An Associated Press news story published on Feb. 15 highlighted the cost
increases of Medicare prosthetic feet in 2010 compared with 2005 despite a
slight decline in the number of amputee beneficiary recipients for those
devices. The story raised questions as to why Medicare’s 2010 $94 million
bill for prosthetic feet was nearly $35 million more than in 2005. On its
website, the American Orthotic and Prosthetic Association (AOPA) posted a
response detailing key points left out of the Associated Press article that may
help explain the increase to O&P business professionals.
The five-page AOPA response also clarifies assertions made in the August
28 Health and Human Services Office of the Inspector General report,
Questionable Billing by Suppliers of Lower Limb Prostheses.
O&P Business News spoke with Tom Fise, JD, executive
director, AOPA to get his response firsthand.
“There are some issues with the data, but overall there is no
denying that if you look at the 6-year time frame that there were shifts in the
utilization of products and increases in costs,” Fise told O&P
Business News. “I’m not shocked by that.”
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| Tom Fise |
According to Fise, one of the aspects of the increase overlooked in the
Associated Press story was that in that same time frame, Medicare’s annual
fee schedule increased by 12%, resulting in almost one-third of the total
increase. Even if a device in 2010 was exactly the same as 2005, the price
would have gone up by 12%.
“If you ignore the fee increase, that skews the numbers to begin
with,” Fise said.
In Response
The AOPA response published on its website also contended that “a
significant number of patients moved from less expensive earlier generation
technologies to more expensive, more recent, improved technologies.”
“I think it is the nature of any technology that over time, older
technology fades into lesser use and more recent technology absorbs a larger
portion of market,” Fise said.
Involvement in two wars, coupled with the notion that older amputees are
more active and mobile than their predecessors, has increased the level of
technological sophistication in prosthetic devices, which in turn increases the
cost.
“We have had a technology explosion due to the Department of
Defense’s DARPA program and the US Department of Veteran’s Affairs
making a major commitment in resources to the rehabilitation of soldiers who
have lost one or more limbs,” Fise said. “Some of that technology has
now reached a point to where they are available to the average consumer. Who is
going to be the one to tell Medicare beneficiaries that they are not entitled
to the best technology that is available?”
The Associated Press news story also raised a fundamental question: who
makes the decision as to the level of prosthetic care that a patient can
receive?
According to Fise, Medicare created K-Level guidelines and the physician
is asked to make the proper prognosis for recovering mobility based on those
guidelines.
“The decision based on the prospects of mobility is made by the
physician,” he said. “Those are the measures that the patient can
achieve if they have the right mobility equipment. It is not something the
prosthetists can control or dictate.”
Fise contended that if readers take into account the fee schedule
increase and the technological evolution in the O&P field, the numbers
provided in the Associated Press story are not that newsworthy.
“I think this is not an extraordinary situation given the explosion
of technology and the fact that the numbers that were cited, either
inadvertently or conveniently, left out the changes in the fee schedule.”
— by Anthony Calabro
For more information:
American Orthotic and Prosthetic Association. Per capita cost
increases in prosthetic foot costs, OIG, DME MACs, CERT reports relating to
claims for orthotics and prosthetics: Where there is smoke, is there really
fire? http://www.aopanet.org/OIG_talking_points_2_16_12.pdf. Accessed March 9,
2012.
