President Releases Budget, “Doc Fix” deal, Off-the-Shelf Orthotics Codes Released

There is a lot to get to this week!

On Monday, the President released his proposed budget for FY2013 that forecasts an annual deficit of over $1 trillion for the fourth consecutive year. The President’s proposal closes many corporate tax loopholes and increases taxes (by allowing the Bush tax cuts to expire) on upper income Americans to help pay for an over $400 billion increase in domestic spending on infrastructure projects and helping the American manufacturing industry. The President’s budget is mostly just a fictitious document, especially in an election year, as congress creates the federal budget, the President only gets to approve it.  There were several health care related cuts in the President’s budget, including: more than $50 billion from Medicaid — including $17 billion over 10 years by establishing a new, and already controversial, “blended rate” for Medicaid and CHIP in 2017 and $21 billion by reducing provider taxes. Medicare would see $267 billion in cuts, many of which had been proposed earlier, including $35 billion from reduced provider “bad debt” payments, $9 billion from graduate medical education payment cuts, $56 billion gleaned through payment changes and $155 billion from requiring drug manufacturers to provide Medicaid rebates for all low-income beneficiaries, and extends Medicare competitive bidding rates to state Medicaid for DMEPOS, saving an estimated $2 billion.

Also this week, negotiators reached a tentative agreement to extend the Social Security payroll tax cut and unemployment benefits through the end of the year, and also avoid a 27% cut to physician reimbursement payments by tweaking the “sustainable growth rate” formula, otherwise known as “doc fix”.  The agreement caps a several month-long struggle that included a 2-month extension in late December, with most of the negotiations centered on how to pay for the popular, or otherwise necessary extensions.  Congressional Republicans offered to  drop their insistence that the payroll tax cut (an estimated cost of $100 billion) be offset with additional budget cuts and a deal to extend all three provisions moved very quickly after that. The deal found offsets that included trimming total unemployment benefits from 99 weeks to 73 weeks and decreased funding for the prevention and public health fund that was created in the Affordable Care Act.  MORE

Late last week, CMS released a list of codes they consider to be included in the “off-the-shelf” orthotics category which is eligible for the Medicare competitive bidding program for DMEPOS.  AOPA worked with CMS to ensure OTS orthotics were not included in Round II of competitive bidding, but orthotics and prosthetics professionals would be wise to comb through the list of HCPCS codes and provide comments to CMS on why these codes require more than just taking a brace off the shelf and slapping it on a patient, stressing the necessary clinical component. Comments can be sent to CMS through March 8th.  Find the full list of off-the-shelf orthotics HERE.

Finally, an interesting article in USA Today that discusses the increase in costs for custom foot prosthesis relative to the decreasing percentage of diabetics in the United States. This article underscores the importance of orthotics and prosthetics professionals focusing on quantifying the value of the new technological advances have had on patient outcomes. Read the full article HERE.

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