On Monday June 10, 2019, the NAAOP Fellows spent the day at BOC headquarters in
Owings Mills, Maryland. We were warmly welcomed by BOC’s President and CEO, Claudia
Zacharias, as well as the entire BOC staff. We spent time learning about the roles each staff
member plays within the organization and were able to see the team mentality they all embrace.
We learned about their history as an accreditation organization, the makeup of their board of
directors to include practitioners from all certification categories, and their proud recognition of
the awards they have received in recent years, including nine Stevie Awards. John Schulte, CPO,
joined us and took us through the process he follows as a Facility Accreditation Surveyor and
what the BOC looks for in a facility. Everyone really showed to us the work they perform in
trying to help the O&P community work together to achieve a unified goal. We were inspired by
their commitment to quality and are thankful for all the work BOC put into planning and
executing a great day for the NAAOP Fellows!
NAAOP’s 2019 Fellows began their summer experience on May 28th with a week of orientation and education on O&P policy and advocacy. In addition to Washington-based advocacy, the Fellows will be traveling in June to learn about clinical prosthetics, orthotics, and policy and advocacy at the state level. They will be hosted for a day by each O&P Alliance organization and will attend the annual conference held by the Amputee Coalition in July. They will also learn about the future of O&P data collection, electronic medical records, and the Limb Loss and Preservation Registry. When in Washington, the Fellows will be focused on their main projects, which have been tailored to take advantage of each Fellow’s strengths and interests.
Susannah Engdahl recently completed her PhD in Biomedical Engineering at the University of Michigan. Having grown up using myoelectric prostheses due to congenital absence of both hands, she has a strong interest in applying science to improve functional outcomes for individuals who use prostheses. Her main project this summer will be to compile a set of evidence-based statements from the literature regarding the effectiveness of prostheses and orthoses, which the NAAOP can draw from in future advocacy work. Susannah says, “I am very excited to be working with the NAAOP this summer and to learn how I can become a more effective advocate for O&P care. Thank you to everyone who has worked to make this experience possible for me. I truly appreciate your efforts and am looking forward to the coming weeks!”
Alicia Carver is a born advocate who is passionate about advancing care that benefits O&P consumers. After congenital ankle deformity caused her to utilize orthoses during her childhood, she is now a user of limb prostheses. She brings a consumer perspective to Washington, and knows some of the challenges of accessing orthotic and prosthetic care in rural areas of the country. She has experience in state-based advocacy as a Lead Advocate for the Amputee Coalition representing the state of Indiana where she calls home. Alicia is a graduate of Ohio University with a bachelor’s degree in Technical and Applied Studies. Alicia’s main project will be to visit every Member of the key House and Senate Health Committees to promote the Medicare O&P Patient Centered Care Act. When asked what she hopes to learn during the ten-week fellowship with the NAAOP, Alicia said “I am excited to be focusing on becoming a stronger advocate as I focus on advancing the bill. I want to be a sponge and soak in this wonderful experience and gain valuable tools that I can use to be a stronger advocate on behalf of the O&P community.” She also expresses her gratitude to everyone that has worked together to organize the fellowship and the sponsors that collectively make this fellowship possible.
THANK YOU to all those who have contributed time, talent and treasure to the 2019 NAAOP Fellowship. We greatly appreciate your support.
We just returned from a trip to Michigan, where we had the opportunity to shadow Jan Stokosa, CP, at the Stokosa Prosthetic Clinic and meet some members of the Michigan Legislature at the State Capitol building. At the Stokosa Prosthetic Clinic, we first learned about billing and some of the procedures that the Stokosa team follows when submitting insurance claims and appealing coverage decisions. Although, as individuals with limb loss ourselves, we both have experience with being denied coverage as patients, it was interesting to learn about this process from a provider perspective. We were also given a tour of prosthetic clinic, including the exam rooms and the laboratory. There was an assortment of prostheses in the laboratory that were in various stages of fabrication, which helped us see how much work is involved in designing, fitting, and fabricating a prosthesis. We were also able to observe Jan as he modified and repaired an elevated vacuum system and adjusted a socket to reduce pressure points on a patient’s residual limb.
During our trip, we talked with many patients who had diverse experiences in terms of their amputation level and history of prosthesis use. Most of these patients had experienced complications following their amputation that resulted in significant long-term pain, as well as revision surgeries to correct these issues. They also shared stories about their difficulties in getting insurance coverage for their prostheses, even though the prostheses had significantly improved their functional status, pain levels and overall quality of life. We will keep these stories in mind as we move forward with our advocacy efforts.
We also spent a full day at the Michigan State Capitol in Lansing, Michigan visiting with the Michigan legislature. We were introduced to Jack Schick with Karoub Associates. As a lobbyist and an amputee himself, he gave a tutorial in lobbying 101. We had scheduled meetings with Senator Vanderwall and Representative Vaupel. Senator VanderWall was kind enough to take us onto the floor of the Senate chamber. We learned what it is like to be a state lobbyist and the art of grabbing the attention of members of the House and Senate to get a few moments of their time. We are grateful to Jan and Mary Stokosa for being such gracious hosts, to the staff at Stokosa Prosthetic Clinic, and to everyone who made us feel so welcomed on this trip and shared their time with us.
Calling it “one of the largest health care fraud schemes in U.S. history,” the Department of Justice recently indicted 24 defendants and suspended Medicare payment privileges for 130 durable medical equipment companies for fraudulently billing $1.7 billion in Medicare orthotics. The indictments included CEO’s and others associated with five telemedicine companies, including three licensed medical professionals. The investigation involved over 80 search warrants in 17 federal districts, with tentacles reaching internationally into the Philippines and throughout Latin America.
The joint investigation involved the DOJ, the HHS Office of Inspector General, the FBI, CMS’s Center for Program Integrity, and the Internal Revenue Service. The alleged scheme involved the payment of illegal kickbacks and brides by DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist and knee braces that were medically unnecessary, according to the DOJ statement. The defendants allegedly paid doctors to prescribe these orthoses either without any patient interaction or with only a brief telephonic conversation with patients they had never met, which were then shipped to the patient directly.
This type of announcement potentially tarnishes the reputation of the field, but NAAOP and its Alliance partners have been warning CMS, Congress, MedPAC and anyone else who would listen of these types of arrangements for months. We continue to press CMS to move forward with implementing BIPA Section 427 to link Medicare payments for custom O&P care to accreditation and licensure status.
In addition, the new version of the Medicare O&P Improvement Act, which will likely be called the Medicare O&P Patient-Centered Care Act upon introduction in the 116th Congress, is likely to directly prohibit the drop shipment of orthoses and prostheses to beneficiaries, with certain limited exceptions. This proposal to prohibit the shipment of orthoses and prostheses is expected to save the government money, which could be used to offset the cost of the proposal to restore Congressional intent by limiting the range of off-the-shelf orthotics subject to competitive bidding.
NAAOP will continue to work with AOPA, which is taking the lead on this legislation, as well as its Alliance partners, to advance this legislation and implement BIPA 427 for the benefit of O&P patients and the providers who serve them.
We invite you to join the NAAOP leadership in representing the O&P profession on Capitol Hill as we fight to ensure a patient’s right to choose their own provider and to maintain fair and reasonable reimbursement in a timely manner.
With one of the largest freshman classes in Congress, 2019 can prove to be a revolutionary year and advocacy has never been more imperative. The Policy Forum is your best opportunity to learn the latest legislative and regulatory details and how they will affect you, your business and your patients. Once you are armed with the facts, we as a profession will educate our members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work.
New to the Policy Forum? No worries, we have you covered with Lobbying 101, a pre-event civics refresher course that will also help you develop effective rhetoric when meeting with legislators. Your congressional appointments will be scheduled for you.
We hope to see you at this year’s Policy Forum May 7-8, and we invite you to bring a patient. The Policy Forum host hotel will be the Ritz Carlton Pentagon City, 1250 South Hayes Street, Arlington, VA.
NAAOP Fellows: NAAOP’s Board of Directors is pleased to announce the selection of NAAOP’s Policy Fellows for 2019. The selection committee interviewed multiple, highly qualified nominees and chose two fellows, doubling the size of the NAAOP Fellowship program since last year’s pilot of the program. The fellows are:
Alicia Carver: Alicia is a born advocate with an enthusiasm for advancing O&P care to benefit people with limb loss and limb difference. Alicia is a graduate of Ohio University with a bachelor’s degree in technical and applied studies. She has experience with state-based advocacy and brings the insight of individuals who experience the challenge of accessing prosthetic care in more rural areas of the country. Alicia has personal experience with both custom orthotics and lower extremity prostheses. (Read Full Bio)
Susannah Engdahl: Susannah is a Ph.D. candidate in biomedical engineering from the University of Michigan, with a major focus on prosthetic and orthotic research. Susannah will be very helpful in promoting the importance of evidence-based O&P practice, research, the O&P registry, and other important public policy issues impacting people requiring orthotics and prosthetics. She has personal experience with upper extremity prostheses. (Read Full Bio)
These fellows will experience a 10-week policy fellowship this coming summer based in Washington, DC, with NAAOP serving as the principal host and sponsor of the program. Many individual NAAOP board members, company members, and O&P organizations have contributed to the fellowship, both financially and by hosting the fellows for learning experiences during the fellowship itself. NAAOP is incredibly grateful to all of its sponsors.
NAAOP President, Becky Hast, stated, “Finding Susannah and Alicia, both highly qualified and enthusiastic candidates, for the NAAOP Fellowship’s second year has reinforced our commitment to assisting this next generation of patient advocates to realize their potential. Many supporting associations, companies and individuals in the O&P community believe as we do — preparing for the future is some of the most important work we do today.”
OTS Orthotics: CMS has announced that it will proceed with Medicare competitive bidding of Off-the-Shelf (OTS) orthotics over the next year and a half, culminating in implementation in the year 2021. This is the first time CMS has expanded competitive bidding to O&P, albeit to a limited number of HCPCS codes. 23 knee and back orthoses will be impacted by the program. Although OTS orthotics is the only type of O&P care authorized by law to be competitively bid, CMS interpreted the term “off-the-shelf” very broadly, impacting more than just orthoses that require minimal self-adjustment. This risks losing the clinical care associated with these codes.
NAAOP is working with its O&P Alliance partners to address our concerns with CMS and is expected to soon introduce legislation to serve as an alternative to competitive bidding of OTS orthotics, among other O&P priorities.
As the 116th Congress gets off to a slow start, the President’s plans for health care policy will begin to emerge over the coming weeks. First, the President will deliver his delayed State of the Union address which will include goals involving HIV/AIDS and perhaps other health care priorities. Next, we will see the President’s FY 2020 federal budget proposals which will be released late due to the impact of the federal shutdown. Once these proposals are made public, NAAOP will report on their potential impact on access to O&P care.
In the meantime, NAAOP is working with AOPA and members of the O&P Alliance on the path forward on off-the-shelf (OTS) orthotics and other priorities in the Medicare O&P Improvement Act. Last year witnessed the enactment of the provision recognizing the value of the O&P practitioners’ clinical notes as part of the patient’s medical record for determining medical necessity. This was a significant victory with many positive implications.
Extensive efforts were also expended to pass a provision redefining and limiting the scope of OTS orthotics subject to possible competitive bidding in the future, but this legislation did not make it across the finish line before the 115th Congress adjourned. Late in the session, the Congressional Budget Office surprised everyone by claiming that the cost of the bill would have to be offset by a 35% reimbursement cut to over 50 orthotic codes, which was a non-starter. The bill was actually pulled from House floor consideration hours before it was scheduled for a vote.
We are now in the process of working collectively to plot a legislative strategy for the 116th Congress. We intend to reframe the O&P Medicare Improvement Act to focus on patient protection. We intend to streamline the bill, focus on those provisions that developed traction in the previous Congress, and eliminate the most complex aspects of last year’s bill. We are also discussing new provisions that will recast the bill in a manner that we hope will engender positive attention from Congress and the Administration.
This is particularly important now that CMS has announced its intention to subject 24 knee and back orthoses to competitive bidding in the next round of that program. NAAOP and the O&P Alliance believes that 22 out of the 24 codes at issue are custom fit orthoses, not off-the-shelf, and are, therefore, pushing back hard against this proposal.
NAAOP will continue working with its O&P allies to advance policies that benefit patients and the providers who serve them.