Amputees are worried the federal government will limit their access to prosthetics and may be saddled with antiquated technology.
The Centers for Medicare and Medicaid Services is considering an overhaul to how Medicare reimburses leg prosthetics, issuing new conditions for patients to meet to receive a prosthetic lower limb. Many amputees spoke in opposition to the controversial proposal during a public meeting near Baltimore and more than 100 protested in front of the Department of Health and Human Services in Washington Wednesday.
All amputees, not only those on Medicare, are concerned about the proposal.
“I feel like they are violating my rights,” said Peter Tainer, a 21-year-old at the protest.
Tainer is more than a few years away from Medicare eligibility, but amputees are worried since commercial insurers and other agencies such as the Department of Veterans Affairs usually follow Medicare’s lead on reimbursement policies.
About 2 million amputees live in the U.S., and about half of them get below-the-knee prosthetics, which are the only limbs affected by the proposal. Of that 1 million, up to 170,000 are on Medicare, said Thomas Fise, executive director of the American Orthotic and Prosthetic Association. The nonprofit that helped organize the protest represents prosthetic and orthotic businesses.
Currently, a prosthetics expert assesses a patient and Medicare generally accepts it. That would change under Medicare’s proposal to have a physician make the assessment. And new conditions could restrict someone from getting a more high-tech prosthetic — or one at all.
One controversial condition in the proposal is that a patient must walk with a “natural gait” with a prosthetic to receive it. Therefore, if he can’t walk with a natural gait then he has to get a lower-grade prosthetic or the claim may be denied altogether, the association said.
Advocates said they had trouble defining whether their gait, which itself is defined as a person’s manner of walking, is in fact natural.
“Who walks with an absolutely normal gait?” asked Adrianne Haslet-Davis, 35, who got a below-knee prosthetic after she survived the Boston Marathon bombing.
“I don’t walk with a natural gait,” Tainer said.
Connie Moe came up from Richmond to join the protest. She said that under the proposed changes, she couldn’t get parts for her prosthetic leg because she has high blood pressure.
The feisty 79-year-old said it was the first protest she had ever attended because the issue was “very important to me.”
Another restriction for receiving a high-quality prosthetic was whether the patient used a walking assistance device. The new proposal says that anyone who has used a cane, crutches, walker or wheelchair can’t get a high-quality prosthetic and are downgraded.
That rankled several protesters. The 21-year-old Trainer said that at times he has needed assistance from the devices.
Another issue is the criteria for determining a person is functional. For instance, if you can walk only short distances in your home but not to your neighbor’s down the street then you would qualify for a lower-class prosthetic.
Advocates say the criteria isn’t fair as it eliminates any consideration of whether a patient can improve his mobility through advanced prosthetics.
“This issue is especially critical to recent amputees who are progressing through their prosthetic rehabilitation,” according to a form letter drafted by the prosthetic association. “Limiting coverage to only allow consideration of where a patient is today, rather than considering what they can achieve through the provision of appropriate prosthetic components will lead to poor patient outcomes and will hinder the patient’s ability to return to the best functional state they can achieve.”
A Centers for Medicare and Medicaid Services official told the Washington Examiner that the intent of the proposal is not to “restrict any medically necessary prosthesis.”
Medicare goods and services are paid through payment contractors, the official said. Those contractors can propose changes to coverage policies in their area if there isn’t a set national policy.
In this case, regional equipment contractors proposed to update the policy on reimbursement, which is called a local coverage determination.
The agency said late Thursday that officials met with advocates concerned with the proposal. The officials, which include acting CMS Administrator Andy Slavitt, “appreciated hearing personal stories and comments on the proposal,” a statement said.
The officials will work with regional contractors’ medical directors to ensure any final policy is supported by clinical evidence and doesn’t limit services.
However, the agency did not return a request for comment on why it was specifically pursuing the update. Fise speculated that it is in response to a 2011 Government Accountability Office report that said spending on prosthetics was too big, rising by 27 percent from 2005 to 2010.
But Fise said spending on prosthetics has declined in recent years. Medicare spent $664 million on all prosthetics in 2013, down from $753 million in 2009.
Comments on the proposal are due by Monday, and then the agency plans to issue a final ruling after reviewing them.
Fise said his association has reached out to several members of Congress to get their support, including double amputee Rep. Tammy Duckworth, D-Ill. A problem has been getting congressional support during the recess, which ends early next month, Fise said.
