From the Hill

It's Time for O&P to Receive a Raise
By Walter Gorski

O&P professionals last received a Medicare payment increase of 1.1 percent in January 2003. However, if current law remains intact, we could be in store for a modest payment update of 3 percent to 4 percent over current payment beginning in 2007. While this is definitely good news, tough battles lie ahead before this update can become a reality.

Threat to O&P payments

Recent rumblings from Capitol Hill indicate there is growing sentiment among legislators to address several critical Medicare issues before year’s end—even after the election in what is called a “lame duck” session of Congress. At the top of the list of issues is addressing Medicare physician payment problems.

If the physician payment formula is not adjusted by Congress, doctors are slated to receive about a 5 percent payment cut next year. Preventing these cuts has become an annual exercise for lawmakers in recent years, and there is reason to believe they will be scrambling again to prevent this sizable payment cut before year’s end.

The physician community has made preventing a payment cut its top priority. With the ongoing drive among lawmakers to control Medicare spending, it is clear that funds will have to be found if the doctors are going to get paid.

But the temporary physician payment “fix” does not come cheaply. The Congressional Budget Office (CBO) estimates that providing a zero percent update (i.e., maintaining 2006 payment rates in 2007) to physicians will cost between $10 billion and $11 billion.

The problem is that the source for the money is not clear. Lawmakers do not want to add to the federal deficit. If the issue of physicians’ Medicare payment is addressed, lawmakers are likely to look for savings elsewhere in the program—such as the O&P payment update.

The O&P payment freeze

Is a 4 percent raise really worth fighting for? AOPA believes the answer is a definitive “yes.”

Over the last three years, the most conservative economic indicator, the consumer price index (CPI), has increased by 8 percent. This is a conservative estimate, because the CPI is known as a general inflation measure. Medical inflation, a measure that tracks more closely with the costs of doing business in the health care arena, has gone up much faster.

To see how these figures affect O&P, let’s assign some dollar figures. Projected over 10 years (2004-2014), the three-year O&P payment freeze (2004-2006) will result in approximately $1.1 billion in lost Medicare payments alone. And this projection does not account for all the insurance plans tied to Medicare payments. 

Looking at this issue from another angle, the three-year freeze has cost an O&P facility with $1 million in annual revenue anywhere from $200 to $400 per day in lost Medicare payments in 2006.

With the costs associated with running a successful patient care facility increasing at a faster pace than our Medicare update (see chart), every dollar counts. It is imperative that we make every effort to receive a fair update in 2007.

Fighting for payments

More troubling is that O&P is not the only group with reason to be concerned. When Congress is trying to save $10 billion in a single year from the Medicare program, all provider groups fear being targeted and will work hard to get or maintain their piece of the Medicare pie.

Pharmacists, home health providers, nursing homes, hospitals and Medicare Advantage plans are just a few of the powerful provider groups that will muster all available resources to gain the support of lawmakers.

The O&P profession is competing against each of these other interests in the quest for adequate payments. Therefore, we must get our message out at all costs.

Join the fight

I doubt there are any O&P practitioners who don’t see the need for increased Medicare payments. I suspect, however, there are some who believe that one person cannot make a difference.

Nothing could be further from the truth. If you believe that you need a raise to maintain the high level of service you give to your patients, then you owe it to yourself and the field to join in the effort. The groups that have the most success are those that spread their message most effectively.

There are many ways you can help. Even just one more person can make a difference.

Here are two steps you can take in the next week to help protect O&P.

First, learn more about the O&P Political Action Committee (PAC). The O&P PAC is the only PAC dedicated to educating lawmakers about the importance of O&P services. And educating lawmakers is crucial. Most legislators have very little understanding of O&P. The PAC gives us the opportunity to sit down with members of Congress and tell our story.

Also, inviting your member of Congress to your facility is an excellent way to show the importance of what you do. It is impossible to visit an O&P facility and not be impressed by the difference O&P practitioners make in the lives of your patients.

In the current environment, with Congress looking for ways to cut Medicare spending, we all need to work to ensure O&P providers are given the necessary funding to continue providing our patients with the outstanding care they need.

Please call me at (571) 431-0809 if you want to join the fight to preserve O&P.

Walter Gorski is the director of legislative and regulatory affairs for the American Orthotic & Prosthetic Association (AOPA). Through government relations efforts, AOPA works to influence policies affecting the future of the O&P profession. Questions? Call (571) 431-0809 or visit www.AOPAnet.org.