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Will Round 2021 crack ‘bedrock’ of O&P care? 

Will Round 2021 crack ‘bedrock’ of O&P care? 

YARMOUTH, Maine – The majority of competitive bidding contracts for off-the-shelf back braces in Round 2021 went to less than two-dozen companies, including a few that haven't traditionally provided them direct to consumer. 

Companies with contracts include Hangar, a national provider of O&P; Medline, a distributor; and Breg, a manufacturer, which all won contracts nationally. Other contracts went to regional providers, like Wright & Filippis, which won a contract for Michigan. 

“Generally, this was a ‘cover a region’ or the entire U.S. attempt by the bigger players, which included Hangar, and a few distributors that have PTAN numbers to bill direct,” said Mark Higley, vice president of regulatory affairs for VGM, who conducted an analysis of the contracts. 

Of the 2,878 contracts awarded in the product category, 1,908 (66%) went to 22 companies that received 30 or more contract offers. 

As with previous rounds of the bid program for other product categories, numerous contracts were awarded to out-of-state companies with no local presence or companies with little previous experience in the product category, including in the Little Rock, Ark., area, says local provider Ted Oury. 

“Even the two largest O&P companies in town are not on the list and they specialize,” said Oury, operations manager for Diamond Medical Supply. “One small company on the list currently doesn’t do braces.” 

Oury, who has a division that specializes in off-the-shelf bracing, filed an appeal when his bid was disqualified on a technicality. 

One big surprise for the product category: a wide discrepancy in single payment amounts. For example, the SPA for L0457, a lumbar support, is $1,095.58 in Charlotte, N.C., compared to $199.16 in Los Angeles, a difference of 82%, according to Higley’s analysis. 

“Those who have ended up with the lowest payments did not have the proper knowledge or education in terms of the formula and process being used to establish rates,” said Todd Eagan, president of the Orthotic Prosthetic Group of America, a division of VGM. “My bigger concern is truly that there will be no qualified provider, whether it be a certified orthotist or fitter, that is involved in the process for counseling, interaction and intervention.” 

Those rates are especially concerning because private insurers typically follow Medicare rates, says Dennis Clark, a partner in Clark & Associates Prosthetics and Orthotics in Cedar Rapids, Iowa, and past president of OPGA. 

“The bedrock of O&P care that’s out there is going to have a tough time competing in this bid universe,” he said. 


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