AOPA: Insurers denying coverage based on proposed CMS rule | British company develops bionic adapter for prosthetic limbs | Surgeon urges intervention to reduce limb loss in African-Americans
April 26, 2016
AOPA In Advance SmartBrief
News for Professionals in the Orthotics, Prosthetics and Pedorthics Profession
Top Story
AOPA: Insurers denying coverage based on proposed CMS rule
Private health insurers such as UnitedHealthcare and Cigna are limiting prosthetic coverage in response to more restrictive local coverage determinations proposed by the CMS, even though their implementation has been suspended. "We predicted that the rule would, ultimately, be exploited by private health insurers," said Michael Oros, president-elect of AOPA, which also decried the lack of transparency in the review process for the changes. "There is no assurance that any stakeholders or patients would be involved in this," said AOPA Executive Director Tom Fise.
HME News (4/22) 
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Science and Technology
British company develops bionic adapter for prosthetic limbs
Cambridge Bio-Augmentation Systems has designed an implantable device that processes nerve impulses in soft tissue and transmits the information to a prosthetic limb. Company founders hope the device, which has been likened to a standard USB connector in computers, could eventually replace the cup and socket in conventional prostheses.
International Business Times (4/25) 
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Medical News
Surgeon urges intervention to reduce limb loss in African-Americans
African-Americans disproportionately suffer from peripheral artery disease, which can lead to amputation, and often lack access to revascularization and other techniques than can restore blood flow and save limbs, writes surgeon Bryan Fisher, co-director of limb preservation at Centennial Medical Center in Nashville, Tenn.
Morning Consult (4/22) 
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Researchers ID final target of autoimmunity in type 1 diabetes
The human protein tetraspanin-7 was discovered as the fifth and final target of autoimmunity during the development of type 1 diabetes, according to a study in Diabetes. UK researchers believe that this discovery could lead to the development of more effective type 1 diabetes treatments. (U.K.) (4/25) 
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Aggressive care after mini-stroke cuts secondary stroke risk, study finds
Aggressive treatment following a transient ischemic attack can substantially cut the likelihood of another stroke or death, researchers report in the New England Journal of Medicine. Patients who received the most aggressive care available after a mini-stroke had only a 3.7% risk of recurrent stroke or cardiovascular event 90 days after the treatment, well below the expected 12% to 20% risk seen in previous studies. The international study analyzed data from 4,789 patients from 61 sites.
United Press International (4/21) 
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Legislative and Regulatory
Coalition urges streamlined access to Medicare claims data
A coalition of medical societies and physician-led organizations is encouraging Congress and the CMS to give them greater access to Medicare claims data. The groups say they could improve care by linking claims data to clinical registries, and the Medicare Access and CHIP Reauthorization Act gave qualified clinical data registries access to claims data. The CMS says access is available through the Research and Data Assistance Center, but physicians say the process in overly cumbersome and expensive.
HealthLeaders Media (4/21) 
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House panel proposes changes to Tricare, military health system
The House Armed Services Committee is working on a proposal to overhaul the military health care system and Tricare. Current Tricare fees would remain in place until 2020 but could change then. The proposal would reorganize Tricare into two options.
Military Times (tiered subscription model) (4/22) 
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Trend Watch
Double amputee completes half-marathon
Bilateral above-knee amputee Seth Alexander completed his first half-marathon in Oklahoma City last weekend. His prosthetic legs comprise a ComfortFlex socket, a hydraulic knee and carbon fiber blades. "It takes 300 to 500 percent more energy for a bilateral amputee just to walk on a flat surface," said Randy Richardson of the Hanger Clinic in Oklahoma City.
The Oklahoman (Oklahoma City) (4/24) 
Business and Finance
Why small-business owners need to form an exit plan
Many small-business owners want to move on at some point, but research suggests that most have not formed an exit strategy. Planning ahead is key, and entrepreneurs should focus on getting their documents and accounting records in order. "The majority of small business owners want to transfer or sell the business, preferably to a family member, partner, or key employee," writes Christopher Coble. "Each scenario has its own pros, cons, and pitfalls that a proper exit plan could overcome."
FindLaw (4/22) 
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Bill introduced to place moratorium on CMS' LCD lower limb proposal
On April 25, Rep. Ellmers (R-NC-02) introduced HR 5045: the Preserving Access to Modern Prosthetic Limbs Act of 2016. The bill is "to impose a moratorium on the implementation of a proposed Medicare local coverage determination on lower limb prostheses." The bill places a moratorium until June 30, 2017, on implementing the July 16, 2015, Local Coverage Determination (LCD): Lower Limb Prostheses (DL33787). More on this story in today's AOPA's Breaking News.
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AOPA holds press briefing on private insurers adopting policies from LCD
On April 21, AOPA held a telenews event to discuss the impact that the CMS' proposed lower limb LCD is having in the private sector. Media participants heard from AOPA President-Elect Michael Oros, CPO, FAAOP, Tom Fise of AOPA and Mark Martin and Rob Rieckenberg, two amputees who have been affected by the new policies.
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You are too important to the bigger picture to just fall off the canvas.
Johnnie Dent,
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