O&P Stakeholders Push Revamped Bill

Published in Orthotics & Prosthetics on August 16, 2023

O&P Stakeholders Push Revamped Bill This article was originally featured in HME News.

O&P stakeholders say a new bill would not only curb fraud and abuse and improve patient care but also eliminate a five-year default timeline for when Medicare beneficiaries can get replacement devices.

The Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R. 4315), which was re-introduced June 23, includes a new provision that would ensure beneficiaries can access replacement custom-fitted and custom-fabricated orthoses when a change in their condition or clinical need occurs, stakeholders say. 

“(Currently), if something wears out in three years, too bad, the patient has to wait two more years,” said Jim Hewlett, CO, BOCO, at Freedom Prosthetics and Orthotics in St. George, Utah. “But the kind of patient that wears out a brace is one that is ambulatory in the community. They are doing what they need to do to stay healthy, so it saves money for Medicare (in the long run).”

The bill would also prohibit “drop shipping” of custom orthoses and protheses, and ensure beneficiaries can access the full range of orthotic care from one O&P practitioner, rather than requiring them to visit multiple providers when the treating orthotist or prosthetist does not have a competitive bidding contract.

Stakeholders acknowledge the Congressional Budget Office may see an associated cost with the replacement provision, but they say that a similar change in prosthetics several years ago did not result in a major increase in utilization.

“I haven't run those actual numbers, but I've looked at the trends and there wasn't a big spike in utilization when the law was changed to do this exact thing for prostheses all the way back to 2000,” said Joe McTernan, director of health policy and advocacy for the American Orthotic & Prosthetic Association.

The bill’s larger goal of cracking down on unnecessary devices or fraudulent practices is welcome, stakeholders say. It’s also better care, says James Rogers, CEO of Phoenix Rehab & Mobility & PPS Orthotic & Prosthetic in Chattanooga, Tenn.

“A lot of times patients are sold on the idea of less pain by calling a 1-800 phone number,” he said. “It’s taking advantage of their vulnerabilities. I wish they could be directed to a facility that specializes in that and will be there after the sale in case there’s an issue with the product, whether it’s fit or just a warranty type of thing.”

Stakeholders have been in regular contact with lawmakers to lobby for the House bill and to push for a Senate companion.

“We're working specifically with the office of Sen. Mark Warner, D-Va., and we’re also working with Sen. Steve Daines, R-Mont.,” McTernan said.

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