Home | About | Resources | Blog | Family | Email Dan
Dan Gottry's Blog
Monday, September 24, 2007Mothers, don't let your sons grow up to be DUI/DWI Defenders!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! Monday, September 10, 2007Lots of ChangesI 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 Wednesday, March 14, 2007Insurance Update: Providers in Illinois Take a Hit from Blue Cross Blue ShieldAccording 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 LossesAccording 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." Tuesday, February 13, 2007Contact with CIGNAThe 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). 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. 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 Tuesday, January 09, 2007He Loved Hanger!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! Friday, December 29, 2006Hanger/Linkia ... "Does Not Play Well With Others"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! Tuesday, December 05, 2006Consistent Quality of Care Through Hanger/LinkiaAfter 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!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 Friday, December 01, 2006Is CIGNA Really Getting What it Pays For?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. |
Previous PostsArchives
Helpful links
|
|
|
