An Open Letter To The Orthotic and Prosthetic Field On Sexual Misconduct, Harassment, and Discrimination In The Workplace

The undersigned organizations stand united in condemning sexual misconduct, harassment, and discrimination in all forms. Sexual misconduct includes abuse and assault. These behaviors are illegal and have no place in the orthotic and prosthetic (O&P) community.

Please consider this letter our clear message to the entire field that we support a zero tolerance policy for sexual misconduct, harassment, and discrimination based on sex (including sexual orientation and gender identity), race, color, national origin, religion, age, and disability, as well as retaliation for the reporting of such conduct.

Sexual misconduct, harassment, and discrimination of any kind can be reported to one’s employer or supervisor, law enforcement authorities, state employment discrimination authorities, state O&P licensure boards, and/or the Equal Employment Opportunity Commission (EEOC). ABC, BOC and NCOPE all have processes in place to address ethical violations by certified individuals, accredited facilities or residents. Certified/licensed professionals witnessing such behavior also have an obligation to report it to the appropriate credentialing organization.

Those affected by sexual misconduct, harassment, and discrimination should know that all reports of such conduct will be taken seriously, investigated, and addressed in alignment with the processes of each of the undersigned organizations. All parties will be treated with dignity and respect and afforded due process.  There are numerous public and private agencies that serve as confidential resources to offer support and answer questions.

Each of the undersigned organizations has resolved to review and, if necessary, refine its policies on sexual misconduct, harassment, and discrimination in the workplace. We resolve to enhance education, training, and compliance with such policies, and impose appropriate sanctions and disciplinary action where allegations have been substantiated, within the scope of each organization’s authority.

We encourage every O&P clinic, business, or academic or research program to take similar steps to proactively address these important issues with respect to compliance plans, policy manuals, and where otherwise appropriate.

 

American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC)

Board of Certification/Accreditation (BOC)

National Association for the Advancement of Orthotics and Prosthetics (NAAOP)

American Orthotic & Prosthetic Association (AOPA)

American Academy of Orthotists and Prosthetists (AAOP)

National Commission on Orthotic and Prosthetic Education (NCOPE)

Harassment Advocacy Work Group

 

Download an offline PDF copy of the open letter

  • Written by Web Updates

Rebecca J. Hast on Workplace Discrimination

Respect and empathy in the work place have always been important, but the value of raising awareness about the impact of discriminatory practices and sexual harassment in today’s world is imperative if we want to attract and retain a talented, diverse and productive workforce. The work that began at the Ossur Women’s Leadership Conference last summer and the follow up from the O&P Alliance are an exciting beginning. At NAAOP, we are committed to helping our members and our industry understand the impact of these issues and identify pathways for improvement.

Rebecca J. Hast
Incoming NAAOP President

  • Written by NAAOP

David McGill on Workplace Discrimination

NAAOP believes the Alliance’s statement about preventing sexual harassment and other forms of discrimination in the workplace is an important first step in raising awareness about this issue. NAAOP was fortunate enough to have several members of our organization attend an Ossur Women’s Leadership Initiative (OWLI) event where multiple individuals bravely shared their stories. We were honored to participate in that meeting and thank the rest of the O&P Alliance for its rapid response once we brought these facts to the group’s attention. By raising awareness about this serious issue, we can hopefully help prevent both O&P professionals and their patients from having to experience sexual harassment and other forms of discrimination in the future.

David McGill
NAAOP President

  • Written by NAAOP

NAAOP Announces 2019 Fellowship on Public Policy and Advocacy

NAAOP Announces 2019 Fellowship on Public Policy and Advocacy

ATTENTION ALL O&P CONSUMERS:  The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is soliciting applications for its annual health policy/advocacy fellowship. NAAOP is a national nonprofit association advocating for consumers/patients requiring orthotic and prosthetic care, as well as the providers who serve them.  The NAAOP Fellowship is a paid, 10-week summer program based in Washington, D.C.  The fellow will learn about orthotic and prosthetic (O&P) policy, advocacy, and how NAAOP and other O&P organizations function on behalf of the O&P community and within the broader rehabilitation and disability policy and advocacy environment at the federal and state level.  The fellowship also includes exposure to O&P clinical and business settings, and state-based public policy and advocacy, at no cost to the fellow.

Two fellows will be selected for the summer of 2019 through a competitive process using the application on the www.naaop.org website.  The deadline to electronically submit this application is January 31, 2019 by 12:00 Midnight, Eastern Time.  Finalists will be interviewed via videoconference and two will be selected, assuming high quality candidates are identified.  If the finalists selected cannot accept the fellowship for any reason, the next highest ranked fellow will be offered the position.

Selection CriteriaAll applicants must:

  • Personally use a custom fabricated orthosis or prosthesis;
  • Have an interest in public/health policy and advocacy;
  • Demonstrate an interest in advancing O&P care;
  • Have excellent writing, speaking, and analytical skills (see application for additional factors).

NAAOP fellows each receive a stipend of $500 per week for a ten-week period, although the fellow will have paid time-off during Independence Day week.  NAAOP will provide the fellows with an office, phone, and computer in its offices at NAAOP’s counsel, the Powers Law Firm, 1501 M Street, NW, Suite 700, Washington, DC 20005.  NAAOP will assist the fellows in exploring inexpensive summer housing options with area colleges for those with no other housing options.  The NAAOP fellows will be responsible for their own housing costs but NAAOP housing subsidies may be available if necessary.

The NAAOP fellows will shadow NAAOP’s General Counsel, Peter W. Thomas, who will assign and oversee the fellows’ health policy and advocacy work.  That work will focus on O&P policy but also include exposure to the broader rehabilitation and disability policy environment.  Other O&P organizations will host the fellows for a day of activities.  The fellows will also be exposed to policy and advocacy speakers, attendance at Congressional hearings, participation in coalition and “think tank” meetings/presentations throughout Washington, and meetings with organizations in the broader rehabilitation and disability field.

Application Deadline:  12:00 Midnight, Eastern Time, Thursday, January 31, 2019

Fellowship Selection Announcement:  March 6, 2019

Fellowship Term:  10-weeks (May 27th to August 2, 2019).

Download 2019 Fellowship Application

  • Written by NAAOP

Update on VA Choice of Practitioner

On October 17, 2018, the Prosthetic and Sensory Aids Service (“PSAS”) briefed the Federal Advisory Committee on Prosthetics and Special Disabilities on the status of the proposed rule, 82 Fed. Reg. 48,018 (the “Proposed Rule”), which would grant the Department of Veterans Affairs (“VA”) the sole authority to determine whether a VA orthotist/prosthetist or a private, VA-contracted orthotist/prosthetist will furnish orthotic and prosthetic (“O&P”) care to an eligible veteran.  In December 2017, the VA received over 300 comments from the public, including from NAAOP and the O&P Alliance, on the Proposed Rule.  The Proposed Rule largely remained dormant since the closing of the public comment period, and it was unclear whether the VA intended to finalize the Proposed Rule in its current form, modify its proposals, or rescind the Proposed Rule all together.

Approximately one year after the publication of the Proposed Rule, the PSAS revealed in its briefing that the VA is proceeding with rulemaking and carefully considering the public comments.  The PSAS suggested that the VA could take up to a year (or perhaps even longer) to finalize the rule, although it remains unclear what form the final rule will take and whether the VA will address our concerns on veteran choice of practitioner.  One potential reason for this extended timeframe is that the VA is simultaneously in the process of promulgating regulations under the recently-enacted MISSION Act, which allows veterans to gain access to non-VA, community providers for primary care and related services.  Once the Proposed Rule on prosthetics is finalized, the PSAS indicated that it would update existing handbooks and policies to ensure consistency with the final rule.

NAAOP will continue to monitor the status of the Proposed Rule and advocate against eliminating veterans’ long-standing right to select the orthotist and prosthetist who best serves their specific needs, whether the orthotist or prosthetist is a VA employee or has a VA contract.

In addition to the discussion on the Proposed Rule, the PSAS clarified that the threshold reimbursement amount for “prosthetics” under the VA is being raised from $3,500 to $10,000 per claim.  This means that prosthetics (which is a term that is defined broadly under the VA program) with reimbursement levels up to $10,000 may be purchased directly by VA prosthetic staff from non-VA providers, without going through the formal VA procurement process, which typically is a longer and more complex process.  This will likely have a positive impact on many orthoses purchased by the VA from private orthotists with VA contracts.  It will likely have less of an impact on limb prostheses as these are typically greater than $10,000 in reimbursement level.

Lastly, the PSAS confirmed that “urgent” or “emergent” prosthetic items (e.g., splints, crutches, slings, or soft collars) are being covered under the MISSION Act’s Patient Centered Community Care contracts, while non-urgent and non-emergent items (i.e., the vast majority of custom orthotics and prosthetics) will continue to be provided by PSAS under the existing reimbursement system.  NAAOP will continue to keep you informed as developments occur.

  • Written by NAAOP

NAAOP Fellowship and Pre-Midterm Election Update

NAAOP Fellowship Program:  The NAAOP board of directions recently met in Vancouver to discuss this past summer’s pilot test of the NAAOP Fellowship program.  Nicole Ver Kuilen proved to be an exceptional Inaugural Fellow—see the September issue of O&P Edge to read about her Washington education.  The board unanimously agreed to continue the fellowship program in 2019 and, if fundraising is successful, expand to two NAAOP fellows next summer.  Stay tuned for more formal announcements in the future and please keep your patients in mind for recommendations to this program.  O&P consumers are the most compelling advocates.

Pre-Midterm Election Update:  The House is already in recess and the Senate is not far behind.  Both parties recognize the importance of the coming midterm elections and how the outcome will drive the agenda for the next two years.  Before adjourning, the House and Senate were able to agree on a number of major appropriations bills that will fund the federal government through the end of fiscal year 2019 which ends on September 30th, a year from now.  They also agreed to a continuing resolution to fund several federal agencies temporarily, through December 7th, where Congress will have to revisit longer term spending levels.  The Department of Health and Human Services received a full year budget including:

  • National Center for Medical Rehabilitation Research (NCMRR): The NIH received another $2 billion increase in funding, bringing the overall budget to $39 billion.  This was the third $2 billion increase in three years.  These increased funds trickle down to the NCMRR, which recently announced the funding of a $5 million grant over five years for a prosthetics registry.  This is an exciting development that will require substantial participation and investment by the O&P community and should yield, over time, excellent data on which to base coverage policies, outcomes research, and treatment recommendations.  NCMRR was established in 1990 and NAAOP played a major role in its creation, our first legislative achievement!

It is difficult to forecast whether the “lame-duck” session of Congress after the election will be productive based on the uncertainty of which party will control the House and Senate.  Political pollsters believe the House is more likely to turn than the Senate.  If this occurs, Congress will likely push most of its remaining business off until the new Congress is seated in January.  If the House and Senate remain in Republican hands, there is a real chance for passage of several bills, including a number of bills that impact the health care area.  This may provide a legislative vehicle to attach legislation to clarify Congressional intent by redefining off-the-shelf orthotics.  This redefinition would reinstate the true meaning of the words “minimal self-adjustment” and require CMS to pare back the broad list of orthotic HCPCS codes that may be exposed to competitive bidding in the future.

  • Written by NAAOP

The Value of a Washington DC Education

By Nicole Ver Kuilen

The following is a firsthand account of lessons learned from the ten-week fellowship I experienced this summer as the Inaugural Fellow of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP).

One year ago this month, I set out on a mission to raise awareness on behalf of millions of amputees like me living in the United States. I quit my job, recruited my family, and decided to take on a 1,500-mile triathlon down the west coast. Inspired by the Tom Hanks film, I called my journey “Forrest Stump.” It was by far the most challenging athletic endeavor I had ever attempted. I was determined to make it across the finish line, but I wondered whether I had a prosthesis that could survive the journey. What began as an effort to raise awareness for amputees has become much larger than I ever anticipated.

My story as an amputee began at age ten when I lost my leg to osteosarcoma. Since then, I’ve pushed myself physically to earn the right to be called an athlete. Yet, I’ve continuously come up against the same obstacle—having a prosthesis designed for walking when all I really want to do is run. The reality is that it is the only prosthesis my insurance covers. I find myself caught in a paradox where technology exists that could erase my disability almost entirely, yet few have access to it. That became the mission driving my advocacy efforts: To expand access to the most appropriate prosthetic technology for all amputees.

ALL ROADS LEAD TO OUR NATION’S CAPITAL

I knew I had a lot to learn about healthcare policy if I was going to make any headway. So, the next stop on my journey seemed like an obvious decision. The best place to immerse myself in policy and to create nationwide change is in Washington. As luck would have it, NAAOP was seeking an individual for their inaugural O&P health policy and advocacy fellowship this summer.

NAAOP believes that “an educated advocate is the most effective advocate,” and through this ten-week fellowship program they guided me in developing a proactive message to take to Capitol Hill. The fellowship provided me the opportunity to learn from the experts, namely Peter W. Thomas, JD, NAAOP’s general counsel, who is a disability lawyer and bilateral amputee; David McGill, JD, NAAOP president, who is an amputee and senior executive with Össur; and George Breece, the founding executive director of NAAOP. Throughout the summer I traveled from Washington for meetings at various clinics and professional organizations around the country to learn what each is doing to advance the field of O&P for amputees like me.

THE GATEKEEPERS OF THE FIELD

Once I arrived, I started to lay the foundation for my Washington education, beginning with a visit with the O&P Alliance. The O&P Alliance is made up of the leading national organizations representing the O&P profession. This includes the American Academy of Orthotists and Prosthetists (the Academy), the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC), the American Orthotic & Prosthetic Association (AOPA), the Board of Certification/Accreditation (BOC), and NAAOP.

Each organization generously hosted me at its office and briefed me on its mission. The organizations’ missions span the scientific, research, professional, business, and quality improvement aspects of the O&P field. As a coalition, they collaborate on important federal and state policy measures. In a sense, they are the gatekeepers of the field.

To succeed in the mission of expanding access to prosthetic technology, it is going to take a collaborative effort by organizations like those belonging to the O&P Alliance to solve the multifactorial issues surrounding lack of access to appropriate care. As a starting point, I have identified four primary barriers the O&P profession must address to improve access to care.

HIERARCHY IN PROSTHETIC COVERAGE

Simply stated, amputees’ access to certain prosthetic technologies, and thus their mobility, quality of life, and functional/athletic potential is determined by their insurance coverage. In my experience, amputees who have the lowest level of coverage are those covered under most commercial insurance plans. These plans typically offer limited coverage for prosthetic care. The second level of coverage is provided by the Centers for Medicare & Medicaid Services (CMS) followed closely by the Veterans Health Administration (VHA). Amputees whose prosthetic care is covered through workers’ compensation, automotive insurance, or other litigation circumstances including injured active-duty military personnel in the Department of Defense (DOD) are often covered at the highest level, meaning their plan or program affords them access to the most advanced prosthetic technologies. However, how you lost your limb should not determine the level of care you receive.

While shadowing Thomas over the past few months, I’ve had the opportunity to meet with CMS, VHA, DOD, and United Healthcare (UHC). As the NAAOP fellow, attending these high-level meetings gave me an exclusive look at our fragmented healthcare system, but it also gave me hope that we can find innovative ways to address our nation’s complex web of coverage, whether through internal pilot programs, federal or state legislation, or healthcare regulation.

For example, the Extremity Trauma and Amputation Center of Excellence (EACE) was formed through legislation to enhance collaboration between the Department of Veterans Affairs (VA) and DOD, which operate separately but have an overlapping amputee population. Additionally, UHC is a large national insurer that covers millions of people with disabilities, including users of O&P care. I had the opportunity to meet with leaders from these entities who are working to expand access to care.

NONPROFIT SECTOR INCREASINGLY FILLS THE INSURANCE GAP

With decreasing coverage and rising costs of healthcare, thousands of amputees are looking to a growing number of nonprofits and philanthropic resources to cover the expense of prosthetic care. Although this does meet a need in the short-term, it is not a sustainable or equitable distribution of resources. To understand why this is happening and what we can do to solve it, we must ask ourselves: Why are we, as a society, choosing to provide uncompensated charity care?, and What are we losing by providing healthcare in this manner?

To answer the first question, I believe it comes back to an equation I learned shadowing Jan Stokosa, CP, board member and past president of NAAOP, at his prosthetic clinic in Lansing, Michigan, as part of my fellowship. The equation is:

Redefining what is possible is what inspires O&P clinicians to provide better care, and it inspires engineers to design technologies and components that better replicate human movement. When parts of this equation are not being fulfilled—such as by a lack of available technology or a prosthetist’s inability to innovate because of increasing administrative burdens—the outcome is limited. That’s why philanthropies have decided to step up in the care of amputee rehabilitations: They want to be part of what is possible.

But, we are also losing critical data and information by providing healthcare in this manner. Millions of dollars in uncompensated care, and potentially improved health outcomes, are not being reported to healthcare payer data systems, comprising important sources of information for future coverage gains. If we cannot prove that prosthetic intervention increases mobility outcomes, then we will not be able to make the case for its coverage.

Two organizations that hosted me this summer are tackling this challenge. AOPA, in partnership with the Amputee Coalition, has commissioned a number of studies by highly respected health economists and researchers, including Dobson DaVanzo and the RAND Corporation, to show O&P intervention saves the U.S. healthcare system money in the long term, providing value not only to the patient, but the payer as well. To showcase the initial Dobson Davanzo study and promote further research, the organizations created the Mobility Saves initiative (www.mobilitysaves.org).

Additionally, Hanger Inc., Austin, Texas, specifically James Campbell, PhD, CO, FAAOP, chief clinical officer, is leading a comprehensive program to capture medical outcomes of patients who use lower-limb prostheses across Hanger’s 800 clinics. Using the independent, scientifically validated PLUS-M instrument and Hanger’s Mobility Empowerment Score Card, Campbell and his research partners have already collected thousands of individuals’ outcomes data and are helping patients assess their own improvements in mobility. The research team has conducted a landmark study known as the Mobility Analysis of Amputees (MAAT I). The largest of its kind, the study measured the correlation of mobility to quality of life and patient satisfaction for people living with lower-limb loss. The findings demonstrated a significant direct correlation.

In the short-term, philanthropy is critical to filling the access gap quickly and showing what is possible for amputees; however, moving forward, we must ramp up our efforts to demonstrate that O&P care increases mobility outcomes and provides value to healthcare payers. To help, nonprofits must take a lead role in communicating their efforts to Congress and having a seat at the advocacy table.

AMPUTEES IN THE MEDIA VERSUS REALITY

There is a widening gap between perception and reality when it comes to amputees’ access to prosthetic technology and care. The stories told in the media focus on a fraction of the over 2 million amputee population in America, highlighting active-duty veterans and Paralympic athletes who typically have greater overall access to prosthetic technology. What the public and amputee community does not understand is that for nearly two decades insurance companies have been restricting coverage of prosthetic devices, diverting spending away from mobility-enhancing prosthetic technology toward less advanced, less costly prosthetic components available decades ago. This information gap has created a false perception that only certain amputees can benefit from advanced technology, and many amputees still don’t realize they need to advocate for a higher standard of care.

While speaking with Carrie Davis, director of patient experience at Hanger Clinic, she stressed the importance of advocating for the “everyday normal.” We need to share more stories of amputees who just want to play with their grandkids, or learn how to cook again, or run with their local running club. An amputee should not have to go to extreme lengths, or fit into the top 1 percent, to be able to access the technology that is designed for a wide range of amputees to help them get back into the community.

For more of these everyday normal stories to be told, we need an army of advocates who recognize the gap in access and are willing to share their stories, at the right time, in the right way, and with the right people. In addition to NAAOP, AOPA, and others, the Amputee Coalition is helping to build this army through a grassroots and lead-advocate program, designed with varying levels of commitment to get involved. For example, amputees can text “ACadvocacy” to 201-21 to send a pre-written letter to their state and federal members of Congress.

Moving forward, it will be absolutely critical for amputees to take charge of their own narrative if we want to close this access gap. When the time comes for this community to speak out in masses to upend this divide, it will be critical that we are informed, educated advocates who can take the right message to the halls of power.

PROSTHETISTS AND ORTHOTISTS AS PROFESSIONALS PROVIDING CLINICAL CARE

As a relatively small segment of healthcare, the O&P profession’s survival is dependent upon its ability to compete for representation in the larger healthcare arena. However, currently, the profession is battling severe misrepresentation, where prosthetists and orthotists are viewed more as suppliers of devices, rather than being recognized as providers of comprehensive clinical services, which happen to include the modality of providing a prosthesis or orthosis to enable function. In order to advance the O&P profession into the 21st century healthcare environment, this needs to change, not only at the policy level, but in the minds of fellow professionals on the rehabilitation team at the local level.

Fortunately, the gatekeepers of the profession, the O&P Alliance members, realize how these policies are perpetuating a misinformed understanding of prosthetists’ and orthotists’ roles in the treatment and care of amputees. Throughout the years, they have also identified a number of O&P champions in Congress and cultivated strong bipartisan support. As a result of these efforts, a bill has been introduced to specifically target the outdated policies, the Medicare O&P Improvement Act of 2017 (H.R. 2499 / S. 1191). The bill would separate O&P from durable medical equipment (DME), restore Congress’ original intent in defining off-the-shelf orthotics for purposes of competitive bidding, and ensure only qualified O&P practitioners can be reimbursed by the Medicare program. One major provision from the bill has already been enacted into law: the provision that recognizes the clinical notes of the prosthetist and orthotist as part of the Medicare patient’s medical record for purposes of determining medical necessity.

As a fellow this summer, I had the privilege of meeting two core proponents of the bill including Senator Tammy Duckworth (D-IL), co-sponsor of S. 1191, and Rep. Glenn Thompson (R-PA-5), sponsor of H.R. 2499.

As the bill’s provisions are enacted, they will set a critical foundation for all future O&P policy efforts and help ensure O&P practitioners are being recognized and rewarded for their education, expertise, skill sets, and scope of practice. However, there is still much to be done at the local level.

THANK YOU FOR THE FELLOWSHIP OF A LIFETIME

As I wrap up my fellowship, I wholeheartedly agree that “an educated advocate is the most effective advocate.” Although I shared many of my summer experiences in this reflection, I could not possibly have included them all. From my 20 Hill visits with the VGM Group, to meeting Minority Leader Nancy Pelosi (D-CA) and Senator Bob Casey (D-PA), to visiting the Children’s Healthcare of Atlanta O&P facility, the list goes on with once-in-a-lifetime experiences. This fellowship program with NAAOP is unique and an incredible way to learn health policy and advocacy from the brightest minds and immerse oneself in Washington life and culture.

I would like to thank NAAOP, all of the hosting organizations, and the donors who made this experience possible. They’ve added another highly engaged and well-trained advocate to the O&P field, and I’m ready to help as a soldier in the consumer movement, a policy advocate, and as a future leader.

Moving forward, I would like to challenge amputees everywhere to get more involved and to aspire to participate in this fellowship opportunity. We need more amputee advocates who can bring our collective voices into the rooms where decisions are made in our nation’s capital. The army has begun to form.

Nicole Ver Kuilen is forming Forrest Stump as a nonprofit advocacy organization with the mission to raise awareness and expand access to the most appropriate prosthetic technology for all amputees. She will be undergoing paratriathlon training at the Olympic Training Center and this fall will attempt to summit Cotopaxi in Ecuador with the Range of Motion Project in honor of the 28th Anniversary of the Americans with Disabilities Act. You can follow her journey at www.forreststump.org.

  • Written by NAAOP

VA Issues Report on Access to New Prosthetic Technologies

On August 27, 2018, the Department of Veterans Affairs, Office of Inspector General, issues a report #16-01913-223, entitled, “Use of Not Otherwise Classified Codes for Prosthetic Limb Components.”  The findings and recommendations in the report are disturbing and, unfortunately, reflect a lack of understanding of coding and pricing of new prosthetic technologies.  The report was triggered by two anonymous employees who challenged the process for assigning reimbursement levels for new technologies under the prosthetic benefit.

The report concludes that the VA overpaid “contract” prosthetists by $7.7 million between 2014 and 2017 because the VA permitted these prosthetists to use “not otherwise classified” or “NOC” HCPCS codes when submitting invoices for new prosthetic technologies to the VA for reimbursement.  The report alleges that this allowed the VA, particularly specific individuals within the VA, to overpay contract prosthetists for prosthetic technologies that the Centers for Medicare and Medicaid Services reimburses at much lower levels.  The report also asserts a lack of sufficient processes, internals approvals, and appropriate oversight for the assignment of these codes and reimbursement values.

The report is seriously flawed in that veterans in need of these new technologies would not have been able to access these innovative components if the VA reimbursed at levels established under existing HCPCS codes.  Veterans simply would not have had access to these new technologies.  Prosthetists would not have provided them to veterans because prosthetists would have taken significant losses in the course of doing so.  The new technologies at issue would have been downgraded to more established, HCPCS-coded components instead.  It is disingenuous for the VA to routinely tout to Congress and the public how it is at the cutting edge of providing advanced prosthetic technology to veterans and then refuse to compensate prosthetists appropriately to design, fit, and fabricate those technologies into a functional limb.

NAAOP will continue discussing this disturbing report with its O&P Alliance partners and will respond to the VA and the House and Senate VA Committees in the near future.  We hope to work with the VA to ensure continued access to new prosthetic and orthotic technologies in the future, despite this most recent VA report.

  • Written by NAAOP

NAAOP Fellowship Farewell and VA Update

NAAOP Says Goodbye to Inaugural Fellow

August 7th was Nicole Ver Kuilen’s last day as NAAOP’s inaugural summer fellow, and we could not have asked for a better experience for the launch of our fellowship program. Over the past 10 weeks, Nicole shadowed Peter Thomas, NAAOP General Counsel, throughout Washington, traveled around the country meeting with various O&P clinics and professional organizations, and was immersed in state government activities. From her 20 Hill visits with the VGM Group on Capitol Hill, to meeting Democratic Minority Leader Nancy Pelosi and Senator Tammy Duckworth (D-IL), bilateral amputee and cosponsor of the Medicare O&P Improvements Act of 2017 (S.1191), Nicole says her highlight reel is full of once-in-a-lifetime experiences. NAAOP would like to thank the organizations that hosted Nicole – Stokosa Prosthetic Clinic, Children’s Healthcare of Atlanta, Hanger, Inc., Orthotic Prosthetic Group of America, and the Amputee Coalition – for the opportunity to expand her learning across the country. We would also like to thank each organization in the O&P Alliance for hosting Nicole, and to our generous NAAOP donors who helped fulfill our vision for this fellowship. In Nicole’s words:

“I would like to thank NAAOP, all of the hosting organizations, and the incredible donors who made this experience possible. They’ve added another highly engaged and well trained advocate to the O&P field, and I’m ready to help as a soldier in the consumer movement, a policy advocate, and as a future leader.”

Nicole has written a first-hand account of the lessons learned as the inaugural fellow, which will be published in the O&P Edge’s September issue. You can also find a photo gallery highlighting Nicole’s experience at http://naaop.org/gallery/2018-fellowship-photo-gallery/

The NAAOP Board Fellowship Committee will meet in Vancouver to discuss the success of the program and look for ways to improve upon and expand on this initial pilot. We look forward to sharing our vision with you for the year to come.

House VA Health Subcommittee Holds “Roundtable” Discussion

Peter Thomas and Nicole Ver Kuilen participated in a Roundtable held by the Veterans’ Affairs Subcommittee on Health to discuss the VA’s proposed rule, which limits amputee veterans’ ability to choose their O&P practitioner. Both Chairman Neal Dunn, M.D., (R-FL) and Ranking Member Julia Brownley (D-CA) expressed concern that the proposed rule would upend the long-standing practice of veteran choice and reduce access to care by substantially redefining medical necessity. The Veteran Service Organizations (VSOs) in attendance agreed with these remarks and were aligned with the position of NAAOP to preserve veteran choice and ensure access to quality care. The VA responded that they valued the partnerships in the room and were willing to alter the language in the final rule.  Peter Thomas also discussed the Injured and Amputee Veterans Bill of Rights (H.R.2322), which received a hearing by the VA Subcommittee on Health earlier this spring. We hope to move forward as expeditiously as possible on that bill and we keep you informed as developments occur.

  • Written by NAAOP

Special Alert: Major Developments in O&P Policy

Over the past two weeks, a number of major, long-awaited developments in O&P policy have occurred. NAAOP and its Alliance partners have been diligently working on these measures over the past few years and we are excited to share an update on the progress that has been made.

  • Issuance of CMS Interagency Workgroup’s Consensus Document: After publishing a DME MACs Draft Local Coverage Determination (LCD) for Lower Limb Prostheses in 2015 that caused enormous public comment and concern, CMS placed that document on hold and formed an Interagency Workgroup in February 2016 to further explore the issues. Last week, CMS published the results of the Workgroup’s efforts. The Workgroup has recommended CMS to take the following immediate actions:
  • Instruct the DME MACs to remove the 2015 Draft LCD and continue coverage for lower limb prostheses under the current LCD, with no changes.
  • Support the establishment of an interagency federal research group in order to create a guidance document to promote industry research standards in the field of lower limb prostheses.
  • Consider creating a National Coverage Determination (NCD) to evaluate the use of microprocessor knees (MPK) for individuals using their prostheses as a limited community ambulator (K2 functional level).

The removal of the draft LCD is a major victory for the O&P community. However, there are still significant areas of concern in the Consensus Document that could be improved. These include:

  • The recommendation that CMS move toward pre-authorization of lower limb prostheses, a process led by the DME MACs.
  • The characterization of prosthetists as “consultants” to the physician for purposes of determining functional level.
  • The conclusion that current literature does not support improved functional health outcomes of power assist ankles and vacuum systems. Nonetheless, these devices may be covered if justified in the pre-authorization request.

Note: On June 21st, the DME MACs announced the retirement of the Draft LCD on Lower Limb Prostheses. This Draft LCD is finally dead.

  • Release of the MEDPAC Report on Orthotics: The Medicare Payment Advisory Commission (MEDPAC) report, filed with Congress last week, includes a substantial section on orthotics and recommends implementation of competitive bidding for off the shelf (OTS) orthotics. However, the report largely focused on abuses of this benefit by non-orthotist providers and even suggested that orthotists, like physicians, should be able to provide OTS orthotics without having a Medicare competitive bidding contract. Importantly, the report did not recommend expansion of competitive bidding to all orthotics and prosthetics, a policy that had been considered prior to NAAOP and its Alliance partners meeting with MEDPAC staff.
  • VA Report by OIG: Over the next few weeks, we expect to see a report from the Office of Inspector General (OIG) of the Department of Veterans Affairs (VA) that may impact coding and coverage of orthotics and prosthetics. We will share this with you when we learn more.
  • Written by NAAOP