prosthetic care, and places a huge burden on society,” Rossbach concluded.

Prosthetic Parity Hearings a Huge Success!

Members of the Limb Loss Coalition and amputees from across the great state of Missouri showed up in Jefferson City Tuesday to support the Prosthetic Parity Bill before House and Senate Committees. Representing P&O Care were Jon Wilson, Clinical Director, Mark Woodson, Director of Fabrication, Bill McLellan, Director of Sales, and Suzi Schumacher, a young working amputee and active member of the Coalition.

Around 2:00 p.m., four witnesses testified before the Senate Small Business and Insurance Committee, chaired by Senator Lowden. Dr. John Rush, Medical Director for Hanger Orthopedic and a national expert on prosthetic parity, flew in to testify on many of the more technical issues. Then Mark Wilson, President of Prosthetic and Orthotic Design, Inc., in St. Louis testified that as a small business owner, he was not given the option of purchasing health insurance that did not include ridiculously low caps on prosthetic coverage. Next, Jeff Damerral, Chairman of the Missouri Coalition for People with Limb Loss, testified about his personal experience loosing both his legs below the knee to meningitis while a freshman at Truman State University. Damerral said that while he had good insurance through his father at the time, he is fighting for everyone who doesn't. Now that he is on his own and working as a lawyer for a small firm, Damerral must pay approximately $16,000 every 3-5 years to have his two legs replaced.

Finally, AK amputee and Secretary of the Coalition Jean Freeman brought the whole room to the verge of tears, telling how caps on her prosthetic coverage force her to hope that the various parts of her prosthesis don't wear out at once. "As an amputee, I am being discriminated against," she said.

Several registered lobbyists for the insurance companies spoke briefly against the bill, saying they opposed prosthetic parity for the same reason they have always opposed every other "mandate" the state has passed, such as those insuring coverage for mental health, women's health screenings, and wigs for children with cancer. They believe on principle that policies should be able to exclude coverage for any condition, provided that policy can be sold to a customer or employer. On being questioned by Senator Day, one gentleman did not know that some plans include once-in-a-lifetime clauses for prosthetic devices. "Do you mean that a person is expected to wear the same leg at 18 months as 18 years?" she asked incredulously. "I'll have to get back to you with that information," he replied.

The hearing in the House of Representatives began around 7:00 p.m., and since it was after business hours, many more supporters showed up. The bill sponsor, Rep. Dr. Wayne Cooper, introduced it to the committee, and Dr. Rush, Jeff, and Jean testified again. This time Jon Wilson, Clinical Director of Prosthetic and Orthotic Care, Inc., represented the state's prosthetists. "Surgeons often ask me to speak with patients before they loose their limbs, often to convince them that it's worth an amputation to save their life. I tell them I can help them walk again," Wilson said. "But later, when they're ready for the prosthesis, I have to be the one to tell them that their insurance won't pay for it. When they need health insurance the most, it isn't there."

Wrapping things up was Bill Brannan. He told how good health insurance has enabled him to live a productive life for ten years since he lost his leg at age 65; but he also told about meeting a young mother in a grocery store, juggling her kids and her cart and trying to get along in a wheelchair because her husband's insurance would not pay for her to get a prosthesis. The fine individuals who had to get up and represent the insurance companies after Bill sat down seemed like they were just going through the motions, stating rather plainly that they always oppose mandates, even inexpensive ones that seem to make all the sense in the world like ours does.

The representatives seemed to understand our case, and members from both parties told us the hearing had gone extremely well. It's always dangerous to get over confident, but here is what Dr. Rush thought comparing the parity effort in Missouri with other states where he has testified: he said that whereas elsewhere most of the real work gets done behind the scenes and hearings are just window dressing, we could have actually won our case in one day on hearings alone! We'll wait and see just where things go from here.

Wall Street Journal Covers Prosthetic Parity

Prosthetic and Orthotic Licensure in Missouri?

Today's cover story from O&P Business News discusses various efforts to get licensure laws passed in states across the nation. Now, only 12 states, excluding Missouri, require prosthetists and orthotists to be licensed. That means that anyone can fit an arm, leg, or brace here in St. Louis!

P&O Care's practitioners are licensed in Illinois and certified by the American Board for Certification in Prosthetics and Orthotics. We are also certified to train prosthetic and orthotic residents coming out of graduate school at Northwestern University in Chicago. Missouri needs a licensure law for the field of prosthetics and orthotics.

State by State: Licensing in O&P

O&P Business News delves into the debate over mandatory state licensure. Is this where the profession is headed?

By Stephanie Z. Pavlou

On the heels of the Centers for Medicare & Medicaid Services’ (CMS) announcement that all orthotic, prosthetic and pedorthic facilities must obtain accreditation by Sept. 30, 2009, professionals across the United States are wondering if licensure also will become mandatory. O&P Business News explores this standard, its benefits and its practical applications.

Licensing by state

According to the American Academy of Orthotists and Prosthetists’ Orthotic & Prosthetic Licensure: A Comprehensive Guide, licensure benefits the patient through established criteria for education and experience.

“Licensure requirements are in the best interests of the profession in that they give official status to the practice of the profession, establish a recognized scope of practice for orthotists and prosthetists, and will be recognized by other health care practitioners in crossover of patient care responsibilities,” the Academy wrote in the Guide.

With initial costs ranging from $20,000 to $100,000, licensure has not been a state priority. In addition, ongoing costs can run between $100 and $800 for individual practitioners or for facilities, depending on if the facility owner decides to pay for each practitioner in the office.

A dozen states, however, have stepped forward to pave the way for the rest. Currently, O&P practitioners are required to be licensed in the following states: Alabama, Arkansas, Florida, Georgia, Illinois, New Jersey, Ohio, Oklahoma, Rhode Island, Texas and Washington. Tennessee became the 12th state to pass a licensure bill in 2006, and enacted the law this January; O&P members are working to finalize its provisions.

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Prosthetic Parity Action Alert

On behalf of the Missouri Coalition for People with Limb Loss, I am excited to let you know that House Bill 2100 has been referred to the Special Committee on Health Insurance. This bill requires health insurance companies that claim to cover prosthetics to pay Medicare allowable rates without capping coverage at ridiculously low levels.

Real prosthetic parity is within our grasp! If we can get a hearing scheduled, we can all go to Jefferson City, drum up some publicity, and make our case before our legislators in public. Otherwise, our effort will fail this time around. It is absolutely necessary that as many Missourians as possible contact the committee chair, Rep. Wilson, as well as their own legislator, and ask for a hearing! Here is some information to make that easier for you to do right away. Please, take the time to stop what you’re doing and make just one or two phone calls or e-mails. What you do will make a difference!

Representative Kevin Wilson, Chair, Special Committee on Health Insurance
Home Zip: 64850; Counties: McDonald, Newton; District 130
Capitol Phone: 573-751-9781
E-mail: Kevin.Wilson@house.mo.gov

Everyone, please call and/or e-mail Rep. Wilson and say:
Please grant a Hearing for House Bill 2100 concerning prosthetic parity.

If you would like to say more, here are three quick talking points you can include in a phone call or cut-and-paste into an e-mail (also see attachment):

1. Employers, working Missourians, and amputees are being deceived into thinking that prosthetics are covered in their policies when, in fact, payment is capped at less than one-fourth to one-half the cost.
2. Some working-age amputees have found it better to get on Medicaid or Disability instead of returning to their jobs because coverage is better than with private insurance.
3. The cost of prosthetic parity laws on private health insurance is somewhere between 12 and 25 cents per member per month, or less than $3.00 per year.

Also, include any personal information, especially if you are an amputee or have been affected by insurance caps on prosthetic coverage.

If any of you or your patients or friends live in Rep. Wilson’s district, please get them involved!

Here is a list of all the members of the insurance committee. By clicking on their name you can immediately send them an e-mail.

Wilson, Kevin, Chair
Kraus, Will, Vice Chair
Bland, Craig C.
Grill, Jason
Hubbard, Rodney R.
Kratky, Michele
Pollock, Darrell
Portwood, Dr. Charles R.
Sander, Therese
Sater, David

Please check and see if your legislator is on this list, either by clicking on their name or by looking up your rep here: http://www.senate.mo.gov/llookup/leg_lookup.aspx. You can send an e-mail or make a phone call and say the same things listed above for Rep. Wilson. Once we get a hearing, we can go from there.

Thank you for your participation in this worthy cause. Feel free to forward this blog post to anyone, especially other amputees, whom you think will want to get involved. For more information, continue to check our blog at http://molimbloss.blogspot.com.

Pistorius Appeals Ruling

The South African sprinter Oscar Pistorius is appealing the ruling that threatens to keep him out of this summer's Olympic games in Beijing, China. He is taking his case all the way to the top, to the Court of Arbitration for Sport, arguing that his two prosthetic legs do not give him an unfair advantage over able-boddied athletes.

House Bill 2100!

True to his word, Rep. Cooper filed the prosthetic parity bill! Click here to read House Bill No. 2100 or here for updates on its progress.

It was read for the first time on February 12. It was read for the second time on the 13th. Rep. Cooper is listed as the sponsor and Rep. Avery as the co-sponsor.

Please call your State Representative and ask him or her to vote for House Bill 2100. We will let you know when a similar bill has been introduced in the Senate and when any hearings have been scheduled.

Super Tuesday!

On behalf of the Missouri Coalition for People with Limb Loss, I want to let you all know what a successful day we had in Jefferson City yesterday, February 5, 2008. For us, it really was a Super Tuesday! We found three Representatives enthusiastic about sponsoring our bill for prosthetic parity: Rep. Dr. Wayne Cooper (left), Rep. Jim Avery, and Rep. Rick Stream.

Dr. Cooper is the Chairman of the Health Policy Committee, and he committed to giving our bill a hearing. After lunch, we were also able to get the support of Senator Griesheimer, who will sponsor our bill in the Senate and introduce it to his committee for small business and insurance.

At this point, our next step is to wait for the draft bill we gave Dr. Cooper to be drawn up with the right language. In the meantime, we need to start contacting amputees who might want to travel to Jefferson City for the hearing, whenever that is. Once we have a bill introduced and a hearing scheduled, we can begin to make phone calls and write lots and lots of letters to those Reps on the committee, hopefully from people in their district.

Prosthetic Parity: Saving Money, Saving Lives

Prosthetic Parity: Saving Money Saving Lives

Activists Visit Senators

Bill McLellan, Jeff Dameral (Chairman), Jean Freeman (Secretary), Jim Weber.

Last Tuesday, activists from the Missouri Coalition for People with Limb Loss visited Jefferson City for appointments with two Republican Senators. Senator Kevin Engler, Majority Whip, and Senator Scott Rupp both expressed sincere support for prosthetic parity. They did not know and could not believe that insurance companies in Missouri claim to cover prosthetic limbs while capping coverage at less than a fourth of what they actually cost.

While Republicans generally have a hard time with insurance mandates, they agreed that prosthetic parity is not a traditional mandate. It simply requires insurance companies to cover what they claim to cover and stop taking advantage of employers and individuals who have no idea how much a prosthesis costs. Senators Rupp and Engler, as well as other Representatives we met with in the hallways of the State Capitol, want working Missourians who tragically and suddenly loose limbs to be able to return to work instead of becoming dependent on Medicaid.

It looks like prosthetic parity has broad bi-paritisan support in Missouri, but we are still looking for a Republican Senator and Representative who has the time and dedication to sponsor our bill in their houses of Congress. It takes more than sincere support; we need to become a priority on the 2008 legislative agenda, and for that to happen, individuals across the state need to contact their Senators and Representatives and write letters to the editors of their local newspapers in support of prosthetic parity legislation.

Most persuasive are the personal stories of working Missourians like Jeff and Jean who lead the Missouri Coalition, real people who have suffered from hidden caps on prosthetic coverage.

It's Official: Oscar Pistorius Barred from Olympic Games

Today, the IAAF has issued its official ruling that Oscar Pistorius' two carbon fiber prosthetic feet give him an unfair advantage over able-bodied athletes. It has barred him from the 2008 Beijing Olympics and any other track meet it sanctions.

As reported by the news agency Reuters, the official report issued by Professor Peter Bruggeman at the German Sport University in Cologne concludes that "Pistorius was able to run with his prosthetic blades at the same speed as the able-bodied sprinters with about 25 percent less energy expenditure." The same data, however, could also be interpreted to show that with his cardiovascular strength, he could run faster than those guys if he had their legs.

Nevertheless, Oscar Pistorius has done so much to raise awareness around the world about amputation, prosthetics, disabled sport and disability in general. His is a truely heroic sport story!