Medicare change could cause problems for amputees
Amputees could find themselves in trouble if a recent proposed change to Medicare goes through.
Medicare contractors released a drafted policy July 16 that will change patient eligibility and require — among other things — stricter documentation for lower-limb prosthetics.
Proponents say the proposal is a cost-saving measure. Local medical professionals, however, say the change would make it difficult for lower-leg amputees to get appropriate technology.
Doug Jack, owner of Northern Care Inc. Prosthetics & Orthotics in Kalispell, said the proposed change will send patients back decades in treatment.
“Medicare is saying that any new amputee can’t use new technology,” he said. “They have to use a basic wooden foot. This is 1970s technology.”
The proposal, still in the draft stages, would have patients use outdated and clumsy equipment because it is cheaper, Jack said. It was also prevent “add-on codes” to any prosthetic.
“That means no liners. On an immature limb that has just been amputated, that means it will bruise against hard plastic and be extremely painful,” he said. “And this has got to be an oversight, they say nothing about a strap to keep it attached. Do they want to put patients in a peg leg?”
Jack and Stan Gautier, a fellow prosthetist/orthotist, said one of the worst parts of the proposal was a potential look at past patient history.
“If a patient had used a cane or a walker or a wheelchair in the past, they can be denied a prosthetic leg and told to use those,” Gautier said. “Sometimes people can overdo it and want to use a wheelchair for a few hours to take a load off. This law doesn’t take that into consideration.”
Patients using Medicare could be relegated to using old equipment unless it can be medically documented that the patient needs “newer” technology.
“The things we prescribe patients now have been in place for 20 years,” Jack said. “We’ve been using them for decades, and now Medicare wants to rewrite the books to use even older equipment.”
It’s possible the strategy will save money, but Jack said he thinks it is more likely patients will suffer instead.
“We don’t think it is in the best interest of the patients,” he said. “I think it is coming because Medicare found out it wasn’t policing itself and it was being scammed by these places in the South.”
Jack refers to Medicare/Medicaid scams where the government was being billed for patients who didn’t exist or had died years before.
He said the change was written so vaguely to try and catch medical frauds that his practice could be denied payments.
The change would require documentation from physicians for every step of the way back to full recovery. If a doctor forgets to specify or is vague, a recovery audit contractor can come and take back the payment, sending Northern Care off into legal disputes that can take years to resolve.
It could be coming to non-Medicare patients as well.
“Medicare designed L-code billing, which all insurance goes by,” Jack said. “It will probably, eventually, I’m 99 percent certain, affect private insurance. If they look at this and say, ‘Hey, Medicare is saving money by doing this,’ they will definitely follow.”
Northern Care already struggles with proper doctor documentation. This new policy could wreak havoc on the business that Jack has run for 23 years, he said.
“Amputees don’t know this is happening,” he said. “They aren’t going to stop living their lives, so this could place them at a higher risk for injuring themselves when they can’t afford to pay for prosthetic limbs.”
A White House petition is online at petitions.whitehouse.gov/petition/rescind-medicare-proposal-restricting-access-prosthetic-limbs-and-returning-amputees-1970s-standards-care. More than 100,000 signatures are needed for White House staff to review the petition.
Reporter Ryan Murray may be reached at 758-4436 or by email at rmurray@dailyinterlake.com.