On 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: AOPA President 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.
You can take action on the LCD Draft Policy in these ways:
1. Send a prewritten letter to the DME MACs and your representatives in Congress through www.AOPAvotes.org.
2. Send your customized comments to DMAC_Draft_LCD_Comments@anthem.com and make sure to reference “LCD Draft: Lower Limb Policy” in the subject line.
3. Sign the “We the People” petition.
4. Involve your patients by hanging this flyer in your reception area.