Month: August 2015

AOPA submitted comments on the LCD Policy on Friday, August 28. Read the comments here.

Researchers Referenced in CMS’ Bibliography in Support of LCD Submitted a Letter Objecting to their Use of their Work. Read their comments here.

Today is the last day to submit comments on the policy. You can quickly submit a letter from www.AOPAvotes.org.

The August 26 rally at HHS caught the attention of top CMS officials who met with O&P representatives at 4:00 PM that afternoon.

Adrianne-Haslet delivered a powerful testimony during the CMS Public Meeting on the morning of August 26.

AMPUTEES, EXPERTS:  DON’T “TURN BACK THE CLOCK” ON STANDARD OF CARE FOR TWO MILLION AMERICAN AMPUTEES 

Former Senator Bob Kerrey, Boston Marathon Survivor Join Amputee Coalition and AOPA in Urging Medicare to Rescind Draft Rule Imposing “Serious Setback” for Amputees. 

WASHINGTON, D.C – August 25, 2015 – A double amputee who has worn advanced prosthetic devices for decades no longer would be eligible for new prostheses because he never achieved a perfect “natural gait.” A 68-year-old minister of a church, who had her left leg amputated above the knee as a result of diabetes, would be denied an advanced prosthetic limb because Medicare once paid for a set of crutches that she used when she got up to use the bathroom during the night.  A 65-year old Viet Nam War veteran, who suffered an injury from an explosion at Khe Sahn in 1972 and had his right leg amputated above the knee, switched from Veterans Administration (VA) health care to Medicare, and would not get his ninth prosthesis because he occasionally used a wheelchair during business travel. A retired mechanic, who suffered a sepsis infection that resulted in the amputation of his  right leg below the knee, would be denied a prosthetic device by Medicare because he takes a common medication for the treatment of hypertension. 

These real-life stories are drawn from the ranks of the estimated two million American amputees who would see significantly reduced access to care under a rule proposal now pending before Medicare, according to a warning issued today by the Amputee Coalition and the American Orthotic & Prosthetic Association (AOPA). While all of the individuals cited above qualify for reimbursement of care that is readily available today, the draft Medicare rule would “turn back the clock” to a time when the type of prosthetics available were less functional and provided less mobility. The proposed changes in coverage for services provided not only would have a devastating impact on Medicare amputee beneficiaries, but on all of the two million amputees in the U.S., since commercial health insurance payers and the VA tend to follow the lead of Medicare on coverage matters.

For weeks now, a groundswell of opposition has been growing to the proposal now before Medicare.  More than 105,000 Americans have signed a “We the People” White House petition asking Medicare to rescind the proposal restricting access to prosthetic limbs.  The Amputee Coalition also has organized a social media campaign using the #notaluxury hashtag aimed at helping amputees to learn about the proposal and provide comments to Medicare.

The debate over the draft Medicare rule will reach a boiling point tomorrow.  A Wednesday public hearing will be held at 8 a.m. in Linthicum, Maryland, where amputees and other stakeholders will present their concerns about the new proposed Medicare policy. Also on Wednesday: An amputee rally organized by AOPA will take place at 2 p.m. outside of the offices of the Department of Health and Human Services (HHS) on the north sidewalk in front of 200 Independence Avenue SW.  Hundreds of amputees and other concerned individuals from across the U.S. are expected to participate.

Hon. Bob Kerrey, former U.S. Senator from Nebraska, said: “Today, Medicare officials have before them a draft rule that would increase the suffering of hundreds of thousands of men and women who are working hard to make their way in the world as amputees.  It is not an exaggeration to say that research into advanced prosthetics will not only cease but the standard of care will regress back to the good old days in 1969 when I was first fit with a wooden leg.”

Adrianne Haslet, Boston Marathon survivor and professional ballroom dancer, said: “My life changed completely in 3 seconds at the finish line of the Boston Marathon, and I am very fortunate to have had access to the advanced prosthetics that have allowed me to return to dancing and a largely normal life.  Medicare beneficiaries deserve the same chance those high-quality prosthetics have given me.”

Dan Berschinski, chairman of the board of directors, Amputee Coalition, said: “This proposal represents a significant setback for amputees in the United States. It would mean that hundreds of thousands of Americans who now are active parents, grandparents, employees, and community volunteers would not be able to receive the most appropriate device for their needs at the most appropriate time.”

Charlie Dankmeyer, president, American Orthotic & Prosthetic Association, said:   “It is very difficult to imagine any other aspect of American healthcare where millions of people would be denied available and appropriate treatment and devices that can speed their return to the fullest and most active possible life. Even worse, there is no medical or scientific justification for these unreasonable and inappropriate hurdles that would amount to a return to a 1970s standard of care.”

Paul F. Pasquina, M.D. (Colonel, U.S. Army retired), said:  “Throughout my medical career I have had the opportunity to treat many patients and advise them and their families during their physical and psychological recovery after amputation.  I have seen the tremendous improvements in prosthetics in recent years, and how they have greatly improved the lives of individuals with limb loss – enhancing rehabilitation outcomes and independence.  It is for those reasons that organizations such as the Department of Defense, Department of Veterans Affairs, and the National Institutes of Health have invested so heavily in supporting the advancement of this technology – not only to enhance the care of our nation’s heroes, but to elevate the care of all Americans with disabilities.  It is therefore, disheartening for me to see Medicare proposing steps that would likely place barriers between patients and these very beneficial advanced prosthetics.”

Jack Richmond, an amputee from Cleveland, TN., and board member of the Amputee Coalition, said:  “The Amputee Coalition has always maintained that arms and legs are not a luxury and shouldn’t be treated as such. Everyone needs to know that amputees matter and that any changes to current amputee care must ensure patients are able to receive the most appropriate prosthetic device for their needs when they need it.”

Among the key concerns about the proposed Medicare policy restricting care for amputees are the following:

• If you are an amputee using – or who has used in the past — an assistive device such as a cane, crutch or walker, you will be limited to less functional prosthetic devices – even if you only use the assistive device briefly or for limited purposes, such as getting out of bed at night to go to the bathroom.
• You could be provided a less functional prosthesis or denied a device altogether just because you may not be able to attain the “appearance of a natural gait.” However, as this first of two videos shows, it is not uncommon for individuals in the initial post-operative and rehab periods to have great difficulty. As this second video shows, the same individual may improve far beyond how he or she is assessed initially.  However, no such improvement would be possible if a prosthetic device is denied by Medicare based on an unduly negative front-end assessment.  In other cases, patients who never achieve a truly “natural gait” can and do rely up prosthetics to live a full life.
• If your medical record references certain health issues, including such common conditions as high blood pressure and asthma, Medicare could deny you access to the best available care. With no sound scientific basis, this arbitrary provision would unfairly and needlessly knock hundreds of thousands of amputees out of consideration for the most appropriate prosthetic device for their needs.
• The Medicare proposal redefines the rehabilitation process for amputees and forces new amputees to undergo rehab using out-of-date technology that they will not even use once they receive their permanent prosthetic device. This means that the rehab for amputees will be of less value than if it was carried out with the most appropriate prosthetic device for their needs, as is common practice today.

The current Medicare policy for reimbursements is available online at http://www.medicarenhic.com/viewdoc.aspx?id=2948. The draft Medicare policy may be read at http://www.medicarenhic.com/viewdoc.aspx?id=3109.

The audio is available at http://www.hastingsgroupmedia.com/AOPA/medicarerulenewsevent.mp3

GROUPS: MEDICARE IS EYEING A “SIGNIFICANT SETBACK” IN CARE FOR TWO MILLION AMERICAN AMPUTEES

“Return to 1970’s Standard of Care”: Proposed Cost-Cutting Move Would Severely Limit Availability of Appropriate and Medically Necessary Prosthetic Care for Amputees.

WASHINGTON, D.C. – August 19, 2015 — Proposed changes to Medicare’s reimbursement for lower limb prosthetic care would create unreasonable and clinically unjustified hurdles to amputees receiving care that is now routinely provided, according to a warning issued today by the Amputees Coalition and the American Orthotic and Prosthetic Association (AOPA). The proposed changes in amputee care not only would have a devastating impact on Medicare amputee beneficiaries, but on all of the two million amputees in the U.S., since commercial health insurance payers tend to follow the lead of Medicare on such matters.

According to the Amputee Coalition there are roughly two million persons in the U.S. living with limb loss, and there are approximately 185,000 new amputees each year. Medicare’s data for 2009 showed over two million prosthetic services with a total expenditure of $655 million including new prosthetic feet for 36,600 Medicare beneficiaries. The Medicare policy would extend on a de facto basis to an estimated 10 million prosthetic services per year when including all payer sources for two million amputees.

Amputee Coalition President Susan Stout said: “This proposal represents a significant setback for amputees in the United States. It would mean that hundreds of thousands of Americans who now are active parents, grandparents, employees, and community volunteers would not be able to receive the most appropriate device for their needs at the most appropriate time. The Amputee Coalition is working hard to ensure that amputees are able to reach their full potential and that two million Americans do not see their standard of care negatively impacted by this proposal. Amputees must be able to continue to receive the most appropriate device for their needs.”

AOPA President Charles Dankmeyer said: “It is very difficult to imagine any other aspect of American healthcare where multiple millions of people would not be able to receive appropriate treatment and devices that can speed their return to the fullest and most active possible life. Even worse, there is no medical or scientific justification for these unreasonable and inappropriate hurdles that would amount to a return to a 1970s standard of care. No one is asking for more here; this is simply a situation where an appeal is being made to avoid forcing millions of Americans to suffer with much less in terms of the care readily available to them today.”

Among the highlights of patient concerns with the proposed Medicare policy:

 If you are an amputee using an assistive device such as a cane, crutch or walker, you will be limited to less functional prosthetic devices – even if you only use the assistive device briefly or for limited purposes, such as getting out of bed at night to go to the bathroom. If you have a higher functional level, Medicare will not pay for you to have a wheelchair.

 You could be provided a less functional prosthesis or denied a device altogether just because you may not be able to attain the “appearance of a natural gait,” or if your medical record references certain health issues, including such common conditions as high blood pressure. This would unfairly and needlessly knock hundreds of thousands of amputees out of consideration for the most appropriate prosthetic device for their needs.

 The Medicare proposal redefines the rehabilitation process for amputees and forces new amputees to undergo rehab using out-of-date technology that they will not even use once they receive their permanent prosthetic device. This means that the rehab for amputees will be of less value than if it was carried out with the most appropriate prosthetic device for their needs, as is common practice today.

A groundswell of opposition is growing against the proposed Medicare rule attack on the standard of care for America’s amputees. More than 100,000 Americans have signed a “We the People” White House petition to rescind the Medicare proposal restricting access to prosthetic limbs. The Amputee Coalition also has organized a social media campaign using the #notaluxury hashtag. For more information, go to https://www.facebook.com/AmputeeUSA on Facebook and @AmputeesUSA on Twitter.

ABOUT THE GROUPS

Today, almost 2 million Americans have experienced amputations or were born with limb difference. Another 28 million people in our country are at risk for amputation. The Amputee Coalition is the nation’s leading organization on limb loss, dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss. With the generous support of the public, we are helping amputees live well with limb loss, raising awareness about limb loss prevention and ensuring amputees have a voice in matters affecting their ability to live full, thriving lives. Visit us at www.amputee-coalition.org.

The American Orthotic & Prosthetic Association is a national trade association committed to providing high quality, unprecedented business services and products to O&P professionals. Since our founding in 1917, we have worked diligently to establish ourselves as the voice for O&P businesses. Through government relations efforts, AOPA works to raise awareness of the profession and impact policies that affect the future of the O&P industry. AOPA membership consists of more than 2,000 O&P patient care facilities and suppliers that manufacture, distribute, design, fabricate, fit, and supervise the use of orthoses (orthopedic braces) and prostheses (artificial limbs). Membership in AOPA represents a professional milestone; it is recognition of leadership and achievement in the O&P community. Visit us at www.aopanet.org.

MEDIA CONTACTS: Alex Frank, (703) 276-3264 or afrank@hastingsgroup.com; and Pat Mitchell, (703) 276-3266 or pmitchell@hastingsgroup.com; or Abra Hogarth ahogarth@amputee-coalition.org.

Dear AOPA Member,

Everyone throughout the orthotics and prosthetics world has pulled together and gone “all in” on the effort to fight back the DME MAC proposed revisions to the Local Coverage Determination (LCD) for Lower Limb Prosthetics, and hopefully restore some sanity to delivery of prosthetic limbs to Medicare amputee beneficiaries in the future.  We are more than halfway through the short 45 day comment period which ends August 31. The meeting where the DME MACs will hear from interested stakeholders is August 26^th — eight days from now.  We owe every AOPA member a report, in summary form, of the things we have been doing, and will be doing in the coming days.

Your One-Pager…The Low-Down on the Dozen Essentials You Shouldn’t Miss

1. AOPA has activated communications to members, and placed explanatory content on both the AOPA website for members and on the Mobility Saves website for patients– we had recorded about 1,175 O&P/AOPA members comment letters, as well as 2,075 patient comment letters.
2. NAAOP President (and AOPA Board Member) Dave McGill has initiated and provided excellent promotion for a “We the People” petition to the White House which achieved its 100,000 mark this past weekend reaching 102,770.
3. AOPA is partnering with the Amputee Coalition on Postcards that have been distributed to O&P facilities for distribution to patients.
4. AOPA has registered at least 4 participants, including AOPA President Charlie Dankmeyer, and AOPA Member Tom Watson, to appear and provide statements at the DME MAC meeting in Linthicum, Maryland on August 26 from 8-12 noon.
5. AOPA has activated plans to hold an amputee patient demonstration at the HHS building in DC on August 26 from 2 to 5 pm—know an amputee who would like to attend? Email landerson@aopanet.org for details.
6. AOPA has initiated PR efforts focusing on The “Glass Ceiling of Prosthetics” concept, and is being transformed into (i) broadcast and print ads to run in the DC area August 23-26 and (ii) placement on the Mobility Saves website. Print advertising is slated over the next 3 weeks, and TV broadcast advertising, starting with two messages that will appear in the Washington DC market on ABC’s Sunday morning News programs, “This Week with George Stephanopoulus,” on August 23, and continuing with morning programs all week on CNN, Fox News, CSNBC and other media outlets.
7. AOPA has worked on challenging the absence of scientific/medical/literature support for the LCD, having generated a request to the DME MACs for such information in light of its absence from the proposal.
8. AOPA has generated a series of true to life Patient Vignettes in cooperation with the Amputee Coalition that capture the very specific impact of the proposed LCDs on patient care.
9. AOPA, in consultation with former CMS Administrator, Tom Scully and other AOPA lobbyists scheduled one and possibly more meetings with CMS officials to discuss the LCDs.  The first meeting took place on August 11 with Sean Cavanaugh, the Deputy Director of CMS.
10. Input from physicians–three past presidents of the American Academy of Orthopedic Surgeons, plus communications from a President of the Association of Bone & Joint Surgeons, the American Orthopaedic Foot and Ankle Society, and the International Federation of Foot and Ankle Societies. A draft letter is in the works from a couple of Past Presidents of the American Academy of Physical Medicine and Rehabilitation, and the American Medical Rehabilitation Providers Association has started its own sign-on letter.
11. AOPA Analysis of Data Since 2010 Shows Steady Decline in Medicare Prosthetics Payments–OIG Report has dictated CMS and contractors behaviors for the past five years. Medicare’s determination to squelch that progression as ‘fraudulent (in some unknown way)’ pushed the number of all types of K3s  down, resulting in an increase  in K2s AND reduction in the total dollars Medicare spends on prosthetics each of the past 4 years.  CMS and the DME MACs have succeeded in practicing medicine and changing the prevailing standard of amputee care for the worse.  You’ll want to take a look at this, which demonstrates that data shows no reason for the LCD.  Medicare prosthetic costs DOWN 13.8% in past 4 years.
12. If you go to the mobilitysaves.org home page, you’ll find: (a) list of amputee talking points; and (b) you’ll be able to link to the remarkable letter authored by former U.S. Senator Bob Kerrey. (website update in progress)

A. Things AOPA has done…

The pace of activities regarding the LCD proposal has been incredible, and this is a very brief summary of how we are doing in implementing the AOPA Action Plan that was approved by the AOPA Board less than a month ago, on July 21.  Attached are a fair number of items to help you get the larger picture and we will give a sentence or two synopsis.

1. The AOPA Coding and Reimbursement Committee met on August 3 and provided great assistance in framing both AOPA’s comments as well as those of the O&P Alliance.
2. AOPA has prepared and circulated an extensive summary of the proposal, along with an Executive Summary.
3. AOPA has activated communications to members, and placed explanatory content on both the AOPA website for members and on the Mobility Saves website for patients.  The sites contain links to AOPAVotes.org where folks can generate comment letters to the DME MACs on the proposed revisions. As of yesterday, we had recorded about 1,175 O&P/AOPA members comment letters, as well as 2,075 patient comment letters.  Every comment letter goes not just to the DME MACs, but also to the writer’s two Senators and their one Representative.
4. AOPA has drafted Physician Talking Points.
5. AOPA has participated in outreach to Congress, including joining in the O& P Alliance letter to CMS Administrator Andy Slavitt, consulting with offices of Reps. Duckworth and Guthrie and prepared a draft letter from Rep. Guthrie to HHS Secretary Burwell, and worked with Hanger attorney former Rep. Scott Klug on a proposed letter for the Chairs of three Congressional Committees to consider forwarding to Mr. Slavitt seeking rescission of the policy.  Contacts with a dozen proven O&P Congressional champions are proceeding to urge them to communicate directly to the HHS Secretary and to participate in press on the LCD. More such contacts will continue even though the timing for this LCD action has managed to occur over the period of Congress’ summer recess. They are out until after Labor Day, a week past the August 31 deadline for comments on the proposed LCD.
6. The O&P Alliance has held 7 meetings (another set for tomorrow) to work on Comments for the Alliance.
7. NAAOP President (and AOPA Board Member) Dave McGill has initiated and provided excellent promotion for a “We the People” petition to the White House with objective of securing 100,000 signatures challenging the LCD by August 31.  The petition achieved its 100,000 mark this past weekend reaching 102,770.  The White House promises response to any petition which includes 100,000 signatures.
8. AOPA has convened the Prosthetics 2020 Physician Medical Advisory Board (August 3) and several contacts for follow-up action have been initiated.
9. AOPA is partnering with the Amputee Coalition on postcards that have been distributed to O&P facilities for distribution to patients.
10. AOPA has registered at least 4 participants, including AOPA President Charlie Dankmeyer, and AOPA Member Tom Watson, to appear and provide statements at the DME MAC meeting in Linthicum, Maryland on August 26 from 8-12 noon.
11. AOPA has activated plans, and received necessary permit to hold an amputee patient demonstration at the HHS building on August 26 from 2 to 5 pm.  We are expecting 100 amputees as well as a substantial number of non-amputee participants.
12. AOPA has initiated PR efforts.
13. The “Glass Ceiling of Prosthetics” concept is being transformed into (i) broadcast and print ads to run in the DC area August 23-26 and (ii) placement on the Mobility Saves website;
14. PR promotion of both a press advisory session sometime before August 23, as well as promotion of the Patient Demonstration on August 26 at HHS.
15. AOPA has worked on challenging the absence of scientific/medical/literature support for the LCD, having generated a request to the DME MACs for such information in light of its absence from the proposal.  This resulted in a response from the MACs pointing to a 31 item bibliography which was woefully weak in providing any scientific evidence to support the proposed changes. Some of the authors cited in the bibliography acknowledge their work cited by the DME MACs does not provide any support for proposed changes.
16. AOPA staff, with strong assistance from members of the AOPA Executive Committee, has generated a series of true to life Patient Vignettes in cooperation with the Amputee Coalition that capture the very specific impact of the proposed LCDs on patient care, eligibility for advanced prosthetics and overall patient welfare.
17. AOPA, in consultation with former CMS Administrator, Tom Scully and other AOPA lobbyists scheduled one and possibly more meetings with CMS officials to discuss the LCDs.  The first meeting took place on August 11 with Sean Cavanaugh, the Deputy Director of CMS with responsibility for the Medicare program.  Efforts continue to arrange a meeting with both the CCSQ, as well as with CMS Acting Administrator Andrew Slavitt.

B. Where we stand right now?

I’m pleased to report that 2,075 patients and 1,175 practitioners and other O&P professionals have used the AOPAVotes mechanism to generate letters for inclusion in the official record for the LCD rulemaking.

Input from physicians and patients is probably going to count more than input from O&P professionals.  So, additionally, we have, with strong assistance from AOPA Board member Don Shurr, a group letter from three past presidents of the American Academy of Orthopedic Surgeons, plus communications from a President of the Association of Bone & Joint Surgeons, the American Orthopaedic Foot and Ankle Society, and the International Federation of Foot and Ankle Societies.  A draft letter is in the works from a couple of Past Presidents of the American Academy of Physical Medicine and Rehabilitation, and the American Medical Rehabilitation Providers Association has started its own sign-on letter. Suffice it to say we are gaining some traction!

Data is always king in payment related discussions, and AOPA has spent some time and money to capture the current state of Medicare payments for prosthetics.

You’ll want to take a look at this, which demonstrates that data shows no reason for the LCD.  Medicare prosthetic costs DOWN 13.8% in past 4 years.

What does this information mean and how does it interact with the proposed LCD?

1.  Data Since 2010 Shows Steady Decline in Prosthetics–OIG Report has dictated CMS and contractors behaviors for the past five years. The data in that report was used to reach an errant conclusion.  Moreover, CMS is locked into that 5-year old data—if the agency looked at its own data it would see that the 2015 picture is the exact opposite of the 2010 data.

What we have in terms of data is an over-reaction to where things were between 2005-10.  In that period the number of Medicare beneficiaries was flat, but costs rose because more amputees were getting their first crack at recently available new technologies–MPKs, energy-storing feet–that triggered higher per capita cost but delivered better results in terms of amputee mobility and independence.  Medicare’s determination to squelch that progression as ‘fraudulent (in some unknown way)’ pushed the number of all types of K3s  down, resulting in an increase  in K2s AND reduction in the total dollars Medicare spends on prosthetics each of the past 4 years.

CMS and the DME MACs have succeeded in practicing medicine and changing the prevailing standard of amputee care for the worse, and they have missed the last four years of data and don’t know that 2005-10 data is outdated and is really no longer relevant.

One of the topics raised in the DME MAC proposal related to their wanting to institutionalize the Proof of Delivery requirements that have vexed O&P providers since February.  AOPA’s research indicates that these requirements are inappropriate since it is FDA, not CMS, that has been given the authority by Congress to prescribe what appears in medical device labeling.  So, we have provided a request to CMS challenging the entire Proof of Delivery rule.

AOPA Meets with Deputy Administrator of CMS Regarding the Proposed LCD for Lower Limb Prosthetics:

On Tuesday afternoon, August 11, AOPA had a meeting with the Deputy Director of CMS, Sean Cavanaugh, to discuss the DME MACs LCD Lower Extremity Prosthetics Policy Article published July 16, 2015.  The AOPA delegation included: Charlie Dankmeyer, CPO, Dr. Paul Pasquina (AOPA Prosthetics 2020 Medical Advisory Board Member), Sam Liang (Hanger Clinics), Brad Ruhl (Ottobock), Michael Park (Alston & Bird), Peter Thomas (Powers Pyles), and AOPA Executive Director Thomas Fise.

This meeting was to the best of our knowledge the first opportunity for anyone from the O&P community to alert and present our serious concerns about the LCD to the top leadership at CMS.

We started by asserting our patient-centric objective and outlined the fact that this errant policy could potentially impact ALL 2 million amputees in America (as private payers follow Medicare’s lead) and their roughly 10 million services per year, reverting amputees to the standard of care and limb technology of the 1970s.  We informed Mr. Cavanaugh that if enacted this policy would dramatically and adversely impact patient standards of care.

We challenged the dearth of scientific support for the policy, and provided an overview of the prevailing CMS/DME MAC perception driven by the 2011 OIG report that showed substantial increases in dollars expended for prosthetics from 2005-10.  During this same period we experienced a quantum leap into the advanced technologies spawned by Iraq/Afghanistan.  CMS interpreted the OIG report as suggestive of fraudulent activity which in turn triggered the massive audits.  Starting with 2010-13 the converse picture is clear from Medicare data—incremental DECREASES in total Medicare payment for prosthetics every year, and an even steeper downward slope each year in payments for K3 technologies, accompanied by a steady increase in payments for K1 and K2 technologies.

We explained to Mr. Cavanaugh that the behavior of CMS officials and their contractors tells us that they are still living the 2005-10 data and seem to be behind in recognizing that the entire trend line from Medicare’s own data shows a 180 degree reversal of direction.  We concluded by reiterating the O&P Alliance request for rescission of this policy and we pledged to work in earnest with CMS, the DME MACs and other stakeholders around a new direction, starting with a proposed demonstration project through the CMS Center for Innovation that would update coding, that would be evidence-based, benefit patients and be value-based– all of the things that this proposal is not. Dr. Pasquina completed the session with a comprehensive overview of improvements in patient care over the past 10-15 years, and a plea not to allow this progress to be further reversed by a misguided new policy.

Mr. Cavanaugh appeared to understand the points we made.  He recommended we also meet with the CMS Office of Clinical Standards and Quality, a suggestion we had expected and plan to pursue as this group also has a key role on these issues.  He offered that we should feel free to come back to him as needed.  It was a good start to a dialogue that must continue toward putting aside this proposed LCD revision and moving forward with a sounder approach to any updating of the LCD on lower extremity prosthetics.

What does the LCD proposal mean for patients?  If you go to the www.mobilitysaves.org home page, you’ll find two things.  There is a list of amputee talking points that highlight the real world terrible impact this proposal, if enacted, would have in denying Medicare amputee beneficiaries access to the higher quality prosthetic devices and care.  Secondly, you’ll be able to link to the remarkable letter authored by former U.S. Senator Bob Kerrey.  Can just one letter make a difference?

Yes, it certainly can.  Recently, former U.S. Senator, and former Nebraska Governor Bob Kerrey, and a lower limb amputee, contacted NAAOP to say he had heard about the DME MAC LCD proposal, and how it would limit availability of advanced technology prosthetics to Medicare amputee beneficiaries.  Read the letter he wrote to HHS Secretary Burwell to explain just how detrimental implementation would be for himself and other amputees!  And then send a letter yourself and assure that your voice will be heard.

C. What Will Happen in the Next Week?

AOPA has a full-fledged PR effort underway which will start with a press release to all health media within the next couple of days, and culminating with the Teleconference Press Conference to be held next Tuesday, August 25, the day before two big events—the DME MAC open meeting in Linthicum, Maryland in the morning on August 26, and the Amputee Demonstration which AOPA is sponsoring in front of the HHS/Medicare headquarters at 200 Independence Avenue, SW from  2- 5 pm on the afternoon of 8/26.

1. Starting this weekend, AOPA will begin an advertising campaign around the LCD issue to appear primarily in the Washington DC area. There will be print advertising over the next 3 weeks, and TV broadcast advertising, starting with two messages that will appear in the Washington DC market on ABC’s Sunday morning News programs, “This Week with George Stephanopoulus,” on August 23, and continuing with morning programs all week on CNN, Fox News, CSNBC and other media outlets.
2. As noted above, Wednesday, August 26 will be a big day. A large group of people will appear at the DME MAC open meeting in Linthicum—AOPA President Charlie Dankmeyer, Past President Tom Watson, Executive Director Tom Fise and Boston Marathon Survivor Adrianne Haslet-Davis are among the many who have requested the opportunity to speak at that open forum.  In the afternoon, we expect well over 100 amputees to converge at the HHS/Medicare headquarters building at the base of Capitol Hill.  All amputees are welcome—we plan to carry signs, speak with press, and some legislators who are national champions for amputee patients have been invited to stop by to pass on some words of encouragement!
3. August 31 is the official deadline to submit your comments. You can go to AOPAvotes.org to send a standard letter which will only take a minute or two, and/or you can write your own letter.