United Health Care Stops Covering Vacuum Pumps

The Lower Limb LCD Policy Proposal, despite being just a draft proposal, is now being felt in the private sector: United Health Care has now deemed vacuum pumps as not medically necessary, effective October 1, 2015. Read the policy now.

AOPA is pursuing a two part strategy: (a) AOPA partnered with a congressional representative in UHC’s state, who contacted UHC requesting that they set up a high level meeting with AOPA reps; and (b) AOPA is joining in a letter of objection to the policy from the O&P Alliance, together with the Amputee Coalition, due for release this week, challenging the assertion that there is no scientific evidence to support this treatment, and seeking a meeting with UHC’s Medical Director.  We believe the results can be additive and symbiotic, not divisive, in bringing attention to the problem from multiple directions.

We promise to continue to keep you posted on the UHC issues, but we have also received an early indication about another mischievous outgrowth of the commercial sector jumping on the draft LCD as an opportunity for cutbacks–this time from one of the state BCBS plans.  We are waiting to see documentation, but if this proves correct, we will again communicate with the insurer AND communicate to CMS (as we did when the UHC policy first arose) underscoring yet again the need for a quick decision to rescind the draft LCD. Read this news article published in the Minnesota Star Tribune.

Obama White House Disappoints With Interim Response to “We the People” Petition on LCD

Over 100,000 people took President Obama at his word when they shared their names, email addresses and trust in/commitment to government, signing on in 17 days to surpass the 100,000 signatures required to prompt direct White House intervention and action on the draft lower prosthetic LCD. Others were skeptical, seeing the ‘We the People’ process as 90{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} public relations and only 10{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} substance. Well, the first response from the White House did nothing to dissuade the PR skeptics.

On Friday evening that report did not represent any action by the White Hiouse on the petition as had been promised. Rather, it did precisely what the President frequently criticizes Congress for doing–the White House report simply kicks the can down the road. It engages in a pious promise to eventually do what’s right, without giving either a hint of what the substantive action might entail, or when a final substantive decision will be rendered.

The interim We the People report came:
* exactly 3 months after the LCD was released as a proposal;
* exactly 60 days after the 100,000th signature on the White House petition;
* exactly 50 days after the DME MAC public meeting, the amputee rally at HHS HQ, and the date when top CMS and HHS senior officials met with O&P stakeholder representatives and promised a prompt, fair solution that would assure that all Medicare amputees will receive appropriate replacement limbs;
* it occurs 15 days after the first of an expected stream of commercial payers began embracing this very deficient draft as if gospel, as a premise to invoke the misguided draft’s content as an excuse to cut costs, ramp up profits, and downgrade amputee care. That’s too long! Inaction and failure to rescind this deficient policy now allows it to disenfranchise amputees, sadly in the year when the Administration touted the 25th anniversary of the Americans with Disabilities Act!

While we remain confident that the final resolution of this draft LCD will be a favorable one for the O&P professional and the patients we serve, the question remains… Is the ‘We the People’ promise merely PR fluff, or will it ultimately proves more substantive? Whichever, it clearly does not reflect timely, fairness and responsiveness. Read the response below:

An initial response to your petition on a Medicare local coverage determination:

Thanks for using We the People, and for sharing your concerns about the local coverage determination for lower limb prostheses proposed by Medicare contractors. In order to get the most up-to-date information concerning your petition, we’ve gone to the Department of Health and Human Services (HHS) — specifically, the Centers for Medicare and Medicaid Services (CMS), and the Administration for Community Living (ACL).

You can learn more about LCDs and how they’re determined here.

The coverage determination process is still ongoing, but CMS wants to make clear that they’re committed to providing high quality care to all Medicare beneficiaries. They also wanted to make sure you know that HHS has met with stakeholders on this important issue, and both CMS and its contractors understand the questions that have been raised about access to the right prosthetic care — including related technologies — for Medicare beneficiaries.

We will be in touch with another update.

–The We the People Team

 See the petition and response on the “We the People” website.

CMS’ Own Data Refutes Need for LCD Policy Change

The Data Doesn’t Lie

Medicare Data Shows That:

  1. The 2011 OIG Report, Dear Physician Letter, and RAC Audits, misread an upward trend in prosthetic spending that had already reversed*;
  1. For better or worse, Medicare has practiced medicine and changed the prevailing standard of amputee care for the worse; and
  1. They appear to be completely oblivious to the last 4 years of Medicare’s own data—2010-13 proves that 2005-10 data is outdated and the real picture is a 180 degree reversal of direction—dramatic reversion to less effective, cheaper technologies of 1970s in proposed LCDs would make decline in Medicare quality of amputee patient care that much worse

all prosthetic servcies

k1 and k2

k3 knees
*OIG Report missed that the 2005-10 increases reflected initial private sector availability of quantum leap in technology stemming from Iraq/Afghanistan, federally funded research to improve amputee care. The data proves that related cost increases for 2005-10 had already started to decline before OIG, “Dear Physician and RACs drove down quality of care to try to reduce Medicare expenditures that unbeknownst to them had already started to fall.

Copyright, 2015, American Orthotic and Prosthetic Association. All Rights Reserved.