Views From AOPA Leadership

ACONSISTENT THEME in my professional life, both in my day job at Fillauer and in my role as president of AOPA, is relationships and communication. They are essential to moving initiatives forward.

I think it is safe to say that most of us feel like the relationship between payors and providers is often adversarial from the providers’ perspective. This is due in large part to providers’ struggle to get paid while scrambling to keep up with payors’ ever-changing policies. But it does not have to be this way; relationships and communication can improve the dynamic and ultimately lead to mutually beneficial policies.

Over the past several years, the AOPA staff and Board of Directors have invested time, energy, and resources into relationships with the influencers of O&P policy, including payors. Most recently, I hope you received the communications that, after feedback from AOPA, the durable medical equipment Medicare administrative contractors (DME MACs) are no longer requiring brand name product selection for Medicare prior authorization. On this issue, AOPA engaged the DME MAC medical directors in very constructive and positive dialogue regarding the need for flexibility in product selection to best meet patients’ clinical needs. While we did not challenge the concept of Medicare prior authorization, we respectfully requested that the DME MACs reconsider the decision to require product selection as part of the process. And they did. This was not the first conversation we have had with the DME MAC medical directors; staff and leadership have been in dialogue with them for years, working to build this trusted and respectful relationship.

In addition to this accomplishment, we have been engaging with state payors regarding coverage criteria, such as a state Medicaid’s prosthetics and orthotics coverage policy. Our relationships and communication have led to successful engagement and response to medical review requests to increase access for patients with both the five-state BCBS/HCSC review of cranial remolding orthoses medical policy and review of lower-limb prosthesis, including microprocessor, medical policy.

To help with the development and fostering of these relationships as well as to encourage and empower the membership to do the same, AOPA invested in Gov Predict as a resource to help you track legislative developments in your states. These developments are posted to AOPA’s Co-OP and disseminated via email as appropriate. If you are looking to get engaged and stay up-to-date on your state’s policies, read the State by State column in O&P Almanac each month (see page 60).

Finally, the relationships AOPA has established on Capitol Hill are what led to the introduction of the Medicare O&P Patient-Centered Care Act in the U.S. House of Representatives last month. Senate introduction is expected this month (and will hopefully have happened by the time you are reading this). If you have not yet, I encourage you to help get this bill passed by participating later this month in the 2021 Virtual Policy Forum. Your relationships and communication of your needs are what will get this vital piece of legislation passed.

These are just some examples demonstrating how important relationships and communication are for influencing policymakers and payors, and how AOPA is leveraging them to help improve policy and reimbursement for you and your patients.

Traci Dralle, CFm, is president of AOPA.

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN

President-Elect Dave McGill Össur Americas, Foothill Ranch, CA

Vice President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN

Immediate Past President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA

Treasurer Rick Riley O&P Boost, Bakersfield, CA

Executive Director/Secretary (Nonvoting) Eve Lee, MBA, CAE AOPA, Alexandria, VA

Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA

Mitchell Dobson, CPO, FAAOP Hanger, Austin, TX

Elizabeth Ginzel, MHA, CPO Baker O&P, Fort Worth, TX

Kimberly Hanson, CPRH Ottobock, Austin, TX

John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY

Linda Wise WillowWood, Mount Sterling, OH

James O. Young Jr., LP, CP, FAAOP Amputee Prosthetic Clinic, Tifton, GA

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX