An effort by Medicare to curb fraud and abuse in prosthetic contractors is forcing amputees into a bureaucratic quagmire.
A recent Medicare proposal to cut costs goes significantly beyond addressing fraudulent claims — and would cut necessary prosthetic devices to amputees. The proposal would fundamentally alter the current path of amputee care, device delivery, and rehabilitation, according to the National Amputee Coalition.
Abra Hogarth, director of communications for the coalition, said amputees have always struggled with insurance and Medicare denials. Her organization helps amputees address fair insurance and Medicare issues.
“Amputees want the life they previously led, just like everybody else does,” Hogarth said.
It is not uncommon for amputees in the initial postoperative and rehab periods to have great difficulty. The patient may improve far beyond how he or she is assessed initially.
However, the association and amputees are worried that improvement would not be possible if a prosthetic device is denied by Medicare based on an unduly negative assessment.
Nearly 2 million Americans have experienced amputations, or were born with congenital limb differences. Another 28 million people in the United States are at risk for amputation.
The message is obvious: Prosthetic devices are not a luxury for amputees, but are necessary to remain active and independent.
Under the Medicare proposal, many amputee patients would be downgraded to a lower functioning level because these new proposed definitions eliminate the patients’ potential when considering their functional level. Amputees could receive a less functional prosthesis, or denied a device altogether, just because they may not be able to attain the “appearance of a natural gait.”
Yet patients who never achieve a truly “natural gait” rely on prosthetics and live a full life, according to Hogarth.
At a meeting in August with Medicare officials, Hogarth said the Amputee Coalition showed up with more than 400 supporters for public comments.
“They were very receptive to listening,” Hogarth said of the Medicare officials.
Following the August public meeting, Medicare officials called another meeting with many of the industry groups, the Amputee Coalition, and individuals for further talks.
The public outpouring at the meeting provided the obvious message that prosthetic devices are not a luxury for amputees, but are necessary to remain active and independent.
The Amputee Coalition even developed the #NotALuxury campaign on social media to combat the proposed Medicare changes. Messages like “Walking is #notaluxury,” “Walking across the street with my daughter: #notaluxury,” and “My legs are #notaluxury,” appear thousands of times on the association’s Twitter and Facebook pages.
Videos of amputees grocery shopping, doing laundry, playing with their children, and participating in sports show how amputees can live independently and well with properly fitted prosthetic limbs.
Ballroom dancer Adrianne Haslet-Davis lost her leg at the Boston Marathon bombing. She attended the Medicare hearing in her dance shoes. She testified that dancing on her prosthetic leg is “reasonable and necessary,” by Medicare standards.
She implored Medicare officials to reconsider their proposal, and asked, “What the foxtrot are you doing to us?”
While many are greatly concerned the draft Medicare rule would “turn back the clock” to a time when the type of prosthetics available were less functional and provided less mobility, they are hopeful Medicare will rescind the proposal, or make substantive changes.
The Amputee Coalition expects an answer from Medicare in a few weeks. The meeting in August was a public comment meeting, and a smaller group was formed from the large public meeting to further research the issues.