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Heather Mills - Amputee Forum
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CaptainKB

Medicare and Obamacare

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Check your political affiliation at the door, or simply ignore this post.

Thanks to Obamacare and to save money in the Medicare system, Congress has been sent a bill which I am sure all of you know of that will bring prosthetics back to the 1970's. If your prosthetist states otherwise then he is either lying to you, or he/she doesn't get what the bill is about. I am sure they are fully aware since it is their livelihood

If this bill passes, 70% of leg docs in America will close shop, plain and simple. Scary? yes, possible? yes. We were able to get over 400k signatures that were sent to DC to stop this bill, but at this point according to my sources at Otto Bock, no decision has been made.

Otto Bock as you can imagine has a lot to lose, like 70% of their sales worth. Otto Bock for their efforts asked 50 amputees to go with them to D.C to speak in front of congress, after the meeting I was told they went to Medicare, and after that there was a closed door meeting. I asked my Congressman and his office, nor does Otto Bock have further information.

To quote an Obama administration Medicare official, “If they want the high priced and unnecessary computerize legs, let them pay for it themselves". This was stated months prior. These people are finding ways to save money to help pay for a failed Obamacare program, this is a factual comment and not mine in any way.

My prosthetist has been around for 40 years, an inventor of items, some of which thousands of us use every day to help us lead a better life. He flat told me that he will close 2 of his locations, be laying off half his staff and that 70% of mom and pops will shut down and for the most part, only the large nationwide companies will survive.

So why did I post this? To scare you? Yes, indeed that is why, because we are 2 million strong and your silent voice will not help! Call and write you Senators and Congressmen and women. Tell them why you need the prosthetics that you use to live everyday life. The administration is stating that a leg with a suction socket, or a knee, or a liner is not needed. Tell them why you need these things. And if you feel you do not want to, or it's too much trouble..........look at what prosthetics looked like in the late 70's. I kid you not, that IS the model that is being used.

I hope and pray this does not come to fruition, but with everything else going on, it is most certainly not on top of our administrations lest I can assure you.

Captain KB

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Captian KB and readers:

You are probably referring to the recent proposal by the major Medicare carriers to "reform" the way prosthetics are covered by Medicare. Details are here:
http://www.aopanet.org/2015/07/update-aopas-analysis-of-proposed-lower-limb-prosthetic-policy/

The proposal isn't a bill or law, it wasn't the idea of anybody in Congress or the White House -- it's a proposal by the corporations involved in billing Medicare for services.

The proposal was up for a comment period, which is over. The public hearings and published comments were thoroughly critical of many aspects of the proposal.

In theory, the Medicare administration could implement the proposal, but it got enough of a public thrashing that I think it's unlikely to be implemented.

If the proposed payment policies *are* implemented, we'll need new legislation to reverse that. There's no bill in congress that we need to oppose, and probably no bill we need to support--yet.

The underlying tensions about what should be paid for or not are present in ANY third-party payer system, whether the payer is a corporate insurance company or government benefit system. The only alternative to a third-party payer system is for you to pay for all your healthcare yourself, which we're all free to do.

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I agree there is not a bill currently up for a vote in Congress but Medicare is looking to save money - do not doubt that. If they can do it by not paying for advanced prosthetics they will do it - do not doubt that either. I don't see any harm in letting our politicians know that prosthetics are not a luxury.

I understand that the "bill" primarily addresses who recommends what type of prosthetic a person requires. Currently prosthetists have a lot of say in what someone "needs". The problem with this is that they also benefit or make money from the sale of the prosthetic. This is seen as a conflict of interest. The document I read indicates that a Dr. or a Physical Therapist would need to be the ones making the recommendation as they don't directly benefit from the sale. The problem with this is that Dr.'s and P.T.'s don't stay current with new advances in prosthetics.

There is also wording that a person would have to undergo rehabilitation with a basic (read 1970's) type of prosthetic before they qualified for something more advanced (read expensive). If you have ever tried to walk with a SACH foot I challenge you to have a "normal" gait pattern with one for any distance or on uneven surfaces. Also the type of suspension would be very limited until you could prove you needed a different one. It's hard to prove you need something you can't try first. So, basically, if you failed to walk "normally" with a crappy leg you would never be approved for a better one.

And don't think if you have insurance other than Medicare you would be safe. Insurance companies have historically followed Medicare's lead.

I am a left BKA and a Physical Therapist.

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Fifty amputees went to D.C along with Otto Bock V.P. They met behind closed doors and talked with congressmen and women. This IS part of Medicare and was brought forth as one of multiple ways to save money to help pay fro Obama Care, this is a fact.

Not a law or a bill at this point, yes that is true, but could have been put into the last budgets which included medicare. Insurance follows what medicare implements, so if this was, or will be passed than we there will be smaller CPO operations that will be forced to close, based simply on economics. There is no mark up on pin socketry and entry level knees and sach feet, and that's what the industry would become.

Your point of being safe, you are spot on! Your comments are all right on point above member. People say "no this won't happen". Yeah, sure it won't. The only thing that will save us is a change of the guard and most portions of Obamacare repealed.

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