Preaching parity

Tuesday, June 30, 2009

Dr. John Rush has lobbied for fair insurance coverage of prosthetic devices “just about every other day for the past two years.” His efforts have helped pass prosthetic parity acts in 15 states. Although the state wins are “nice,” the real objective is to get a federal bill passed, he says. Rush, who recently left his position as chief medical officer at Hangar Orthopedics, spoke to HME News recently about why paying for prosthetics makes sense.

HME News: Does success on the state level boost your cause on Capitol Hill?

Dr. John Rush: Absolutely. If you begin on a state-by-state level, you gain information and build success. Then, when you go to legislators you can say, “Your state already has this bill. If it’s good enough for the people of your state, isn’t it good enough for the American people?”

HME: Where does something like prosthetic parity fit into the overall healthcare reform discussion?

Rush: It’s important to talk about the law of unintended consequences. Before the year 2000, all commercial health insurance policies covered prosthetics without caps or restrictions. Then, one policy in one state said why don’t we just include prosthetics under DME, like the Feds do, and we’ll cap that at $50,000. If that worked and nobody said anything, they would lower it to $25,000, $10,000, $5,000 before they just eliminate the DME benefit altogether.

HME: Why is coverage of prosthetic limbs so important?

Rush: They restore function and prevent further injury. If you are an amputee in a wheelchair, you’re at greater risk for conditions like obesity, diabetes and depression.With a prosthetic leg, you can get back to work. You are being pennywise and pound foolish and that’s the message I preach.