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.
Filed Under: Industry regulations