Resources from an Amputee

Mothers, don't let your sons grow up to be DUI/DWI Defenders!

2007-09-24T07:02:00.000-07:00

I was recently invited by some friends to attend an ASU Football game. We had a great time (ASU won!) but, while walking out of the stadium, we were talking about the pre-game tailgating drinking parties held throughout the parking lots, and the amount of alcohol that would be consumed by attendees before they hit the road. While they don't sell alcohol in the stadium, the role it plays in the evening is hard to miss.

When we returned to our car, we found a card under the windshield wiper, compliments of the Law Offices of David Michael Cantor, P.C., promoting his business. I personally found it disgusting and dangerous. The card gave a number of very specific do's and don'ts about what to do when you are stopped for investigation of a DUI/DWI offense.

I found it extremely disturbing that a law firm would distribute information that, I believe, could be deemed an encouragement for the intoxicated driver to get behind the wheel of his or her car, now that they armed with the attorney's best advice for their defense, if stopped.

Perhaps it is time that law firms who engage in this practice be able to be charged as accomplices in the event someone is injured or killed by one of these well unfortunately informed drivers!

David Cantor ... I hope your mother doesn't see one of these cards!

If you find it disgusting, call (602) 307-0808 or (888) 722-6867 and let them know!

Lots of Changes

2007-09-10T13:07:00.000-07:00

I just looked back at my last blog and found that it was six months ago. Wow! A lot of things have changed in that time. While I was one of many impacted by Hanger/Linkia's power play in the O&P Community, I've left that group.

At the end of March, as a result of an infection, my surgeon performed a hip disarticulation on my residual left limb. Because of my tendancy toward infections, we determined that it was in my best interest to avoid prosthetics and work on my upper body strength. I've added a small scooter to my garage for use on longer treks and have ordered a HandBike to help me get in shape and work on the needed upper body strength. It should arrive within about 10 days ... I'm excited to get back on self-powered wheels!!

Because certain handbikes are impossible to find or see in Arizona, I'm establishing a relationship with Bike-On.com, a premier distributor for handbikes, recumbents and more! You can check out my connection at www.ArizonaHandBike.com!

I'm looking forward to helping others, in my community, get active with these exciting bikes!

Dan

Insurance Update: Providers in Illinois Take a Hit from Blue Cross Blue Shield

2007-03-14T12:34:00.001-07:00

According to Gil Gulbrandson, C.O. from Illinois, Blue Cross Blue Shield had not so great news for Illinois Providers. He indicates that:

"We received a letter last week from BCBS of Illinois informing us that as of June 1, Illinois will have an O&P network. As most of you in IL know, to date there has been no network in IL. You could be a participating provider, but no network. BCBS paid at our list pricing."

"In this new network, BCBS stated that the reimbursement would be Medicare allowable. For those of us in IL this will be a big hit. If you weren't aware, just thought I'd end your day with this cheery news. One more hit to our cash flow!"

From the previous post, I would believe that California providers would prefer Medicare rates to 23% less!

Insurance Update: Blue Cross Reimbursement Rates Result in More Losses

2007-03-14T12:33:00.001-07:00

According to Wade Skardoutos, a CP from Mountain View California, Blue Cross has cut all DME reimbursements to 23% below Medicare. He states "I found it to be a significant loss to my company, and have chosen not to contract."

Additional losses result from the fact that other insurance companies and Workers Comp use the Blue Cross fee schedule to reimburse.

He questions whether this policy is price fixing. While generally price fixing is done by the sellers instead of the buyers, there certainly should be another name for this situation!
His bottom line question is "can't we all just accept Medicare fee and stop these negotiations? Maybe then we could all sleep better and service people better."

Contact with CIGNA

2007-02-13T08:32:00.000-07:00

The following information was sent to Gregory Shannon, gregory.shannon@cigna.com who is responsible for decision pertaining to CIGNA's network of O&P providers. You may wish to join me in communication to Gregory!

Thanks, Gregory, for your response.

I appreciate your willingness to hear issues and consider these issues from the members perspective.

Having been in business for 30+ years ... and for most of that time having to deal with insurance providers from the perspective of a business purchasing coverage, I understand cost concerns and am a proponent of identifying cost saving strategies. My concern is that, in this case, the strategy employed has gone too far, to the extent that it is hurting the end user in such a manner that the cost savings are not sufficient justification.

You asked that I provide specific issues and suggestions and I want to honor that request. I will seek to do that in as consise a manner as possible!

ISSUES:

1. The relationship between CIGNA and Linkia creates a severe limitation to competition which I believe is already resulting in a deteriation in the quality of services to patients. This will inevitably drive providers out of business, allowing one provider to control an industry in a detrimental manner. (82% of independents already indicate a loss of market share to Linkia/Hanger).
2. The limitation in providers has added a great deal of complexity to a patient's ability to access care, often necessitating drives of 3-4 hours to access services, when a qualified provider is located right down the street.
3. By unreasonably requiring patients to change providers, the history that contributes to quality of care is lost.
4. Because Linkia is an additional layer in the provision of service, rates paid by Linkia to providers do not allow profitability required to remain in business. Their payments to their Hanger facilities and the minimal number of non-Hanger facilities who have been invited to participate in the network will result in losses by the providers, therefore eliminating an incentive to provide quality of care. Apparently, even some Hanger facilities have indicated their reticence to serve CIGNA patients because of the financial implications.
5. It appears that Linkia is not delivering quality of care as promised. Not only are patients in our state, and others, required to drive hundreds of miles to a facility, in many cases reported to me, Hanger has provided care in non-accredited facilities, by non-licensed or non-certified clinicians. I have been made aware already of cases in which care was inappropriate and has resulted in a need to have other, non-Hanger providers, complete the work in an appropriate manner. The limited reimbursement to the providers appears also to be resulting in shortcuts being taken in the care provided.
6. Inevitably, as competition is increasingly limited, Hanger will position itself to control rates charged to insurance providers, putting our future care and coverage in jeopardy. I believe within two years, CIGNA will pay an excessive price for the savings it is benefitting from today.

SUGGESTIONS:

1. Until further strategic plans are made to address this issue, allow all existing patients to continue to utilize their qualified providers with a request for continuity of care. Contract with the other significant network (OPGA/Point) to broaden the network of providers available to new patients.
2. Evaluate, with the assistance of provider input, cost reimbursement levels that are reasonable for a contracted provider (as a percentage of Medicare established rates).
3. Eliminate any exclusivity in your contract with Linkia/Hanger. Hanger's CEO has already stated that they do not require exclusivity.
4. Once reasonable rates have been determined, establish CIGNA's criteria for inclusion of a provider (I believe it is reasonable and prudent to require providers to be Certified and perhaps accredited) and offer contracts consistent with the reimbursement levels determined to be reasonable. This will reinstate reasonable competition in the provision of qualified care.

As I've indicated, I have created a website that contains a great deal of information about each of these issues. You can see a great deal of information and responses from patients and providers at http://www.gottrys.com/. Click on resources and also the blog.

I also encourage CIGNA to utilized patients to provide input that will help you make informed decisions. If CIGNA decides to do this, I would be very interested in being a part of a patient resource group.

Thanks for reading ... I'll be looking forward to hearing from you!

Daniel Gottry

He Loved Hanger!

2007-01-09T10:33:00.000-07:00

This morning I received a call from a fellow AK amputee, looking for a little help.

"L" has been an amputee for about thirty years as a result of injuries sustained in an automobile accident. For a great deal of his time, his care was provided by Hanger back when, as he describes it, Hanger was a Ma & Pa company. He says he LOVED Hanger. They provided quality care and served him very well!

Then there was a merger with NovaCare, and they seemed to him to become much more concerned with money than with people. His care "went south".

A few years ago, he moved to Arizona and was seen by a Hanger clinician on a number of occasions. They built a leg for him. They told him they didn't need to cast him as they could put his measurements into their computer and it would design his leg.

They measured ... the computer designed ... "L" didn't walk.

He called and asked for help and was told that they had designed what he needed and they could not help him any more. They were done.

"L" still didn't walk.

Three years ago, he returned to his physician to seek assistance and was referred to a local independent provider for help. He was casted, fitted and has done well with his walking for three years.

Now its time for some change and CIGNA, his insurer, has refused to allow him to see his provider. In fact, the operator on the 1-800 number he called, hung up on him when he asked how to request a Continuation of Care.

The thought of going back to Hanger is one he finds extremely depressing!

Hanger/Linkia ... "Does Not Play Well With Others"

2006-12-29T13:53:00.000-07:00

A new year is upon us ... but some of the old battles remain.

I am grateful to CIGNA for allowing me to continue to receive quality of care through December 31st with my prosthetist. I had my last appointment today, having been fitted with a new socket. Current contracts not withstanding, I fully anticipate that they will allow me to continue to receive that care, in the new year, as needed.

For Hanger/Linkia, I offer my contribution to their annual report card ... "does not play well with others" ... but I guess they figure when they are the only game in town, that will matter very little.

The battle for quality options for O/P patients continues on this front although you might say it has entered a "quiet phase". The O/P list serve has become very resistant to communications on this critical issue. I'm sure the pressure has been overwhelming such that even posts that are much less than combative are censored.

A bad idea, however, is always a bad idea and time does not make it better ... time just makes it more evident. I am looking forward to a meeting with CIGNA personnel in a few days. We all know what the topic of discussion will be. I strongly believe that they are beginning to understand the error of their decisions.

A consequence of the limitations of the list serve is that it is more difficult to hear what others are experiencing. It is very helpful to hear what others are experiencing. If you have a story to share, send it to dan@gottrys.com. And, thanks to all of you who have already send your stories!

Happy New Year to each of you!

Consistent Quality of Care Through Hanger/Linkia

2006-12-05T08:35:00.000-07:00

After Karen's * second surgery, her knee was placed in a cast by her doctor, to stabilize her knee. When the cast was removed, she was sent to a Hanger facility in Phoenix where she was under the care of a clinician in the process of meeting certification requirements. Her experience was a self-described "nightmare".

She was to receive a type of full leg brace and subsequently and AFO.

When she was fitted with the initial brace, she wasn't even able to wear it for the full ride home as it was too painful. She just assumed she just would need to "get used to it". It continued to get worse.

When she want back to be fitted with an AFO, she was told she did not need to have a new mold/cast made as it could be done off the old brace. Because the brace never fit, she requested a new mold/cast but that request was refused.

When she received the AFO, it fit so poorly that she was in fairly constant pain, had swelling in her ankle and could not support her own weight.

Karen had physical therapy for two months with no success and was fighting depression. She wrongly believed that it was her issue ... she just wasn't trying hard enough. The therapist suggested that perhaps the brace wasn't right but who was Karen to question the professional who fitted her?

Finally she returned to her doctor and saw the doctor's assistant. The assistant indicated that Karen's ankle appeared to have shifted.

The assistant sent to another professional immediately. She learned that the brace was actually the wrong type of brace for her needs. Months of therapy could not relieve her pain.

She was fitted with a new correct brace and, after walking for months with crutches or a walker, she was walking with one cane within less than a week and she continues to improve.

At this point, Karen continues to battle her insurance company (United Healthcare) as they will only cover one brace every three years. Her reasonable question is ... what if it is the wrong brace?

I guess that's a question that no one should have to ask.

* Patient's name has been changed for confidentiality

Independent Providers CAN Work Together!

2006-12-05T07:38:00.000-07:00

My experience is that independent business men and women are generally just that ... independent! It was encouraging to last Friday to see 20 O/P independent business professionals from throughout Arizona in one room, addressing a common concern with mutual respect and incredible openness.

These 20 men and women came together, many driving for hours, to consider how they could strengthen their industry and their businesses by working together toward a common goal. They heard a very informative presentation by Jim Andreassen of OPGA/Point about the benefits, in changing times, of working in collaboration with those with common interests. He addressed the benefit of creating a cooperative network within the state of independent providers as well as the benefits of partnering with a national network to help them compete in a changing market. Both of these possibilities were met with a positive response!

The survival of independent O/P professionals is critical to the quality of care that patients will receive and I applaud the foresight of their thinking and their efforts.

For more information, visit www.gottrys.com/resources/

Daniel Gottry
Amputee

Is CIGNA Really Getting What it Pays For?

2006-12-01T07:22:00.000-07:00

FYI ... I asked a friend (CPO) who had responded to me about David Sharma about the requirements and the actual situation and he responded with the following:

"David Sharma works at that office independently as the sign on the front door states. More so his name on the sign does not have credentials. It is my understanding this has been the case since their previous Certified Orthotist David Garcia has left Phoenix and was transferred to Yuma."

"We have a patient who was serviced by David Sharma, she was evaluated by him, casted by him, delivered by him, and was back for numerous adjustments by him. I have specifically asked her about this and she said she was never seen by anyone else in that office."

"Per Linkia's own words and per ABC requirements, a resident can only work directly under an ABC certified practitioner. Per my understanding and how I run a business, that does not mean someone in the building or down the road, that means directly under, or side by side, or shadowing, or assisting... in no way do I see independently as appropriate."

"The bold message states "David Sharma is not certified", that means he is a board eligible resident which per law mandates him to residency requirements. Maybe a call to ABC and NCOPE (National Commission of Orthotic Prosthetic Education) to verify this structure is needed. NCOPE's job is to monitor O&P residents and set their formal guidelines. Davis Sharma is not following the residency guidelines."

I agree that there is certainly "intent" in the requirements that is being skirted by Hanger.

I know a little more about this individual's situation. She was sent to my contact by her physical therapist who found that the device that Mr. Sharma created was so poorly fit it was hurting rather than helping her. She did not tell him anything the therapist said to see if they were in agreement ... when he gave her the same information, she then shared what the therapist has told her. Certainly appropriate supervision would have prevented that issue.

CIGNA Responds to Questions about David Sharma

2006-12-01T06:41:00.000-07:00

Thanks to CIGNA for researching the situation with David Sharma by contacting a Linkia representative.

They were informed that "there are 4 certified prosthetists supporting that location." These include Jack Uellendahl, Randy West, Lori Pipinich and Todd Sheridan, who are each certified with ABC.

While there is no indication at David Sharma's site that they have an involvement (since he is listed as the only "clinician", CIGNA states that Jack Uellendahl, Randy West and Lori Pipinich "also" work at another location.

They confirm that "David Sharma is not certified at this time; however, he is currently in the certification process. In accordance with the American Board for the Certification of Orthotics and Prosthetics guidelines, a practitioner that is not certified can provide care under the direction of a certified practitioner. This requires a sign-off of clinical notes."

The fact does remain that his facility is not listed as an accredited site, something that appears to be in opposition to Linkia's stated requirements.

The ABC requirements, as per the written intent of the standard, go a little further than a simple sign-off. They state:

PC.3: Orthotic and prosthetic care is the responsibility and is provided by or under the direction and appropriate level of supervision of an ABC credentialed, and where appropriate, licensed practitioner staff member.

StdIntent: The underlying foundation of quality orthotic and/or prosthetic care is the provision of care by qualified practitioners. Thus, PC.3 requires that all such care be the responsibility of a certified practitioner. While aspects of patient care may be directly provided by another individual, it must only be delivered under the explicit direction of a certified practitioner.

As used in the ABC Scope of Practice and incorporated herein, the term "indirect supervision" denotes that the care giver is qualified to provide patient care independent (indicating that the individual so supervised, is competent to work with a patient without the immediate presence of the clinical supervisor in the room) of the designated clinical supervisor; however, the supervisor must review and countersign all entries in the patient's clinical record within 15 working days following the delivery of care.

The supervisor must be physically available for consultation within 60 minutes during the delivery of care.

PC.3.1: Non-credentialed or licensed staff may be privileged by the ABC credentialed practitioner to provide patient care according to written objective criteria based on the ABC Orthotics and Prosthetics Scope of Practice.

StdIntent: The underlying foundation of quality orthotic and/or prosthetic care is the provision of care by qualified practitioners. Thus, PC.3 requires that all such care be the responsibility of a certified practitioner. While aspects of patient care may be directly provided by another individual, it must only be delivered under the explicit direction of a certified practitioner.

As used in the ABC Scope of Practice and incorporated herein, the term "indirect supervision" denotes that the care giver is qualified to provide patient care independent (indicating that the individual so supervised, is competent to work with a patient without the immediate presence of the clinical supervisor in the room) of the designated clinical supervisor; however, the supervisor must review and countersign all entries in the patient's clinical record within 15 working days following the delivery of care.

The supervisor must be physically available for consultation within 60 minutes during the delivery of care.

Because the locations are within a couple of miles, it is possible that a supervisor would be physically available within 60 minutes but I question whether care in this situation is delivered "under the explicit direction of a certified practioner." This, I believe, would require a greater presence than appears to be the case.

Questions that remain, from my communication with CIGNA include:

1. Is Linkia firmly abiding by its own standards?

2. While the situation with David Sharma may be explainable, in all other cases where they have chosen to make exceptions to the accreditation standards, such as Jackson, Tennessee, do all of their non-certified practitioners operate "under direct supervision" and have a supervisor available for consultation within 60 minutes?

3. Is their agreement with Linkia truly non-exclusive, as indicated by Hanger's CEO in the O&P Edge?

4. Why is McCleve O&P is still under contract with CIGNA in this area while others have had their contracts terminated?

I have requested from CIGNA the name and contact information on the individual ultimately responsible for the O/P contract decisions but await their response to this request.

CIGNA Slow on Responsiveness

2006-11-29T08:12:00.000-07:00

The following was sent to CIGNA, November 29, 2006, following a significant period with no response to questions about the qualifications of Hanger Facilities:

Christine . I have included below the questions that I sent to you on October 26th. November 2nd, and November 10th, regarding some of my concerns with the provision of services by Hanger facilities under their new, very limiting, contracts with CIGNA. I know that you have passed them on but, to date, I have had no response. I have highlighted my specific concerns in the copies below.

I understand how you ended up in the middle of this because of the questions I raised about the legal issue surrounding this issue. However, I also know that this issue does not fall within your area of responsibility.

Can you please provide the name and email address of the person who has ultimate responsibility for decisions related to contracts for O/P services?

It is my opinion that CIGNA has, unknowingly, become a victim (as have your patients) in this situation. I continue to hear more horror stories of inappropriate care being provided by unqualified practitioners.

I have a strong interest in helping CIGNA to determine a better, mutually beneficial, solution for the provision of consistent, qualified care for amputees and others who require these services. I firmly believe that CIGNA has made a strategic error in the direction they have chosen and inevitably needs to rethink those decisions. You will recall that I have suggested that there would be benefits to CIGNA to involve some of the users of these services in the decision process and have offered to help in any way possible. That offer still stands!

Once I have a contact name and email I will communicate directly with that individual!

Thanks

Dan

----------------
Daniel Gottry
dan@gottrys.com
Visit: www.gottrys.com

------------------------------

-----Original Message-----
From: Daniel Gottry [mailto:dan@gottrys.com]
Sent: Friday, November 10, 2006
To: Reuther, Christine A ESQ TL16F
Cc: Doherty, Jeannine 397
Subject: Provider qualifications

Thanks, Christine. I am still waiting for a response on this. I would guess that some of these answers are hard to come by.

I was rereading a response from CIGNA in which local staff said that Linkia was imposing the same standards (accreditation) on its Hanger facilities as it was on outside providers with which it may contract. The accuracy of that statement seems to be more in more in question as I find more Hanger sites without accredited clinicians and no facility accreditation.

After reading an article in The O&P Edge, I had another question. Hanger's CEO indicated that it does not require exclusivity in its agreements with insurance companies. That seems to be contrary to some information that I've received from CIGNA. Is there any level of exclusivity required in your contract with Linkia??

I have also requested info in why McCleve O&P is still under contract with CIGNA in this area while others have had their contracts terminated. While CIGNA has said told me the longevity of this contract is unknown, word in the rumor mill is that McCleve's contract is still in place because of a longstanding relationship between one of the McCleve brothers and an individual higher up the food chain at CIGNA.

This seems a bit bizarre but, perhaps you could shed some light on why a provider such as McCleve still remains under contract, contrary to CIGNA's stated direction in O&P services!

Thanks! I look forward to hearing from you!

----------------
Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

-----Original Message-----
From: Daniel Gottry [mailto:dan@gottrys.com]
Sent: Thursday, November 02, 2006
To: Reuther, Christine A ESQ TL16F
Cc: Doherty, Jeannine 397
Subject: Provider qualifications

Christine ... haven't yet heard anything about the non-qualified provider in the neighborhood of my office ... but, I thought you might be interested in this letter that I received regarding Linkia's double standard ... resulting in CIGNA patients being cared for by non-qualified providers. I know there are many patients interested in knowing more about how this is really working out!

Thanks

Dan
----------------------------

Re: Linkia/Double Standard

First I would like to commend you for the work and input you have and are doing regarding the Linkia / Hanger situation. I work for a very small Independent with 2 locations . One in Memphis, Tn. and I am in a small rural town 120 miles away. We approached Linkia at the beginning of this whole process and never heard a reply. At the second approach we were told being that Hanger has several location in Memphis we could not be in network with Linkia and also the location for which I am at would most likely not be in network either. The 2 closest Hanger facilities to my location is 75 miles away.

Now, I would like to hit on a subject that struck me a couple days ago that is completely being over looked at the present time, I believe.

THERE ARE DOUBLE STANDARDS GOING ON !!

According to the rules of Linkia, you have to have ABC Accreditation for Network Participation. (exact words) Not all Hanger offices are ABC Accredited!! The 2 closest Hanger offices to me are not ABC Accedited . One of these Hanger locations, in PaducahKy. have (3 )full time ABC Certified practitioners. Not sure why they are not yet accredited. The other Hanger location in Jackson,TN.has (NO) full time Certified practitioner.They can not be accredited with no ABC Certified practitioner.

So how is it that Linkia's rule of participation is not being enforced ???

How is that Linkia contracts with Cignia with rules and regulations that are to be gone by but yet are not being followed ?? Does Cignia know that Linkia is not up holding their own rule especially when it is Hanger offices?? It seems to me that any Hanger office that is not ABC Accredited when seeing or that has seen a Cignia patient thru Linkia would be in violation of Linkia's rule and Cigna should not be liable to pay the claim.

Oh well, guess another situation Hanger will get away with!!

By the way , even if we were able to participate with Linkia , we would not !! Not at the low reimbursement that is contracted ! (35% below medicare) Right!! We also are no longer going to be using SPS as a supplier, I am switching to Cascade Orthopedic Supply.

Again Thank You for your support for the Independent!

----------------
Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

From : "Daniel Gottry"
Sent: Thursday, October 26, 2006
To: Reuther, Christine A ESQ TL16F
Subject: Provider qualifications

First, I want to say thanks for the 90 day extension for me to complete my process with my prosthetist. That is very helpful and appreciative ... and will hopefully allow me to survive until whatever changes occur that will allow me to continue to see a provider that I trust!

I did notice that there is now a Hanger office located in the medical building where my surgeon formerly officed, somewhat convenient to my office. The clinician name on the door is David Sharma.

I was surprised that, 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.

This concerns me as I consider Linkia's promise to provide a "uniform level of quality and care".

There is a Susan Sharma listed on the ABC website as working with Hanger in Phoenix. Reportedly, this is David's sister.

One of my questions from the start was whether Hanger was abiding by the standards that Linkia is promoting. In this case I question whether they are being up front with CIGNA about the quality of their clinicians.

I'd appreciate your help in securing/providing any information that you can about David Sharma's qualifications and certifications.

Thanks!

----------------
Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

CIGNA Has Apparent Difficulty Meshing Hanger/Linkia's Reality With Its P/R

2006-11-14T06:58:00.000-07:00

After a number of requests to CIGNA for information about how Linkia's reality relates to its Public Relations, responses do not come quickly.

Last month I wrote asking about a Hanger Office staffed by a non-certified clinician (according to both the ABC and BOC). This situation seemed to be inconsistent with CIGNA's earlier promise that Linkia is holding its Hanger facilities to the same high standard as non-Hanger facilities.

I also forwarded a question that was posed to me about a non-accredited Hanger office in Paducah, KY (with three ABC Certified practitioners) and another location in Jackson, TN that has no full-time certified practitioners and therefore could not be accredited.

After a number of requests and reminders, CIGNA has not yet been able to provide an answer.

Last week, in an article announcing the appointment of Bennett Rosenthal as a director (Bennett is a founding member of Ares Management, LLC, an investment management firm that is also a principal stockholder of Hanger), Hanger described its four units including Linkia, which Hanger describes as "the first and only provider network management company for the orthotics and prosthetics industry." Although the OPGA/POINT network doesn't meet Hanger's definition of a provider network management company, it now includes more than 1,300 independent orthotic and prosthetic locations compared to Hanger's 600+.

According to an article in a recent edition of "The O&P Edge", Hanger's CEO indicated that it does not require exclusivity in its agreements with insurance companies. Although CIGNA's communications tended to have be believing otherwise, that gives some hope that they could choose to expand their contracts to other non-Hanger providers, or perhaps even to the OPGA/POINT network.

I am anticipating learning more about OPGA/POINTS plans and opportunities at an upcoming meeting in the Phoenix area. If you are a practitioner who would like to learn more as well, please contact me for more information.

A Provider's Comments on Linkia's Double Standard

2006-11-02T15:59:00.000-07:00

The following was received from a provider:

First I would like to commend you for the work and input you have and are doing regarding the Linkia / Hanger situation.

I work for a very small Independent with 2 locations. One in xxxxxx, xx and I am in a small rural town 120 miles away.

We approached Linkia at the beginning of this whole process and never heard a reply. At the second approach we were told being that Hanger has several locations in [the city] we could not be in network with Linkia and also the location for which I am at would most likely not be in network either. The 2 closest Hanger facilities to my location are 75 miles away.

Now, I would like to hit on a subject that struck me a couple days ago that is completely being over looked at the present time, I believe.

THERE ARE DOUBLE STANDARDS GOING ON !!

According to the rules of Linkia, you have to have ABC Accreditation for Network Participation.(exact words)

Not all Hanger offices are ABC Accredited!! The 2 closest Hanger offices to me are not ABC Accedited. One of these Hanger locations, in Paducah Ky. have (3)full time ABC Certified practitioners. Not sure why they are not yet accredited. The other Hanger location in [city] has (NO) full time Certified practitioner. They can not be accredited with no ABC Certified practitioner.

So how is it that Linkia's rule of participation is not being enforced???

How is that Linkia contracts with Cignia with rules and regulations that are to be gone by but yet are not being followed??

Does Cignia know that Linkia is not up holding their own rule especially when it is Hanger offices??

It seems to me that any Hanger office that is not ABC Accredited when seeing or that has seen a Cignia patient thru Linkia would be in violation of Linkia's rule and Cignia should not be liable to pay the claim.

Oh well, guess another situation Hanger will get away with!!

By the way , even if we were able to participate with Linkia , we would not!! Not at the low reimbursement that is contracted! (35% below medicare) Right!! We also are no longer going to be using SPS as a supplier, I am switching to Cascade Orthopedic Supply.

Again Thank You for your support for the Independent!

Sent by an independent provider

Questions for Providers about Hanger/Linkia

2006-10-26T07:42:00.000-07:00

I 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 Target

2006-10-26T06:02:00.000-07:00

For 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!

Hanger Clinician Certification?

2006-10-25T09:29:00.000-07:00

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

2006-10-25T07:08:00.000-07:00

[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.

Is He Talking About Us??

2006-10-19T09:06:00.000-07:00

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??

2006-10-19T08:59:00.000-07:00

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]

A Day of Irony

2006-10-18T06:54:00.000-07:00

Thanks 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 Gatekeepers

2006-10-18T04:54:00.000-07:00

Dan,

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

Being Heard?

2006-10-17T09:03:00.000-07:00

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 ...

2006-10-17T08:56:00.000-07:00

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 Care

2006-10-17T08:02:00.000-07:00

I 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