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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