Northwood on NCB

Saturday, May 31, 2003

Back in 1992, the first of the Detroit auto companies put its DMEPOS benefits out for bid. At first, dozens of independent providers including our parent company banded together to lobby the state legislature to stop the auto’s health plan administrator from facilitating the bid and subsequent contract with a sole provider. The lobbying went on for months, but to no avail, as ultimately a contract was put in place and thousands of patients (including Medicare patients) were transitioned to an exclusive provider. The band of providers realized this would be how certain health benefits of large group sponsors would be purchased in the future. They decided to do something about it. That’s when Northwood was formed. Unfortunately Northwood was formed too late to pursue the auto manufacturer’s business. Time, money and effort had been focused solely on lobbying the state legislature and studying the “any willing provider” statute.

What happened in 1992 should be a lesson for independent providers today relative to National Competitive Bidding. If Northwood had formed its network sooner and informed the auto company of its capabilities and diversity of providers, the outcome could have been different. The writing was on the wall. Most of us ignored their message... much like the denial we are seeing today with NCB. Fortunately there’s more than one automotive company and Northwood had a second chance. Unfortunately, there is only one Medicare program.

— Kenneth G. Fasse is president of Northwood, Inc.
It’s how, and who
I was pleased when I heard Dr. Paul Hughes, Medical Director of Region A, issued his statement regarding the dispensing of therapeutic footwear. Someone had given thought to the kind of training necessary to properly assess, fit and select footwear for diabetic and high risk patients. I was soon disappointed when he backed down over the outcry from those dispensing footwear without formal training.

To properly assess and fit therapeutic footwear requires much training. Every week, I re-fit shoes that have been supplied by drug stores, mail order or “crash course” fitters. As a pedorthist, I spend two-to-five hours per patient assessing, evaluating and selecting the proper footwear for the patient’s medical history, age, lifestyle and current medical problems. This includes non-reimbursable follow-up visits for continuity of care. This does not include patient education which costs hundreds of dollars for informational handouts and pamphlets. Yes, I guess Mr. George Karpman would think that fitting therapeutic shoes are “pretty easy to fit”... for him!

— Rodger Christopher is a pedorthist at Specialty Shoes and Diabetic Supplies, Inc. in Beaumont, Texas
It’s how, not who
Medicare beneficiaries deserve reasonable access to therapeutic shoes and comparable care regardless of provider. CMS and our DMERC medical directors should be commended for proposing regulations providing these standards of care for fitting therapeutic shoes.

Currently, more than 7,000 community pharmacists, trained through multiple education vehicles, provide therapeutic foot care to patients in communities of all sizes across the nation.

While I agree that all licensed health professionals, including pharmacists, should be formally trained and demonstrate competency to provide these services; limiting formal training options would result in limited patient access.

It should not be who provides the formal training, or even the time requirements, but rather that standards and satisfactory outcomes be achieved. Regulations governing therapeutic footwear should deem acceptable all education programs that meet CMS standards [and] result in quality care and greater accessibility to all beneficiaries in need of these vital products and services.

— William T. Popomaronis, P.D. is director of the National Community Pharmacist Association in Alexandria, Va.