A News Health — 04 September 2015

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A recent change in Medicare policy has been raising concern for those who use prosthetic limbs.

The drafted proposal, known as the Local Coverage Determination (LCD) for Lower Limb Prostheses, would reduce coverage for amputees and tie the hands of the prosthetists that help them – effectively reducing the current standard of care to the standard of care last seen in the 1970’s.

Recently, in Baltimore Maryland, over 200 prostheses users, prosthetists, and politicians, met to voice their concerns in a public hearing organized by the American Orthotic and Prosthetic Association.

In a press conference, Nebraska Senator Bob Kerrey remarked, “This is as stupid a rule as I’ve ever seen. This rule completely ignores what’s going on with amputees.” Senator Kerrey lost his right leg in Vietnam.

AOPA wheelchairPete Goller, a prosthetist with Metro Prosthetics, which serves the Baltimore and greater Washington D.C. area, agrees that the change in policy would have a significant, negative impact. “This change in Medicare policy represents a gross oversight in understanding the needs of people who rely on prostheses. The limits being proposed ignore the fact that each individual has different needs. Furthermore, it’s important to address the fact that as a person’s lifestyle and needs change over time, they will need new and different prosthetics. This begins as early as amputation and rehab, then continues for remainder of their life. This policy doesn’t allow appropriate access and coverage to address an individual in the short term nor the long term.”

Late last month, several researchers, who’s work had been sited in the proposal’s bibliography, filed a protest stating, “The articles referenced by CMS claimed to support the LCD, actually have no bearing on any of the policy changes described in the proposed LCD. In fact, many of the citations could be used to refute the proposed changes. Further, these selected references do not support the significantly diminished quality of care that beneficiaries would receive if the proposed changes were implemented. It is also clear that some of the articles referenced in the bibliography are not accessible for evaluation and comment, calling into greater question the quality of the science behind CMS’s proposed decision making when drafting the LCD proposal.”

Highlighting their disagreement with the proposal, they continued by questioning the decision for a change in the policy at all:

“The current standard of practice is fully supported by sound, (peer- reviewed) scientific evidence. The changes proposed are not consistent with the current standard of practice and not derived from consultation with any of the referenced authors. As CMS has used our works in the preparation of this ill-conceived proposal, we are led to question why we, as health care experts in this field, were not consulted. The proposed changes described in DL#33787, in our expert opinion, would diminish both the quality and access to prosthetic care across our nation. We, as the experts cited in this document, wish to go on record as strongly opposing the draft LCD.” Click here to read the entire letter.

There is still time act. A “We The People” petition has been started, to rescind the LCD proposal. The deadline is Sunday, so there is still time to act. Click here to sign an online petition. There are currently over 109,000 signatures, and counting.

You can visit saveprosthetics.org to sign the petition, find help in drafting a letter to Medicare, and other resources regarding the LCD proposal.

You can also visit the Amputee-Coalition website for an outline of the changes or to view the proposal draft.

Images courtesy of American Orthotic and Prosthetic Association.



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Geoff Sims

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