5/9/2007

Returning War Wounded Raises Awareness of O&P

High profile amputees returning from conflict abroad and the aftermath of the Walter Reed debacle has created unprecedented levels of awareness and interest in orthotic and prosthetic care of late. This surge in awareness can be seen most notably in Washington, D.C., where several committees with jurisdiction over Veterans Affairs, active military personnel, and even civilian healthcare programs, are focusing like never before on amputees and the follow-up care they receive in order to return to full function. Although little legislation has been signed into law as of this date, several Congressional committees of jurisdiction over these programs are actively considering issues and programs that impact the field of orthotics and prosthetics.

• Appropriations: The emergency supplemental spending bill which funds the continuing war in Iraq and Afghanistan includes approximately $61 million allotted under the Department of Defense health program, TRICARE, to serve the needs of amputees. The same legislation appropriates another $56 million for amputee care under the Department of Veterans Affairs. Committee report language accompanying this legislation states the following:
  

"The devastating impact of improvised explosive devices in Iraq and Afghanistan has produced unprecedented trauma resulting in increased amputations and a high frequency of traumatic brain injury….Prosthetics research conducted through the Department and other research programs has led to vast improvements in the quality and usefulness of prosthetic devices. The Committee includes $56,000,000 to allow the Department to maintain an adequate supply of high quality prosthetics for veterans."

While the vast majority of these funds will be spent on direct patient care for "wounded warriors" requiring amputation related surgery and prosthetic and orthotic care, there may be some funds included in this package that could be allotted to research and improvements in orthotic and prosthetic care provided to active military and veterans. Unfortunately, President Bush vetoed this legislation over a disagreement with the Democratic-controlled Congress to place limits on the President's authority to conduct the wars in Iraq and Afghanistan. Negotiations are continuing on this same legislation in order to achieve bipartisan support for legislation that the President will sign. But it is highly likely that the spending provisions related to amputees will remain intact in any subsequent bill that is eventually signed into law.



• FY2008 Appropriations:
  
  The Labor, HHS, and Appropriations Subcommittees of both the House and Senate are expected to mark-up spending bills for fiscal year 2008 early this year, in May and June rather than usual years where these bills are not marked up until at least July. The Appropriations subcommittees are considering a number of orthotic and prosthetic proposals, some of which will clearly fall to the wayside as the process continues and pressure against earmark spending is at an all-time high in the wake of the lobbying scandals of 2006. However, the increased awareness and interest in orthotic and prosthetic issues may bear fruit as the appropriations process continues.
  
  
• Veterans Affairs:
  
  The Senate and House Veterans Affairs Committees are actively considering legislation to improve capacity and treatment protocols for veterans with traumatic brain injuries, amputations, and other war injuries. The House and Senate Veterans Affairs Committees recently unveiled legislation to improve treatment for traumatic brain injury and there is significant interest in improving care to veterans with amputations and other orthopedic injuries. Congressional hearings are planned on this series of topics and legislation is expected to be introduced. NAAOP, working in concert with O&P Alliance partners, has engaged in discussions with the House and Senate Veterans Affairs Committees' staff and is serving as a resource to those committees as they consider additional legislation.
  
  
• Medicare Issues:
  
  Having received a significant 4.3% increase to the Medicare orthotic and prosthetic fee schedule on January 1, 2007, the O&P field should be braced for a Medicare bill this year that may attempt to curtail next year's CPI update. Historically, with the O&P fee schedule rising on average approximately 1% per year over the last twenty years, the orthotic and prosthetic field is at risk of an inflation reduction or cut, especially considering the fact that physicians are scheduled to receive a 9.9% cut in their current Medicare reimbursement fees. Resolving the physician fee schedule issue will require off-sets from other Medicare provider groups and, although significant savings cannot be achieved through reductions to the update to the O&P fee schedule (due to the relatively small size of this provider category), orthotic and prosthetic providers may be targeted along with all of the other Medicare provider groups. NAAOP, working in alliance with other O&P organizations, will be working hard to preserve the CPI-U update for 2008 over the course of the remainder of 2007.

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