Ratio of Prosthetic and Orthotic Practitioners to Potential Patients in State Population

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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.

PeerClip: Online tool for Doctors

Social bookmarking has become very popular in the past few months. Sites like Digg and del.icio.us are popular with a wide audience, but now there's a special option just for doctors. Social bookmarking basically works like the "Favorites" tool on your browser, except that you can allow your friends or colleagues to see which sites you have marked. When you select a website, you improve it's performance on search engines like Google. On the bookmarking site's home page, you can also view which pages on the web are most popular with the community.

From PeerClip website:

A simple online tool that enables physicians to organize, share, discuss and discover relevant medical information.

Using PeerClip’s “research assistant” tool that integrates easily into any Web browser, physicians can “bookmark” any type content, including journal articles, blogs, podcasts and videos. Bookmarks are conveniently stored online for easy access in a central location, creating a personal homepage of relevant medical information. Physicians also can organize, keyword tag, rate and share bookmarks.

The PeerClip “research assistant” also provides physicians with at-a-glance information on articles that their peers have tagged and rated as useful. The combined ratings and tagging of all physicians helps the PeerClip member quickly find the information he or she is looking for. Additionally, the PeerClip “research assistant” also recommends other relevant information based on the member’s profile and interests. The simple act of member participation guides the recommendations as well as the member’s discovery while browsing.

Physicians also can invite peers to join the network as well as create personal online peer networks in order to track future bookmarks and comments by peers or Key
Opinion Leaders across the PeerClip community.

Here is a quick snapshot of how PeerClip works:

1) Using PeerClip, physicians can click a button in their browser tool bar to store their favorite online articles, blog postings, podcasts and videos on a personal
home page for easy future reference.

2) Physicians can also view bookmarks, comments and ratings on content their peers have bookmarked in PeerClip.

I will drop more comments as and when I receive the beta invitation.

Posted by Dr.Subrahmanyam Karuturi at Thursday, September 20, 2007

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!

Morgan Sheets: Letter about State and Federal Prosthetic Parity Bills

Dear Editor: Currently, due to archaic insurance regulations, prosthetic care is being put out of reach for many amputees in Wisconsin. Insurance plans are restricting or even eliminating coverage for prostheses. This is a matter that Congress must address.

In return for premiums paid for private health insurance, consumers expect to be covered for catastrophic illness or injury. They expect that their monthly premiums will provide them with the most basic of care, including prostheses.

Policy reports regarding prosthetic parity laws from Colorado, Massachusetts, California, New Jersey and Virginia suggest that the costs are minimal -- anywhere from 12 to 25 cents per member per month.

If amputees are prevented from accessing prosthetic care, this increases state Medicaid costs due to complications. The subsequent cost to the health care system far exceeds that of providing prosthetic care, while the lack of productivity places a huge burden on society.

Prosthetic parity bills have been launched all over the country, including in the state of Wisconsin. A federal prosthetic parity bill is going to be introduced next year. This bill would ensure that prostheses are treated the same as other basic, essential care.Please urge your member of Congress to co-sponsor the federal parity bill when it is introduced. We must give people with limb loss the care they need to fully participate in society!

Morgan Sheets, national advocacy director, Amputee Coalition of America, Washington, D.C.A letter to the editor.

Learning to cope with lifelong scars

BAGHDAD: For generations to come, Iraqis will have to cope with the physical and mental scars of tens of thousands of people severely injured in the violence of the past four years.

They include thousands of amputees, many of them children.

The date, time and place that changed Ali Abdullah's life is etched in his memory.

It was November 24, 2005. A Thursday morning. He was 13.
Ali's father runs a parking lot south of Baghdad. On that day, he had agreed to let his only son open the business by himself for the first time. It was a proud moment.

In the middle of the morning he stepped out for breakfast just as a car bomb exploded nearby. Shrapnel destroyed one of his legs and an eye, and peppered his chest with wounds.

Ali told his story while waiting for a new artificial leg to be fitted at the Baghdad Artificial Limbs Centre, one of the Iraqi capital's two main prosthetics clinics.

"I came here to replace the old one because it became too small and I limp when I walk," he said.

The Baghdad centre alone has registered 2,700 amputees since 2003. The cost of looking after them is high - especially in the case of children, who will need to replace prosthetic limbs regularly as they grow.

"We mostly care for children. We try to provide them with the limb as soon as possible. We like to help them to return to school, to regain a normal life," said Qassim Mohammed, the centre's deputy director.
Besides the physical cost, there is a huge psychological toll.

"Some of them come here in despair, but we try to plant hope in them, because 50 percent of therapy is psychological," said Hussein Majeed, one of about 20 technicians in the centre's workshop, where the prosthetics are built using old machine tools, plaster casts, plastic and glue.

Saad Al Shaboutt, 65, said he now felt able to cope, two years after losing his leg to a bomb at Baghdad's Shorja market.

"I reached the point when I wanted to commit suicide, but I am better now," he said in the centre's waiting room.

"I am a manager at Iraqi Airways. I was about to be transferred to be the head of our office in Cairo, but I cancelled the transfer. Without a leg, how could I go?" he said.

Even doctors become emotionally involved. Sadiq Ali, a psychotherapist at the centre who helps counsel victims to cope with a future of disability, recalled a young man he treated two months ago who had lost all four limbs.

Wounded victims often need advanced reconstructive surgery. Yet Iraq has experienced a brain drain of medical specialists fleeing in fear after doctors were targeted by insurgents or kidnap and extortion gangs.

"I used to have 10 anaesthesiologists, now I have four," said one of Baghdad's leading reconstructive surgeons. His hospital is able to perform only about 10 operations a week, down from 14-15 a week before the war, he said.

West Coast rehab center offers wounded veterans a shorter road to recovery

From PE.com, the Press-Enterprise:

Army infantry Sgt. Wally Fanene's sister calls him "the face of who came back from the Iraq war," a reminder of the savagery confronting American troops daily.

Fanene, while on foot patrol in Kirkuk in September, stepped on a fist-size land mine, heard a pinging noise and temporarily went deaf from an explosion that tore off his right arm and leg and seriously injured his remaining limbs.

The 25-year-old Temecula man's fight today is to rebuild himself as completely as possible, regain as much as he can -- to surf, pick a nickel out of his pocket, change his daughter's diaper, resume his Army career as a weapons instructor. With the assistance of a new rehabilitation center at Naval Hospital-San Diego, it's a war Fanene says he intends to win.

The $4.4 million Comprehensive Combat Casualty Care Center -- C5, for short -- opened in 2006 and provides the latest treatments and prosthetic devices for amputees. The new center means soldiers, sailors, Air Force personnel and Marines who live in the West won't have to move from family and friends to rehabilitate their injuries at Brooke Army Medical Center in San Antonio or Walter Reed Army Medical Center in Washington, D.C.

Fanene's father, Lynn, calls the center a "godsend" and attributes his son's progress to being so close to home.
"We're a hop, skip and a jump away from San Diego," Lynn Fanene said. "We can provide all the emotional help he needs."

In the 15 months since opening, the center has evaluated and treated 34 amputees, fitting many with prosthetic limbs, providing them the physical and mental-health therapy that's part of any successful recovery. It also helps those who can't return to service to forge civilian careers.

All told, about 725 American military personnel have lost limbs in Afghanistan and Iraq.

C-5 staff members say the prosthetics make some amputees resemble 21st century bionic men and women. Jennifer Town, C-5 program director, said the goal is to return the superbly conditioned young military service members to the active lives they led before their injuries. "They don't want people to feel sorry for them," Town said.

Phantom pain persists, like needles being shoved into his missing limbs. He quit taking the powerful painkillers, instead preferring to "gut out" the hurt rather than risk addiction.
Doctors operated in Iraq, Germany and at Walter Reed. On Oct. 1, three weeks after he was wounded, Fanene took his first steps on a prosthetic leg.

His gait has improved since then. Fanene wears his leg up to six hours at a time, far more than the two hours in the weeks after receiving the injuries. He can shave and hold a fork and brush his teeth with his prosthetic arm, all abilities he had to re-acquire. His prosthetic leg includes a "power knee" that can swing freely or provide more resistance, depending on whether Fanene is walking up a hill or running. Sensors in the knee let orthopedic specialists know via computer whether it is operating at maximum efficiency.

Reach Joe Vargo at 951-368-9289 or jvargo@PE.com
San Diego's C-5 Rehab Center
Opened: September 2006
Cost: $4.4 million
Size: 30,000 square feet
Features: Orthopedics, physical rehabilitation, treatment for posttraumatic stress disorder and mild traumatic brain injury.
Amputees treated: 34

NPR Story about Medicare Fraud

I enjoyed listening to this NPR story yesterday afternoon on KWMU. As Greg Allen says, fraud in the medical equipment, prosthetics, and orthotics industry gives the rest of us a bad rap. I guess now we know how lawyers feel, right? Patients and their family members should always check to make sure they actually received the services their statements claim they received, and doctors should make sure they only sign for services they ordered.

Amputee's Experience

An Amputee talks about the need for parity in insurance coverage for prosthetic care.

The Fight for Prosthetic Parity Heats Up in Missouri and Across the Nation

Do working Americans who pay for health insurance deserve to walk again and return to work if a medical condition lands them with limb loss?

That’s the question before twenty-three state legislatures across the country. Parity laws require health insurance companies to cover prosthetic limbs when deemed medically necessary by a physician, without setting unrealistic price caps or once-in-a-lifetime clauses. When insurers fulfill their obligations, amputees are much less likely to depend on government services like Medicaid.

Medicare, Medicaid, and the Department of Veteran Affairs already provide the coverage required by parity laws. But a movement to cut healthcare costs has led some private insurers here in Missouri to place annual limits on prosthetic coverage, ranging from $1500 to $4000, not quite half the cost of a below-knee prosthesis.

Insurance companies and government payers have always used provider contracts with companies like P&O Care to dictate how much they will pay for different types of prosthetics. But these new caps are imposed directly on patients, regardless of their different needs. Individuals and employers shopping for health coverage should not be expected to know that $1500 is an unreasonable cap on prosthetic coverage. In essence, these insurers are advertising that they cover prosthetics, but when patients need that coverage, it isn’t actually paid for.

One of P&O Care’s own patients, orthopedic surgeon Dr. Matthew Bradley (picture above), has testified before the Oregon State Legislature on behalf of a parity law that seems likely to pass there this year. Now, Matt has plans to use his expertise to help work for parity legislation here in Missouri. Through a new committee, P&O Care is joining with individual citizens, prosthetic providers, and advocacy groups all over the Show Me State to get a parity law passed here in 2008.

Besides Oregon, six other states have already passed prosthetic parity laws, including Colorado Maine, New Hamshire, Rhode Island, California, and Massachusetts, where former Governor Mitt Romney was a key supporter. Missouri Governor Matt Blunt has announced that he is supporting Romney’s bid for President: Does that mean he might support prosthetic parity, too?

Nationwide, Current Restrictions to Prosthetic Coverage by Private Insurers Include:

• No coverage for repairs or replacements
• Increased co-pays, deductibles and out-of-pocket expenses
• A cap on benefits if a patient receives a prosthesis from another insurance company
• Annual caps of $1000 to $5000
• $2500 to $7000 maximum lifetime cap
• One prosthesis per lifetime

(This information comes from Action Plan for People with Limb Loss, a publication of The Amputee Coalition of America)

Amputees Rehabbing in Skilled Nursing and Out-Patient Facilities

A gradual shift in Medicare policy has greatly affected amputees and rehab facilities in the St. Louis region. Until recently, most amputees qualified for rehab with their new prosthesis in an acute care setting.

Within a hospital, they benefited from the care of experienced therapists and the camaraderie of other amputees. In the past several months, however, it has become increasingly difficult for new amputees to qualify with Medicare for such extensive rehab care.

While some remain in an acute setting, most amputees are now doing their therapy in skilled nursing and out-patient therapy facilities. This means that instead of being concentrated at a few specialized locations, St. Louis amputees are spread throught the region.

Area rehab organizations are working to get their best therapists into the settings where amputees now find themselves. Prosthetic companies like P&O Care are scrambling to educate more therapists in more facilities. Mroe than ever, amputees and their rehab team need to make sure they get the best care available.

Nothing Slows Down Janetta

Janetta Rogers is one of the most vibrant and active eight-year-olds you could ever meet. And the fact that she wears two prosthetic legs has never slowed her down. Janetta enjoys strolling the mall, winning summer camp relay races, and even ice skating! Her YouTube videos below have already been viewed over 10,000 times. Her newest venture is playing on a third grade girls basketball team.

Born with a rare condition known as PFFD (Proximal Femoral Focal Deficiency), Janetta has worn a right above-the-knee prosthesis and a left below-the-knee prosthesis since she was one year old. Her prosthetist, Dan Luitjohan, sees her more often than most patients ot make adjustments as she grows.

The Amputee Coalition of America reports that roughly one out of every 200 Americans live with limb loss, with 82% due to diabetes and peripheral vascular disease. Comparatively, congenital-related limb dificiencies happen in only 26 out of every 100,000 births. In the US, this rate has remained stable over the past thirty years, while the rate of trauma-related amputations has decreased and the rate of dysvascular amputations has risen considerably.