CMS Reverses Position on Pedorthic Accreditation Exemption

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I opened my email today to find this along with numerous companies soliciting to 'help' me with the credentialing process:

http://www.abcop.org/News_Item.asp?news_id=1210200801

Many of you U.S. podiatrists are probably familiar with this bill and the pending mandatory facility accreditation that all durable medical equipment suppliers will eventually have to complete to bill Medicare. Personally I am all for mandatory accreditation if it is unilateral. In this case they recently gave DPM's and Cped's (among others) a pass while they rewrote this legislation. I believe a lot of their initial decision had to do with the strong lobbying effort of the APMA, good work!

Now they appear to have singled out the segment of providers least able to afford the process and who typically only benefit from the Diabetic Therapeutic Shoe Bill, as no insurers that I am aware of contract with pedorthists for their services, thus many in clinical practice (as opposed to retail) rely on the TSB to survive.

I provide services for a number of orthopedic and podiatric foot specialists for the TSB and other services as well. I don't know how this will affect me, as a chiropractor I have another means of income but I may not accredit my facility just because I find the logic behind their latest mandate so grossly unfair. I am concerned about my pedorthic colleagues who may not be able to afford the expense of accreditation. I know that most of the podiatrists here provide orthoses (whether Medicare or not) but there are those who focus on surgery and refer these services out to a Cped whose work they know and trust. Soon the only choice for referral outside of the DPM's that provide these services in office will be the conglomerates and franchise who can afford this nonsense. Perhaps they lobbied for this bill?

The loss of any of these valuable members of the allied health team due to financial hardship I consider a great shame and this legislation myopic and arbitrary. If pedorthists need to become accredited I find it only fair that everyone who bills Medicare should be burdened with an equal amount of paperwork and economic obligation (whether they be MD's, DPM's, DO's, DC's, PT's ATC's, CO's, CPed's etc).

Some of you may see this very differently and I understand and respect your opinion, I just felt compelled to speak my two cents and to bring some level of awareness to the subject.

Regards,

 

David ...

I hear you regarding the strange inclusions and rapid exclusions announced by CMS. I have my own perspective regarding why credentialed pedorthists had their DMEPOS exemption rescinded.

Although uniformity and efficacy as a whole within my profession are both improved, particularly since ABC merged with BCP, there are still a large number of questionable certificants. By providing unquestioned exemption to those who still travel by van to peoples' homes or set up their offices in cobbler booths, CMS cannot be assured of minimum practice standards when compared to other professions.

This will be a challenging transition for several C Peds. I do believe that in the long run this will be a benefit to those patients enrolled through Medicare to receive consistent, quality care.

 

Jeremy,

I would surmise that you and I have probably reached the same conclusions about why all of this rapid change has occurred.

Palmetto has already visited my practice unannounced and found me in compliance. I would bet that the majority of Cped's are as well that either maintain a physical location or are like yourself, within a physician's group. If their aim is to revoke the privileges to service Medicare beneficiaries and restrict providing for the TSB by unscrupulous traveling van warehouses and those who set up shop in cobbler's booths, I am in agreement.

I feel that it is unfair though to select one segment of providers to single out when I see abuses and poor care across the professional spectrum. I also feel that anyone who like me has another professional degree and who provides part B services for Medicare should be exempt ( the same exemption should apply to practices such as yours within a physician's office where there is obvious oversight).

 

Jeremy,

After countless hours of inquiry and lobbying on my part, I have been informed that DC's are included in the exclusion at this time. Of course this doesn't negate the fact that eventually all facilities and specialties may have to become facility accredited in order to service the Medicare TSB.

While I am thrilled about this latest information on a personal practice level, I still see this as exclusionary legislation, arbitrary and unfair to legitimate pedorthists across the country. If they entertain revisiting mandatory accreditation for podiatrists and allied health professionals who dispense for the TSB I feel that many providers will drop out of Medicare DMERC altogether.

I see this as a financial threat to small practices and sole proprietors in an already undeserved TSB program. They may find the only people willing to foot the bill will be the large O&P conglomerates who outsource all products to a central fab or a vendor. The result with dwindling choices is usually a decline in services and quality.

Thank God for the APMA and their efforts thus far.

Regards