A major new study commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS shows that the Medicare program pays more over the long-term in most cases when Medicare patients are not provided with replacement lower limbs, spinal orthotics, and hip/knee/ankle orthotics.
Patients who received orthotic or prosthetic services have lower or comparable Medicare costs than patients who need, but do not receive, these services.
Issues affecting Prosthetic Consumers
CMS issued a proposed rule on May 28, 2014 that would require prior authorization on all Medicare claims for prosthetics over $1000. This was based on a demo project involving simple medical equipment - power wheelchairs, nothing like customized prosthetic limbs. Requiring prior authorization on your next prosthetic limb could threaten your care with delays in approval; potential time in a wheelchair while awaiting replacement limb; potential downgrade in quality of device you receive, especially if prior authorization for original device recommended by your physician and prosthetist is denied, and the possibility that you will be forced to 'pay substantially out of pocket' for a high quality replacement limb.
AOPA, providers of O&P, and Medicare patients submitted a total of 742 comments to CMS prior to the July 28, 2014 deadline, detailing ways to minimize the harm that Prior Authorization could cause to your patient care and your provider's business. We will keep everyone informed of any developments.
Share your O&P Story and Sign up for our Email List
We welcome you to share your story of how orthotics and/or prosthetics have improved your quality of life. You can also sign up for our email list and we will share occasional updates on research or advocacy that may interest you as a consumer.
Please share here.
Resources
The Amputee Coalition is the nation’s leading organization on limb loss, dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss. Visit
www.AmputeeCoalition.org to find support groups, limb loss events, and other resources.
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