MedPAC report takes CMS to task on orthotics

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Friday, June 29, 2018

WASHINGTON – Although industry stakeholders disagree with a recent MedPAC recommendation to include off-the-shelf orthotics in Medicare’s competitive bidding program, a recent report by the commission is, overall, on point, they say.

“It’s obvious the bid program is still a threat,” Todd Eagen, president of the Orthotic Prosthetic Group of America. “But there is some good news in the report and some continued educational efforts that our community needs to continue to focus on.”

MedPAC’s June 2018 report says expenditures for products not included in the program, like OTS, have grown, making them good candidates for bidding. Expenditures for OTS nearly doubled between 2014 and 2016, from $255 million to $547 million. In particular, spending for a certain back brace (L0650) increased from $46 million to $190 million, a 311% increase.

However, the report says the increase is mainly attributed to a small number of physicians, and stakeholders agree.

“There’s some fairly compelling evidence of impropriety, which is what causes so much volume of bracing to be generated by a very small number of physicians,” said Tom Fise, executive director of the American Orthotic & Prosthetic Association. “They are not targeting treatment provided by certified orthotists. The real target is probably telemarketing.”

Stakeholders were particularly pleased that the report got right the definition of what constitutes an OTS device (something the patient can use with minimal self-adjustment) vs. CMS’s efforts to expand the definition to include devices that can be adjusted by a caretaker or non-certified supplier.

“Obviously, the broader the definition, the broader (range of products) you are going to apply the bid program to,” said Eagen. “If that happens, more orthotics are provided without clinical care and that’s a problem for the beneficiaries.”

The report also takes CMS to task for its use of 23 split codes that have the same fee schedule amounts whether they are classified as OTS or require customization. The split codes provide incentives to suppliers to furnish OTS instead of custom-fitted products because they get paid the same amount whether they provide any fitting or not, says the report.

It’s important for providers to remember, however, that it’s unclear whether or not anything will come of the report, say stakeholders.

“We would remind everyone that this is an advisory report that policymakers can utilize or not, at their discretion,” said Wayne Rosen, BOCP, BOCO, FAAOP, and chairman of the board for the Board of Certification/Accreditation. “BOC will continue to advocate for our credentialees and to move the field forward in a positive manner for beneficiaries, suppliers and the Medicare program."

Comments

As Medicare moves healthcare deeper into Value Based Care, excluding trained professionals and providing cheaper products is NOT the answer if payments are to be based on "Outcomes" 

Exclusion of professionals & use of lesser quality products actually ends up in higher rates of expenditure. Penny wise , pound foolish.  Look at Long term expenditure & outcomes.  PREVENTION is the CURE