Amputee groups fight proposal to limit prosthetic limbs

Groups push back on Medicare policy on prosthetic limbs.

A coalition of amputees and prosthetic device manufacturers opposing a Medicare proposal that they say would limit access to limbs is taking the fight Wednesday to Anne Arundel County, where the federal government will hold its only hearing on the policy.

The proposal would impose new requirements for covering more advanced — and more expensive — lower-limb prostheses. They include a requirement that a patient be able to walk without a cane after receiving a prosthetic limb and have the "appearance of a natural gait" — a standard some opposed to the measure called offensive.

Roughly 2 million people in the U.S. have lost a limb. While only about 150,000 amputees are in the Medicare system, advocates are concerned that similar limiting policies may be adopted by Department of Veterans Affairs and private insurers. Medicare spent $655 million on prosthetic services in 2009.

"This is as stupid a rule as I've ever seen," said former Sen. Bob Kerrey, a Nebraska Democrat who lost his right leg below the knee in Vietnam and who is working with advocates to revise the policy. "This rule completely ignores what's going on with amputees."

The hearing is scheduled for 8 a.m. Wednesday at Airport Square Business Park in Linthicum.

The proposal follows a 2011 audit by the inspector general for the Department of Health and Human Services that found the agency was spending tens of millions of dollars on limbs that were not necessary, given patients' other health problems.

Medicare spending for lower limb prostheses increased 27 percent, from $517 million to $655 million, between 2005 and 2009, the inspector general found, even as the number of patients decreased by 2.5 percent.

Prosthetic limbs have become more advanced due in part to Department of Defense research to assist wounded service members. While the technology has created new opportunities for amputees, it also comes at a price: Most prosthetic limbs run between a few thousand dollars to more than $30,000, advocates said.

Adrianne Haslet-Davis, a dancer who lost her left leg below the knee in the 2013 Boston Marathon bombing, said that the policy would refuse people "what I consider a human right: to walk."

"If we deny this simple, simple right, we all will be forcing them into such a deep depression they may never get out of it," Haslet-Davis told reporters Tuesday during a call organized by the Virginia-based American Orthotic & Prosthetic Association and others that oppose the proposal.

The Centers for Medicare & Medicaid Services, the Woodlawn-based agency that oversees the federal health insurance programs, declined to discuss the genesis of the policy, how many people might be affected or how much money would be saved.

An agency official, who declined to be identified, emailed a statement explaining that the proposal was pending and open for public comment until the end of the month. The official did not respond to follow-up questions.

The agency contracts out policy decisions and claims processing for lower-limb prostheses to private companies. In this case, the four regional contractors have all agreed to move forward with the policy, meaning it would take effect nationwide if approved.

There were 3,053 upper and lower limb amputations in Maryland in 2013, according to data from the Virginia-based Amputee Coalition of America.

The policy would create more stringent requirements before Medicare would approve reimbursing patients for limbs. A patient would be required to have a face-to-face meeting with a physician, an idea recommended by the inspector general in the 2011 audit.

The type of prosthetic would be determined by a licensed medical professional who does not have a financial relationship with the limb's manufacturer.

Advocates say they are concerned about fuzzy language in the proposal, such as a requirement that a beneficiary has "sufficient cardio-pulmonary capacity" to use the prosthesis. Some say the provision could lead to patients being denied for high blood pressure or poor circulation.

Dr. Stephen Fisher, director of health services at the Baltimore-based Chesapeake Employers Insurance Co., said that getting people the correct type of limb is important for their recovery. The company, which provides workers' compensation insurance, also has an obvious interest in getting people back to work.

"A well-fashioned, properly fitted prosthesis is critical to achieving success," he said. "There's both a human cost and a financial cost to this policy."

john.fritze@baltsun.com

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