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Thursday, October 26, 2006Questions for Providers about Hanger/LinkiaI spent a few minutes listing to the Hanger conference call this morning. I apparently missed a little as, when I logged on at the advertised time, the call was already in progress. Much of the discussions seemed to center on Linkia. A couple of things surprised me. First of all, they indicated that there is really no "volatility" related to Linkia. They indicated that, as termination letters were being sent out by CIGNA, providers were contacting Linkia with interest. They indicated that, for those wanting to continue to do business with CIGNA, it is a simple choice, that being to sign on with Linkia. When asked what happened if they didn't want to join Linkia, the response was that there are other providers waiting in line. They indicated they have not experienced any problems with recruitment and don't anticipate they will. They indicate that they will have adequate coverage, and if it can be Hanger coverage, that's preferential. They talked about sending packages of information very quickly to those who were interested. At the same time, on their website this morning, it says: "If you are an O&P provider interested in becoming a member of the Linkia provider network, please check back to the website periodically to learn of new network participation opportunities. At present, Linkia has a network in place serving its existing business. As we add regional and national contracts with healthcare companies, we will have need for additional O&P network providers." I didn't see, on their website, the option to request that packet of information! They did talk about a pricing structure locked down for a couple of years, followed by pricing increases. That will probably not be great news for CIGNA. I'd like to hear from providers throughout the country, with some answers to the following: 1. Particularly if you are in an area with a Hanger presence, have you attempted to contact Linkia about joining? What was the response? 2. Are you a provider that, since receiving a termination letter from CIGNA, have signed on with Linkia? 3. Are you a provider that, since receiving a termination letter from CIGNA, have been asked to join the Linkia network and have chosen NOT to join? If not, why not? Thanks for your response. Hanger Net to Shareholders Misses TargetFor the latest quarter, four analysts on average had expected the company to earn 15 cents a share ... the bottom line was 7 cents per share ... less than 50% of target! Whoops! Per their report: Net income applicable to common stock, on a pro-forma basis, for the third quarter of 2006 was $4.3 million, or $0.15 per diluted share, compared to the prior year's actual $2.8 million, or $0.13 per diluted share. Including the costs of the recent refinancing, the net income applicable to common stock was $1.5 million, or $0.07 per diluted share, for the quarter ended September 30, 2006, compared to a net income applicable to common stock of $2.8 million, or $0.13 per diluted share, in the prior year's comparable quarter. I'm sure they'll make it up in the future by absorbing income from independent providers, nationwide! Wednesday, October 25, 2006Hanger Clinician Certification?Not so great news! There is now a Hanger Office located in the medical building where my surgeon formerly officed. The clinician name on the door is David Sharma. The bad new ... according to the American Board for Certification in Orthotics and Prosthetics website, David Sharma is not a certified clinician. The absence of his name in both the ABC book and the BOC book leads me to question whether David Sharma has either a license or certification to practice O&P. My question to CIGNA and Linkia ... is this what you mean when you say I am provided with a "uniform level of quality and care"? Oh well ... there is a Susan Sharma listed on the ABC website as working with Hanger in Phoenix. Reportedly, this is David's sister. Perhaps, with Hanger, having a certified relative makes you qualified to provide a uniform level of quality and care! General Acceptance Group Signs Exclusive Contract with "BOB" for OB/GYN Services[Please note: This is a satirical document and is for entertainment purposes only] Lake Wobegon, MN, October 24 Basic Obstetrics (BOB) through its wholly-owned subsidiary, GYN Co, LLC, a provider network management company, has announced an agreement with General Acceptance Group (GAG), the nation's largest provider of healthcare insurance, for the provision of Obstetrics and Gynological (OB/GYN) services. As a result, GYN Co, LLC will serve to assist in OB/GYN network management for more than nine million GAG beneficiaries. The agreement will be effective November 1, 2006 and includes all BOB sites as well as a small number of independent providers under direct agreement with GYN Co. Bob Roberts, CPO, Chief Executive Officer of BOB stated, "We are very excited about our broadened relationship with GAG and we believe that this is another indication of how BOB is effectively reaching its goal of total control of the OB/GYN market and the inevitable elimination of all independent providers." "GAG's agreement with GYN Co, LLC supports an overall network strategy to ensure broad access to providers that meet members' healthcare needs," said Roberta Roberts, Vice President of Marketing for GAG. The newly formed network offers services throughout the country through its locations in larger cities and assures members that they will have access to OB/GYN services within no more than 100 miles from their home, assuming providers can be identified who will accept significantly reduced payments for services provided, thereby allowing for the profitability of GYN Co. and its parent company, BOB. ------------------------------------------ Do you wonder why a similar situation could occur with CIGNA and Linkia for O/P services but that GAG & GYN Co., LLC are nothing more than a product of my imagination? I believe the answer lies in the fact that amputees are a small population, easy to target in many ways! Recent data suggests that there are approximately 1,600,000 Americans living with limb loss (not all appropriate for prosthetics) ... and, according to 2000 Census Data, there are more than 143,000,000 women. Thursday, October 19, 2006Is He Talking About Us??There has been questions as to whether J. Davis is who he says he is ... but they have been resolved by the moderator of the list serve.
The note from Paul Prusakowski clarifying this is as follows: Dear Subscribers, Please be advised that Dr. Davis is a legitimate practicing orthopedic surgeon. His opinion is to be respected and he has requested that I ask you all to respect his business and his time. He is very busy and he has no desire to get involved with our industry politics. My first thought, however, is ... gee ... do you think he's talking about us?? I think I have a good shot at being the patient described as having " unfettered access ... to attack and criticize fellow practitioners within the prosthetic and orthotic industry." It is interesting that the copy on the bottom of the posts says "OANDP-L is a forum for the discussion of topics related to Orthotics and Prosthetics". I think that those critical issues that are impacting the Orthotics and Prosthetics industry should be a defined focus! Dan ---------------- Daniel Gottry dan@gottrys.com 480-491-1020 Visit: www.gottrys.com ================ ORIGINAL POST TO O/P LIST SERVE: I was asked by a practitioner that attends one of my ortho clinics to provide my opinion on discussions and postings on this industry supported list serve. I have been forwarded messages from this site for the past few weeks. After providing my opinion to this practitioner, he asked if I would forward my comments directly to this message board. I am on call tonight with some time to spare, so I will share my observations as requested, brief and to the point. According to the web site, "The forum has been endorsed by the International Society for Prosthetics and Orthotics (ISPO) and the American Academy of Orthotists and Prosthetists (AAOP)." If this is in fact true, than I have grave concerns and trepidation for this industry if this represents the professionalism and integrity of the industry and science of prosthetics and orthotics. It is my interpretation as I read many postings that they are nothing more than abusive rhetoric with the sole purpose to attack various groups and organizations, I find it disturbing that a national and international organization would endorse such behavior. This site declares it is moderated, but it appears that the moderator is prone to promoting a particular one sided agenda and is making little effort to screen or moderate or mediate the postings. Majority of postings are long detailed berating sermons to demonize one company or group. What is most disturbing is that there are no facts or validation to confirm any of the postings; it is all opinion and conjecture. I suggest that this is not the stuff that a professional organization is made of. The site also declares that "The forum is NOT intended for commercial advertising", yet a majority of the postings are blatant advertising for various companies and groups to promote their agendas, association, contracting and/or purchasing groups. There appear to be numerous self serving agendas being promoted which is again, not the stuff that defines a professional orgainzation. What is most surprising of all however is that this site allows unfettered access for patient's to attack and criticize fellow practitioners within the prosthetic and orthotic industry. This is appalling behavior and an embarrassing way for supposed professionals to treat one another. To summarize, the e-mails I have reviewed from this site are distressing and disappointing. If this industry endorsed site represents the quality and caliber of the professionalism of this industry nationwide, than this industry is in dire straights and in for a very rude awakening as the health care industry changes and grows. As a group you may want to ask yourselves the reason that the prosthetic and orthotic industry is being encroached by other allied health professionals and being pressured by government agencies and the insurance industry. Perhaps it is a reflection on the way you treat each other within your own industry, if you do not treat each other within your own industry with respect and dignity, how can you possibly expect those outside the industry to do the same. I thank you for the opportunity to share my insights and opinions. J. Davis, MD Orthopedic Surgeon Denver, Colorado Who is Dr. Davis??Wow, what a post. I would like to ask if any practitioners or any other health care professionals can verify and doctor named J. Davis in Denver or the surrounding areas. First off, I went to Doctor.com, and it is a bogus page, where this supposed email address came from. Secondly, I went online, did a google search for this name, nothing came up. Switchboard.com gave nothing either. There are NO orthopedic surgeons that I can find anywhere in the Denver area with that name. I even went to the website for Colorado, checking all Davis' and there are none in that area specializing in ortho. I even called 411 on my verizon phone, asking for that name and for orthopedic clinics and groups...guess what? NOTHING there either, and they can usually find about anything there. So, this is very ironic, this is the kind of bogus email that SHOULD have been screened by the moderator and NOT posted. Who is this coward that will post an email criticizing everyone that has posted comments, with their real names, real identities, and everything else? Who is really behind this email? I am going to check with a friend that is into computer security issues, knows how to track ISP and other information about where these emails originate from. If anyone else has access to anyone that can track this down, it would be interesting to see where it came from. Personally, I have not seen anyone that is blatantly promoting products for gain or for any reason of that nature. But, wouldn't this seem like a perfect place to ask questions about if products are good or not, or to share experiences with products, services, or whatever that we have been happy with, or have hd horrible times with? Or, should we all just have to do the trial and error method on our own, re-invent the wheel, and not talk to anyone about anything, because it might be seen by someone as to be promoting or degrading something...but yet they hide behind an email address at DOCTOR.com. Also, this should be a place where we can openly talk about issues, political, or otherwise, which does or can affect this profession. This email sounds like it was written by someone that is wanting to stick up for some organization that has been openly attacked or openly criticized recently, but yet will not use a name that can be authenticated. If anyone can verify who this person is, and vouch that he/she exists, then I apologize for this email. But, the point that we should be free to discuss whatever we feel is important to the profession, I stand by that. Also, this email would make it sound as if doctors never criticize other doctors, or air their dirty laundry about other associates in their field. How many times have WE as prosthetists heard some surgeon totally trash another one. And, with all due respect, a lot of the time they have good reason to trash the other doctor. How many times have we seen an ampute have to go back into surgery for a revision or reconstruction due to a poorly done amputation? How many amputees have we had in our offices as a result of some poorly done medical procedure, and have had another doctor just come right out and say, the other doctor screwed up? How many doctors sit on malpractice review boards, attacking their "colleagues" and their "associates" and go on the witness stand testifying against their brother? I don't think we, in this field, have even gotten close to the corruption and trash talking level that the MDs have gotten to. Again, some of the trash talking is necessary to protect the patients, and some of the legal actions are also necessary to protect the patients. The discussion on the Linkia deal, which is what really seems to be the drive behind the email, is very much appropriate, and everyone needs to realize the impact this has on the patients, being that their right to choose their provider has been stolen away, by some corporation that is more interested in stock prices and profits than they are in patient care. Also, something new came up yesterday when I read that Palmetto GBA lost the contract for doing the administration for CMS in a few regions. The NEW contracted party is none other than Cigna. How is this going to pan out here? Will this mean that now all claims and benefits for Medicare recipients are going to have to go through Cigna for service, and if so, will only those providers that are in the Cigna network the ONLY providers that will be allowed to treat the medicare patients??? If that is the case, and Linkia is the administrator for Cigna, there are only Hanger facilities in the Linkia network, and so do the math, or use your simple reasoning skills ... Maybe the competitive bidding deal for medicare won't even matter, we might not even have that chance to bid, because if we are NOT a Hanger facility, we cannot be in the Linkia network, and we cannot be a Cigna provider, and if Cigna is over the Medicare benefits, then you can figure it all out. Any ideas on this? Anyone have any clarity or understand what is going on? If so, please let me know and educate me here. Again, if you, J. Davis MD are a real surgeon in Denver, then I offer you my apologies for not being able to find you. But, I think you have enough problems in your own world to get fixed before trying to attack ours. Jim DeWees, CP [Posted to the List Serve] Wednesday, October 18, 2006A Day of IronyThanks to Jim DeWees for sharing the irony of the day, yesterday. Just a couple of thoughts: First: It is a bit ironic to me that this came from the Amputee Coalition of America. For the past few weeks I have had contact with them about having an article or "letter to the editor" in their publications. That request is apparently under consideration by those higher up on ACA. I certainly don't anticipate being published soon ... although it would seem that, as advocates for amputees (not providers) they would be all over this!! Second: Another irony is that, although CIGNA has now said that the Transition of Care process can not be used to request O/P care, they have now responded to my appeal of their denial by giving me 90 days of care to finish what I'm in the midst of with my prosthetist. Apparently, while the process is not applicable, it still will work. I am appreciative to CIGNA for being responsive to my immediate needs and hope that they will soon be responsive to the needs of all amputees! Good Luck With the GatekeepersDan, I only want to say good luck in keeping your prosthetitist in these "gatekeepers-are-multinational-corporations" times. Are you covered by a HMO BTW? I am too cynical after my 13 yrs as an amp to look at any of your issues objectively. I think every Republican rich bitch is cocooned and living in a perception gated community to the point where we are all "Untouchables" in the Bombay cast sense of the term to them. "Life is pain", they think,"and fortunately I'm not feeling any." Name Withheld Tuesday, October 17, 2006Being Heard?Dear Daniel, I can't thank you enough for all the good that you do for our profession. You are a true angel. We have been fighting this fight for years, and now, I am convinced, because of you, we are being heard. The magnitude of what you do is enormous. Thank you from the bottom of my heart. Sincerely, CO Is Hanger Listing ... or ...Dan, Do you think Hanger is listening or just trolling for a possible libel suit? Or ... they may be trying to find out who, if anyone, is a possible source of inside information. Depending on how you have your web site hosted, it might be interesting to block access from the hanger address and see what happens ... Nothing makes a jerk more nervous than thinking somebody is talking about them behind their backs when they can't tell if it's true or not ... Unfortunately, if Hanger "wins" and they are the only game in town, we might end up having to go to Canada to get our O&P needs met! :-) Steve Good News and Bad News on Continuation of CareI have had one successful case using the Continuation of Care form. However, my second request was not so successful. I just received a telephone call from a representative of Cigna informing us that our request was denied because this Continuation of Care form cannot be used for O and P!!! Thanks Cigna! Funny how the rules change midstream in this fiasco! Administrator, OandP Firm I Just Have to Laugh ...I just have to laugh (not because of it being funny or humorous), but because of it being so IRONIC. I saw this last week and actually was bothered by it. Read just the first part of it: "You are only too aware that an increasing number of people living with the loss or absence of a limb are facing daunting obstacles from third party payers when trying to obtain the prosthetic care they need to enable them to return to an active, productive lifestyle. This obviously has a devastating emotional and physical impact on both them, and their families" What does this sound like??? Maybe Linkia/Hanger only having Hanger facilities in the network, making the amputees leave the care of a practitioner or facility that they are very happy with, all over some game of capturing their "market share" and make the share holders happy. Haven't we all been paying attention to Dan Gottry and his frustration of getting permission to continue his care with his current prosthetist, and seems to be failing at this moment. This is written by Morgan Sheets, on behalf of the ACA, who is greatly funded by Hanger. There are ads from Hanger in every publication they produce, and Hanger is ironically helping fund this effort for parity legislation in all states. Wow, talk about a big spin on things. Just thought I would share this while I was on a kick today. Jim DeWees, CP (I know I am not making a lot of friends today, but who needs friends that don't have the same standards anyway....I would rather be hated by the crooks and thieves than friends with them). [Posted by Jim to OandP List Serve] ---------------------------------- From: Morgan Sheets Reply-To: Morgan Sheets To: OANDP-L@LISTS.UFL.EDU Subject: [OANDP-L] APPLL Update: Prosthetic Coverage Date: Tue, 17 Oct 2006 11:55:21 -0400 You are only too aware that an increasing number of people living with the loss or absence of a limb are facing daunting obstacles from third party payers when trying to obtain the prosthetic care they need to enable them to return to an active, productive lifestyle. This obviously has a devastating emotional and physical impact on both them, and their families. The Amputee Coalition of America (ACA) is committed to a course of action to correct this injustice and improve access to appropriate prosthetic care for all amputees. In 2005, we launched our Action Plan for People with Limb Loss (APPLL), and started working to introduce legislation at the state level that requires insurance companies to cover prosthetic limbs. In the past nine months, the Amputee Coalition of America has supported prosthetic coverage efforts in eight (8) states. We have worked with and advised an additional nine (9) states in the early stages of a coverage initiative. And with help from the ACA and its members, Rhode Island, Massachusetts and California all passed bills in 2006, making a total of six states with prosthetic parity bills in place. What's next? -The PA Health & Human Services Committee is hearing HB 2718, a bill for prosthetic coverage this week. -The Wisconsin Society of Orthotists Prosthetists and Pedorthists (WSOPP) met last week. The executive council introduced the parity initiative to their membership. We are uncertain if introduction will occur in 07 or 08, but they are moving forward. -We now have a bill moving in OK. A number of potential sponsors have been identified. We are currently working on bill language. -Our brand new online Action Center and enhanced organizing toolkit will launch this November. -We just put out our new outreach brochure. There are many exciting opportunities just around the corner as we prepare for the 2007 legislative session where 9 states are already poised to introduce legislation Monday, October 16, 2006Buy Shares of Hanger?To gather some power against HGR one tactic that could be utilized is if many CPOs etc bought a some shares they could: 1) receive communication from HGR HQ 2) vote on various issues such as the election of HGR's Board of Directors A few shares bought by 1000+ P&O practioners, techs, administrators & patient could aid the future of O&P. Mike Profit Driven vs. Patient OrientedDear Dan, Last Spring I asked my Amputee Clinic to prescribe a BE Socket with a special non-binding harness that would not impinge on my sound shoulder. There were several "vendors" present, one of them from the local Hanger facility. The request and prescription were specific for a harness/cable operated system due to limitations of the affected side I interviewed at four different facilities in my area to ask what their ideas would be able to accommodate this for me. The Hanger representative that I saw was only interested, and only presented, a myoelectic product even though it was specifically said in clinic, where he was that day, that this was not a feasible application. He repeatedly insisted that he could fit me with a good arm. I have heard the same from other amputees who don't have the "nerve" to question the "expert" about what is proper for them. I really question all the "hype" the media is fed about the wonderful new "bionic" arms and legs that are not feasible for an everyday user who would end up paying for costly repairs due to constant breakdowns. One CP told me he saw more c-legs being pushed around in wheelchairs, rather than walking, while attending an ACA Convention. The majority of amputees are not young, well-informed individuals. They are elderly and are used to being told by "experts" what they should have. The young, new traumatic amputees do not have the information needed to be able to distinguish a good CP from profit guided CP,. their main concern in the first year is just to absorb all the nuances of a different life. However, they do see the "bionic" stuff on TV and wonder if that would make them not so disabled, especially to their friends and family. My son had the same experience 7 years ago when he was "assigned" to a Hanger facility and went through a very difficult time to get a proper fit. When he needed a new leg, he was extremely fearful of having to go through the same painful time again. I sincerely question Hanger's business model. It is apparently profit-driven and not patient oriented comfort with the life giving ability to continue their lives as easily as possible. Thank You Hudaa Nielsen Human Female Amputee How Are Independents Going to Survive!Competitive bidding is coming soon - it is a fact of life. How are independents going to survive? If independents continue to support large distributors owned by their competition they are helping the competition to increase purchasing volume. (Not to mention helping their cash flow). Helping your competition increase purchasing volume enables them to negotiate larger purchasing discounts. These larger purchasing discounts will enable the competition to out bid the independents for the competitive bids. As I said before survival means not sitting on the sidelines and whining it is time to take action now or you won't be in business later. It takes efforts of the industry as a whole. Eric S. Eisenberg M.S.; C.P.O. [Posted to O&P List Serve] Do You Want To Be Heard?Thanks to all for their patience as I posted items to this new blog from the past few weeks. It was very interesting to see that one Hanger Orthotics IP address has hit my website more than 700 times in the past few weeks. For what it is worth, the message is being read! Do you have something to say that you want Hanger to hear? You can post comments to the blogs or send an email to me to be posted anonymously. Please write only those things that I can really post!! Thanks to all for helping to get this critical message out to the public! Dan www.gottrys.com/about/ Sunday, October 15, 2006How Does Evil TriumphThroughout history, it has been the inaction of those who could have acted; the indifference of those who should have known better; and the silence of the voice of justice when it mattered most, that made it possible for Bureaucratic and Mega-Corporate triumph. (Haile Selassie) Human Female Amputee Saturday, October 14, 2006Standing Up To The BulliesI think it about time some body stood up to the bullies. Thanks. Congratulations. Name Withheld Friday, October 13, 2006Ongoing Struggle Within O&P CommunityConcerning the ongoing struggle within the OandP community ... Gandhi's advice to Martin Luther King, Jr regarding non-violent protest: FIRST They ignore you, THEN They laugh at you, THEN Then they fight you, THEN Then You Win !!!! Name Withheld 26 year AmputeeSir, I've only been online for two months and as an BEA of almost 26 years, I am really liking what you are saying. Thank you so much. My postings sound like rants right now, but I am angry as all get out since I found out what was really going on. Two of my Prosthetists told me and I about flew off the handle right then and there. I got out of health care 10 years ago after being in it since 1967. I was a Nuclear Medicine Technologist. I couldn't stand the bureaucracy. Thank you so much. I look forward to getting to your site and be of any assistance I can. Name Withheld Wednesday, October 11, 2006To All Who Are Following Linkia/Hanger IssueTo those that are following the Linkia/Hanger/SPS issue: I just got a call from a rep at Linkia, trying to get me to sign an agreement with them to join the network. I asked her for some prices, and she could not give them to me until I signed the agreement. I asked her if the prices were that bad that she was embarrassed to tell me what they were, or what the problem is. Or was I being suckered into signing a contract before knowing what was in it. She finally told me what the reimbursement for 2 codes was, and because I am probably NOT allowed to share that here on this list, I can say it was between 35% and 40% BELOW medicare in my state. I congratulated her for getting the prize for being one of the lowest payers in the state, even below MEDICAID!!! And, then to top that off, they would only pay the 80% of the allowed, if that was the patients benefits, and I wonder if they still have customers that only have 50% coverage, I did not ask that question. What a loss that would be to basically do charity work and take a loss on a claim, only so that Hanger would benefit and make the money. Nice business strategy, they can put us all out of business eventually if we take a loss on every service we provide. I then asked if ABC Accreditation is required, and she said it was NOT required at this point, and that any person wanting to join the network would not be required to have accreditation or certification. I again had a "wow" response to this, and asked her if they were THAT desperate that they would just allow ANYONE to join in, and how in the world could they ever just let anyone join in with NO certification or accreditation. I thought that was one of their big advertising and seeling point, that they would have only the highest quality standards and requirements by going to this network. (On a side note, Point Source is still in the Cigna network at the request of Cigna, and they DO require ABC Facility accreditation, and also cerfitication, and their reimbursement rates are a LOT higher than what Linkia is offering....I am NOT affiliated with Point, I am not on their payroll or have anything to gain by saying this). So, what is going on here? Maybe it is due to some legal activities going on that they are scrambling to get people other than HANGER facilities in the network. If anyone knows of the legal actions that are going on here, please advise us and fill us in on what is going on. I have gotten some information about the legal battles that Hanger is involved with over stock trading, the medicare issues in New York, and the OIG being on them, etc. But I don't have any credible information about what is going on with Cigna and Linkia. Something must be going on for them to be offering this enrollment with no credentials or anything. We all need to really think about what impact this will have on the field if we join this network, or any other network similar to this one. Are we going to help them build a network that can eventually end up eliminating the competition, which has been a huge discussion lately. I cannot make any comment on what anyone in this field should do, only pose the question and let everyone out there think about it on their own and make their own choice. I know what my answer to this is. I know what Cigna has paid in the past, and I also know what Cigna pays if you are through another network, like Point, which all I can say is they pay a LOT more than what Linkia is offering. I went back over a few of the claims that I have filed with Cigna, and saw what they paid during the past 2 years. Now, through Linkia, the prices have dropped about 40%. How is this good for anyone out here, especially the amputees??!! From what I can gather from all this is, Cigna must still be allowing the same amounts, but they give the money to Linkia first, and then Linkia keeps whatever they can get away with, or what we will tolerate. They keep the rest. That is the ONLY way Linkia can make any money. We need to all look towards the next Hanger quarterly meeting, which is in a few more days. We need to see how much Linkia has made in this last quarter, and see what they project the dollars to be in the upcoming quarter. Just remember, Linkia does not fabricate anything, they do NOT produce anything, they do NOT see patients, the do NOT DO ANYTHING to make any money. The ONLY way they can make money is by skimming money off each claim that gets processed. They only make money by stealing a portion of the payment that Cigna has paid for a device or service, and that is money that should be paid to the actual provider, and NOT SOMEONE THAT DOES NO WORK or provide any services. We need to talk about this with everyone in every area of the country. We CANNOT make any plans of boycotting anything, or cannot do anything like that at all. But, we can talk to each other, educate each other, even if the other facilities in your areas and not your friends, you need to talk to them, because they are probably not on this list serve and may not even have clue as to what is going on here. Heaven forbid if we would expect any organization (ABC, AOPA, the Academy, etc) to educate us on this matter, after all, they are all filled with people from Hanger that run these programs. And, even the ACA, after their big InMotion magazine publication a month or so ago which harped for several pages about these evil insurance companies, and what we were all fighting against (speaking as an amputee), they still will NOT SAY ANYTHING to warn people about any group like Linkia, and just keep a very low profile on this issue. Why? I don't know, maybe they need the money from Hanger so badly that they will just ignore this problem. On another topic that I mentioned in my last post, about SPS. I got many emails, lots and lots or emails, supporting what I was saying, and several from Hanger employees themselves. They have asked me to keep the remarks and identities private, which I have always honored. One of these emails explained that there is a lot of information and data that is collected by SPS, which only makes sense after I started thinking about it. SPS/Hanger can learn and collect information on geographic areas, where there are high volumes of sales. If there are lots of sales in some area, that must mean there must be a lot of amputees, and therefore, a great place for Hanger to go and open up an office. Another person sent me an email about how they had bought everything from SPS for years, not thinking about who owns it, etc. Then, all of the sudden, there was a Hanger office just around the corner from them, and they went out to conquer the area, giving great little gadgets and gifts to all the doctors offices, and tried to get the referrals. It worked for a while, and then the patients and doctors realized that the prosthetic devices were made using the cheaper components, and the patients lost that personal element with the practitioners. So, if you are wanting to give all your data about how many patients you are working with, and give the competition all your information about your business, then just go right ahead and buy everything from a vendor that is owned by the company that wants to be in total control of the market. That is certainly not something that I would want to do with my office and business, give any information away that might entice them to come and open up next door. Again, everyone needs to call the other facilities in the areas, discuss the future of O&P, educate each other on the issues: parity, licensure, medicare changes, managed care contracts, vendors, etc. Do not discuss anything that would be illegal, like price fixing, boycotting, etc. We can leave all the price fixing discussion to the insurance companies, and to 3rd party administration groups, because for some reason it is legal for them to do, but not us, or at least that is what it seems. Good luck out there. Jim DeWees, CP (Posted on O&P List Serve) Monday, October 09, 2006CIGNA Denies Continuity of CareI just received a call from my prosthetist who reported receiving a call from a CIGNA Representative in their Pittsburgh office. She informed him that the request for "Transition of Care" (which she referred to as "Continuity of Care") for Dan Gottry has been denied by the medical director. She commented that this form does not apply to ancillary providers. I asked her if the form only applies to physicians and she could not answer. She could not answer any questions about the issue but did mention letters will be sent out to the patient and the provider. She indicated that we could call to schedule a peer review with Dr. Osbourne, the denying medical director, by calling 1-800-558-4314. As a patient absolutely in the middle of a process with my prosthetist . CIGNA has certainly left me up to my eyeballs in alligators! Dan Tuesday, October 03, 2006Pushing for Prosthetic LegislationI appreciated Dan sharing the informaiton with us regarding Senator McCain and his appeals. I hope the insurance company realizes how ridiculous they are acting about coverage. It gave me a little more information to use in my lobbying for the parity law here. I am from the State of Utah, and I am excited to be pushing for prosthetic legislation here. I have a legislative sponsor for the bill, and we are working hard to have this bill passed in our session in January. Any additional information I can receive in lobbying for this important bill is so appreciated. Tami Stanley (Posted to Washingon University List Serve) Thanks to Those Who Openly QuestionI am also pleased with recent advocacy and movement by some to help and provide the much needed support for reform in the O&P industry. Unfortunately it took the real threat of elimination of ALL independent providers for some to act. In this case, it is again a patient leading the providers to advocate and address the monopoly controversy. Thank you Dan Gottry,Jan Saunders and sadly only a handful of other providers who have openly questioned and retaliated against the industry conflicts and monopoly efforts that have been in place for a long time, but have more recently surfaced with concern of Hanger's wholly owned subsidiary Linkia and network contracting and monopoly strategies thru their 620 facility network AND their wholly owned subsidiary distribution facility. Apathy is dominant in your profession."Providers speak out". You should be more concerned with the 'elimination' of your practices as the result of the complete lack of funding by third party payers, than the fear of possible retaliation by distributors in increasing your costs of components and supplies. www.gottrys.com Tony Barr (Posted to List Serve) It's About TimeThank God. It's about time. I have for years been complaining about the amount of apathy in our industry. It is so refreshing to see the people, not the self-serving trade organizations who don't want to affect their advertising dollars, working in a grass-roots effort to try to make change. Getting Sen. McCain's office to pay attention shows the impact of the power of the people. PLEASE continue to fight this battle as this is just the beginning. We also need to address State Licenser, Parity, and "any willing Qualified Provider" legislation. We need to write letters and tell each and every patient we see that their P&O care is in jeopardy. We need to empower our patients to get up and contact the politicians, as they truly cannot be ignored by the politicians or press. What a loss to our cause when the President of the United States is photographed with a vet missing two legs running with him while the plight of our industry not being conveyed is a shame. By 2010 there will not be enough practitioners to serve 75% of the patients who rely on us. Too few schools, too many practitioners retiring, reduced reimbursement, all [are] impacting the number of new practitioners coming into the field. We are obligated to our patients and our industry to stir up each of our patients and set them on Congress & the State legislature, and yes, the President, if we ever get that opportunity again. Write a letter to your patients, give them some literature, talk to them. Do something. It's your obligation. Don't stop. This is the beginning. Jan Saunders LOP, CPO (Responding on OANDP-L to Mr. Daniel Gottry's recent posts) Efforts on Behalf of AllThanks Dan for your efforts on behalf of all amputees. Name Withheld Thank God O/P Issues Are Being AddressedThank God, it's about time. I have for year been complaining about the amount of apathy in our industry. It is so refreshing to see the people, not the self serving trade organizations who don't want to affect there advertising dollars working in a grass roots effort to try to make change, getting Sen. McCain's office to pay attention shows the impact of the power of the people. PLEASE continue to fight this battle as this is just the beginning. WE also need to address State Licenser, Parity, any willing QUALIFIED Provider. We need to write letters, and tell each and every patients we see, there P&O care is in jeopardy. We need to empower our patients to get up and contact the politicians, as they truly cannot be ignored by the politicians or press. What a loss to our cause, when the President of the United States is photographed with a vet missing two legs running with him, and the plight of our industry not being conveyed is a shame. By 2010 there will not be enough practitioners to serve 75% of the patients who rely on us. To few schools, to many practitioners retiring, reduced reimbursement, is impacting the number of new practitioners coming into the field. We are obligated to our patients, and our industry to stir up each of our patients and set them on Congress & State legislature, and yes, the President if we ever get that opportunity again. Write a letter to your patients give them some literature, talk to them do something, it's your obligation. Don't stop, this is the beginning. Jan Saunders LOP, CPO (Posted on List Serve) Monday, October 02, 2006Forward to Ted Kennedy & Mitt RomneyHi Dan - Can you send me a copy of what you sent to Senator McCain and I'll gladly forward it to Ted Kennedy and Mitt Romney (Presidential wannabe). Thanks, Name Withheld Sen. McCain Forwards Issue to Dept. of Health & Human ServicesA recent letter from Senator John McCain confirms that he has sent information on to the U.S. Department of Health and Human Services, as this situation may fall within its jurisdication. You can see Senator McCain's letter at www.gottrys.com/leggo/ . Specifically relative to Medicare and Medicaid, the U.S. Department of Health and Human Services certainly recognizes that a limited provider network can have "monopoly power" in its negotiation. It would appear that this should also be true in the case of insurance providers. This addressed this as it related to hospitals in: Federal Register / Vol. 70, No. 18 / January 28, 2005 / Rules and Regulations 4625 We noted that in attempting to create region-wide networks, MA regional plans will be forced to bargain with hospitals that may be the only hospital (or the only hospital with a particular service or services) in a broad area. We believed that such a hospital would have a ''monopoly power'' in negotiating with plans that are, in effect, forced to contract with it in order to secure an adequate network of contracted providers with which to serve anticipated Medicare enrollees. Hopefully this perspective has a broader scope than simply medicare! To help make this an issue with investigating, write to: The U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C.20201 |
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