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08/31/2015 Paul Kesselman, DPM
Amputees Decry Medicare Payment Overhaul for Artificial Feet
Amputees Decry Medicare Overhaul for Lower Limb Prosthesis From: Paul Kesselman, DPM
I had the opportunity to personally attend and testify (on behalf of APMA) at the hearings Medicare held in Baltimore on August 26, 2015 on several draft Medicare policies. This included two policies which will no doubt directly effect podiatrists' ability to provide necessary DME to their patients.
One is on the ability for podiatrists to perform a required functional assessment on patients who require toe fillers (L5000-L5020). The current draft policy does not include DPMs as a Licensed Certified Medical Professional in the group which can perform such assessments.
While podiatrists will continue to be able to prescribe and/or order and dispense such devices, it would require the patient see another health care professional (e.g. PT, PA, NP,MD or DO) in order to perform the functional assessment.
In addition, it precludes the person performing the assessment from having any financial relationship with the entity supplying the prosthesis. Therefore eliminating the prosthetist as another professional to assess the patient. This is especially ludicrous for patients who require sophisticated prosthetics. Who knows this aspect of patient care better?
The draft policy also requires the patient to have a potential for a "natural gait" with their prosthesis (who of us has a natural gait with our own natural limbs)?
Lastly this policy has the potential to exclude those patients from prosthetic coverage who may have been provided a crutch, cane, walker or wheelchair within the last five years, regardless of the reason those ambulatory assistive devices were provided.
This hearing was incredibly emotional for many amputees, young and old, who testified before an audience of over 400 people. Some who testified that this policy would set back the treatment of amputees 50 years. Others suggested it would relegate this ever growing segment of the population to being disabled and irreparably harmed into "second class citizen" status.
The second policy I was given the opportunity to testify on dealt with a draft surgical dressing policy which could eliminate many products containing silver or honey. The requirements the DME MAC now has for many dressing classifications is arbitrary and has no basis in current science and ignores many modern day peer review studies.
Because of the urgency on the lower limb prosthesis policy having its comment period ending on August 31, I would urge the reader to consider reviewing the policy (http://www.medicarenhic.com/dme/mrlcddraft.aspx) and follow the instructions on this page, as to where to send your comments. The PDF for both the Lower Limb Prosthesis (LLP) and Surgical dressings draft policies are also located on this page.
Paul Kesselman, DPM, Woodside, NY
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