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Groups say reimbursement proposal a setback for amputees

The Amputees Coalition and the American Orthotic and Prosthetic Association have issued a warning that proposed changes to Medicare’s reimbursement for lower limb prosthetic care would create “unreasonable and clinically unjustified hurdles to amputees receiving care that is now routinely provided,” according to a news release.

“This proposal represents a significant setback for amputees in the United States,” Amputees Coalition President Susan Stout said in the release. “It would mean that hundreds of thousands of Americans who now are active parents, grandparents, employees and community volunteers would not be able to receive the most appropriate device for their needs at the most appropriate time.”

The coalition and the AOPA said the proposed changes would affect not only amputees who use Medicare, but all amputees in the U.S., since commercial health insurance payers tend to follow the lead of Medicare on such matters.

There are roughly 2 million amputees in the U.S., and approximately 185,000 new amputees each year, according to the release. Medicare’s data for 2009 showed more than million prosthetic services with a total expenditure of $655 million including new prosthetic feet for 36,600 Medicare beneficiaries. If applied to patients with commercial insurance, the Medicare policy would extend on a de facto basis to an estimated 10 million prosthetic services per year, according to the release.

Areas in which the coalition and the AOPA said the Medicare proposal would place unreasonable hurdles are:

• Amputees using an assistive device such as a cane, crutch or walker will be limited to less functional prosthetic devices — even if they use the assistive device only briefly or for limited purposes, such as getting out of bed at night to go to the bathroom. If an amputee has a higher functional level, Medicare will not pay to have a wheelchair.

• Amputees could be provided a less functional prosthesis or denied a device altogether because they may not be able to attain the “appearance of a natural gait,” or if medical records reference certain health issues, including such common conditions as high blood pressure. This would unfairly and needlessly knock hundreds of thousands of amputees out of consideration for the most appropriate prosthetic device for their needs, according to the release.

• The Medicare proposal redefines the rehabilitation process for amputees and forces new amputees to undergo rehab using out-of-date technology that they will not even use once they receive their permanent prosthetic device. This means that the rehab for amputees will be of less value than if it was carried out with the most appropriate prosthetic device for their needs, as is common practice today.

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By | 2020-04-15T16:12:46-04:00 August 21st, 2015|Categories: Nursing news|0 Comments

About the Author:

Sallie Jimenez
Sallie Jimenez is content manager for healthcare for Nurse.com published by Relias. She develops and edits content for the Nurse.com blog, which covers industry news and trends in the nursing profession and healthcare. She also develops content for the Nurse.com Digital Editions. She has more than 24 years of healthcare journalism, content marketing and editing experience.

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