S3 Episode 6: 1980s Prices In 2023 You Do The Math!

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In this episode I sit down with the owner of J.K. Prosthetics and Orthotics, Mike Caputo! We discuss why this family owned business can no longer continue to survive on 1980s Medicaid prices in 2023 and what we can do to help. So come roll with us!

Transcript

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02:31Hey everyone, and welcome back to Queens On the Road podcast.

02:35This is Latavia here.

02:36And first things first.

02:38Happy Disability Awareness Month!

02:41This month means so much to me because it

02:43means that we can remove the stigmas that people

02:46may have towards people who are ably different.

02:49We shine bright every month.

02:51But let's make sure we shine even brighter this month

02:54and show everyone that we are here and we matter

02:58(Cheering Sound Effect)

03:15So I don't know if you guys remember or not, but

03:17last week I talked about the Medicaid parity bill and

03:21how the brace and orthotics industry is struggling.

03:24And specifically J.K.

03:25Prosthetics and Orthotics in Mount Vernon, New York.

03:28So today I have on with me the owner, Mike Caputo.

03:32How are you? I'm all right. How you doing?

03:34I'm doing great!

03:35I'm doing great!

03:36Mike: Excellent! So today I brought you on just to talk about

03:40the company in itself and the struggles you are having.

03:43Are you ready to roll?

03:44I'm ready to roll. All right.

03:45Let's roll!

03:50(Instrumental Music)

04:25So could you tell us a little bit about your company?

04:28So the company was started in

04:301974 by my father, Jack Caputo.

04:33We're actually at our second location, but

04:35we've always been located in Mount Vernon,

04:37so it's a family business.

04:38So I sort of run the place, and I

04:40see patients, and my brother Nicholas does the same.

04:44We see a lot of patients at Montefiore, Jacobi.

04:47We also see a lot of pediatrics,

04:49so Blythedale Children's Hospital and Anne

04:51Seton's Children's Hospital as well.

04:54And we've stuck with our own fabrication.

04:56We make our own braces, unlike a

04:58lot of other companies out there.

05:00And, yeah, you know it's been, wow, 40 something years.

05:04And all of us Caputos love this business,

05:06and we really like it to stay okay.

05:08What made you want to go

05:10into the braces and orthotics industry?

05:12Well, other than it being a family business,

05:15I grew up always working with my hands

05:17and also you know loving to work with people.

05:20So when I was pretty much done with college, I really

05:23wasn't sure what direction to go, so I figured I would

05:26come back home and start working you know part time at JK, but

05:30then I ended up just really loving it.

05:31And here I am 20 years ago. Oh, my goodness.

05:3320 years already!

05:34Yeah, that's a very, very long time. Mike: Yeah

05:37And as a brace user, I can tell you

05:40I've been with this company for 30 years now. Amazing.

05:44And I love them.

05:46Like no one makes braces like them.

05:48You know my braces for me, they help me

05:51stand and walk and be independent.

05:53But they're also conversational pieces.

05:55Everywhere I go, people stop and say, oh, your

05:58braces are so cool, where did you get those? Mike: laughing

06:01So I love getting my braces from JK

06:04Prosthetics and Orthotics because like I said, they

06:07start conversations, they don't come across as things

06:10that I used to be independent.

06:12It's seen as something that is very cool.

06:14So it's kinda sad to hear

06:17what's going on with the business now.

06:18Can you tell us a little bit about that? Sure.

06:21So you know it wasn't such an issue 20 years ago.

06:24We mostly work with Medicaid and Medicare as

06:26well, but as the years went by, medicaid

06:29programs started the managed care programs.

06:32So with the managed care programs, what I'm facing is

06:35in order to contract with them and to be able

06:39to service their patients, I have to agree to contracts.

06:42These contracts are 30% to 40% less a Medicaid rate.

06:47So as you can imagine, it's very hard to operate

06:5140% less to Medicaid rate, which mind you, is from

06:531987, so those rates never adjusted with inflation.

06:58It's also very hard to deal with the

06:59managed cares because of their approval process, we're

07:03constantly getting denials, which means the patients are

07:06waiting even longer to get their braces.

07:07And you know this isn't a first time patient.

07:09These are patients who've gotten their braces from

07:11me for the last ten years, same insurance,

07:14and it is a constant battle with them. Wow.

07:17Also, after we deliver the braces and

07:20we bill, they also come back and

07:21audit us for things they approved already.

07:23So it's become much more labor intensive,

07:26never mind making the braces, but just

07:28to get approval for the braces.

07:29And it's come to a point where their payments are

07:32just so low that I can't buy the materials and

07:36keep a staff who obviously is highly skilled to stay

07:39in business and to keep on making braces.

07:41It's just not sustainable anymore.

07:43So that's the story of the managed cares.

07:45Wow, that's really sad.

07:47I don't think people realize that behind this whole

07:51system that they've created, you have patients and people

07:54that really need these things in order for us

07:57to be productive members of society.

07:59Like I said, for me, my braces help me stand

08:02and walk and it helps me to be able to

08:04go to work and be out in the community. Mike: Right

08:07So it's sad that you know everything is a dollar amount because

08:12for me, my braces keep my feet in alignment.

08:14If I don't wear my braces, my feet turn over,

08:17they curl under because of my spasticity and they'll become

08:22contracted where I can't even walk on them.

08:25So it's important sometimes when congressmen and

08:28women are making these bills that you

08:30realize that you're affecting real people's lives.

08:33This isn't just about grabbing money and

08:37trying to make the most money.

08:39It's about helping the people that are going to

08:41be affected by the bills that you make.

08:43So it's just really, really sad.

08:46(Delayed Beat Sound Effect)

08:49Is there anything that we can do? Absolutely.

08:53You're absolutely right.

08:54Problem is, our elected officials, they don't

08:57really understand what Orthotics and Prosthetics is.

09:01And all they're doing is

09:02looking at the numbers, you know obviously.

09:04Save money here, save money there.

09:06They don't realize that you know our patients, like you

09:09said, you know, you need to go to work, you

09:11need to travel, you need to get around.

09:13You know as long as you're active, an active

09:15lifestyle keeps you out of the hospital.

09:17And they just don't understand what

09:20this fields all about. You know

09:21I guarantee you if I asked what's Orthotics

09:24and Prosthetics, they would probably tell me a

09:26foot insert and prosthetics, you know an artificial limb. Right.

09:30But they would have no idea what

09:31you wear and why you wear them.

09:33So you know other than comparing it to the ridiculous

09:36prices that we're getting, they need to know why

09:38it's so important to you guys.

09:40And the only way that's gonna happen is

09:42if my patients contact their legislatures and show them you know.

09:47They always say show, don't tell.

09:48That's how we can do this.

09:50I think that's how we can get this bill passed.

09:52Okay, guys, so you heard him.

09:54He would like all of his patients from JK,

09:56prosthetics and Orthotics to call their legislators and tell

10:00them to pass the Medicaid parity bill.

10:02I know that I have, but I still implore

10:05everyone to call their legislators and tell them to

10:08pass the Medicaid parity bill, because what affects one

10:11of us affects all of us.

10:13So please call your legislators and tell

10:15them to pass the Medicaid parity bill.

10:17But in case people are not convinced by

10:19this passionate plea, could you please tell us

10:22what the Medicaid parity bill will do for

10:25your company and the industry as a whole? Right.

10:28Of course.

10:28So if that bill passes, we set the clock back 15 years.

10:32Ten or 15 years.

10:33I can hire more staff. You know

10:35I can get the braces to my patients faster.

10:38The materials I use unfortunately, I can't use the quality

10:41materials I was able to use ten years ago.

10:43You know They're still safe.

10:44But I feel like we can do better. You know

10:46I can offer more things to my employees.

10:48Most of them have been with me for 20, 30 years.

10:51They do this because they love it.

10:52Not for the pay anymore.

10:54It would be great for the patients.

10:55It would be great for everybody. You know

10:57The doctors would probably be able to prescribe more. You know

11:00And like we said, I'm not the only company around.

11:02And you know, you talk to other companies, and

11:04they're all experiencing the same problems.

11:06I think within the last ten years, I think

11:09about 20 companies have shut down already just because

11:11they can't afford to keep their doors open. Yeah.

11:14And you are absolutely right.

11:15And I've been here for years, so I can tell

11:18that you had to cut back on the materials because

11:21even now, like, the straps, they don't last as long. Mike: Yeah

11:25And it's an industry that is sadly disappearing.

11:29And I've always said it always feels like the

11:32disabled or the ably different community is always forgotten.

11:36We are here, we are out doing things,

11:39but in order to do those things, we

11:41need services and supports to help us.

11:44And for me, when you see them disappearing,

11:47it's heartbreaking because for me, it's like, well,

11:50what am I going to do?

11:51I need braces every year because I

11:53spend 24/7, 7 days a week in them. Mike: Right

11:57I sleep in my braces because I cannot get

11:59up out the bed without my braces on.

12:02And I don't like to feel the spasms

12:04in my feet when I have them off

12:06It's sad to see an industry go away that we're

12:09going to need for the rest of our lives.

12:11And for me personally, I can't use the plastic

12:15braces because my spasticity will bust through them like

12:19nobody's business, and they will be broke in no time.

12:22So the laminated braces you guys make are

12:24more durable, stronger, and can handle my spasticity.

12:28So if you guys disappear and the industry as a

12:31whole disappears, I don't know what we're going to do.

12:34You know the materials you're talking about, right.

12:36So there's carbon and fiberglass in those

12:38braces, and it's like you said, laminated.

12:40Unfortunately, a lot of companies won't even

12:43entertain that idea anymore, and it's because

12:45insurances don't wanna pay for it.

12:47They see no reason whatsoever that we

12:50have to use those kind of materials.

12:52They don't understand.

12:53And I think a big problem is the people

12:56who they have reviewing these claims aren't educated.

12:59You know they're just somebody they hired who has

13:01no background in Orthotics and Prosthetics.

13:03Even half the reviewers who are nurses, you know I'm

13:05sure they're very intelligent, but they don't know

13:07what Orthotics and prosthetics is all about.

13:09So the idea to them is having to pay

13:11a little extra money, right for a laminated brace, and

13:14I'm only talking another $100 for a laminated brace.

13:17They just won't do it.

13:17It's almost an automatic denial. Yeah.

13:20And I absolutely know what you're talking

13:23about because I recently had to fight

13:25to get repairs done on my wheelchair.

13:28And when I called the insurance cause I

13:30had to play the mediator, Mike: Mhmm, I was like,

13:32the vendor said they didn't get the paperwork.

13:34You're saying you did send out the paperwork?

13:37And the lady who was reviewing everything said, well,

13:40you got a manual chair back in like 2016, so

13:45why do you need a power chair now?

13:47I said, Ma'am, the manual wheelchair that you're looking

13:50at on that sheet was deemed unsafe for me.

13:54I no longer have that.

13:55And I am down to one power chair, and I

13:59need the repairs done on this power chair, because without

14:03this power chair, I cannot go to work.

14:05So she's like, oh I'm so sorry, I didn't know that.

14:09So they don't know.

14:10They don't know.

14:11They are just looking at basic parameters

14:15and like, oh, it doesn't fit it.

14:16So I'm going to deny it.

14:18So it's sad.

14:20It is very sad.

14:21I had a, I guess they call

14:23a hearing with Fidelis Health Plans.

14:25They kept denying a brace for this kid who has cerebral palsy

14:28and it was control ankle contractures and it got to the

14:33point where it was denied three times and I had to have

14:35a hearing with some lady who as soon as I got on,

14:38I said it's all in the diagnosis code.

14:41Why aren't you looking at the diagnosis code?

14:43Oh, I'm sorry sir.

14:44I guess we glazed over that.

14:46So that's just an example.

14:47Like you said, they just don't realize

14:49the effect they have on people. You know

14:51But I will tell you a little side note.

14:53If this bill does pass, that

14:55goes for wheelchair as well.

14:56It's a big bill that covers a lot of stuff. So

14:59Yes, it does cover a lot.

15:00And if it does pass, that would mean

15:02it would change everything for us tremendously.

15:04What they need though is people that use

15:07braces and orthotics and use wheelchairs to sit

15:10on these committees to make the decision. Exactly.

15:14You need people who understand the ably

15:17different community to make these decisions. Right.

15:21I'm just imploring Congress to make changes and

15:24put people on these committees that are in

15:27the ably different community know what we need

15:30and can make the decisions for us.

15:32If you don't understand the community that

15:35you're servicing, you can't make these decisions

15:38because they impact our lives. Exactly.

15:41I will definitely sit on the committees in a heartbeat.

15:44I will do it because some changes need to be

15:47made and it needs to happen now because as I've

15:51become an adult, I've seen the services disappearing or they're

15:54diminishing and I'm scared what's going to happen 10, 15,

15:5920 years from now and not even that far.

16:02Five years from now, if things don't change, I

16:06will tell you that this field will shrink.

16:07Five years, it might be gone

16:09and then what's gonna happen?

16:10(Cartoon Ascending Sound Effect)

16:14And the thing that bothers me too, and I think

16:17that needs to change is the every five year rule.

16:20That's ridiculous.

16:21We wear different pairs of shoes every single day.

16:24Right.

16:24For me, my braces are like my shoes.

16:27I put them on every single day.

16:29So with that normal wear and tear,

16:31you're gonna need it every year.

16:33You can't get them every five years.

16:35Think about a child that's growing cause

16:37a child that's growing also wears braces.

16:40And so if you're growing your feet and everything

16:43is going to change in less than five years,

16:46so what do you expect them to do?

16:47Hold on to it?

16:49Well, the five year rule stems from Medicare.

16:51They have a checklist of we'll

16:53cover you less than five years.

16:55If so and so and so and so happens

16:56if activity level changes, if there is a difference

17:01in patient weight and height, or if there was

17:03a natural disaster and braces were lost.

17:06I mean, they don't take any consideration

17:09whether or not the patient works, doesn't

17:12work, is very you know active in the community. They don't care.

17:15And it's funny you said shoes, because usually that's

17:18what I tell them when it really does come

17:20to a point where you know I actually have to get

17:22on the phone with one of them.

17:23I say do you have children? Yes.

17:25Do they wear the same shoe? No. Okay.

17:27This brace is custom made to the child's foot.

17:30So it's a year later, it's time to get a new one.

17:33Oh, I didn't think about it that way.

17:35I mean, there needs to be some

17:36sort of education to all these companies.

17:38They have to start being held responsible

17:41if you know they hold somebody's livelihood in their

17:43hands and they're compensated for it.

17:45There is no reason we should have any sort of

17:47pushback for providing a pair of braces every year.

17:50But there is, and I will tell you, you know what scares

17:52me, is there's no oversight with these insurance companies.

17:56Nobody's monitoring them on whether or

17:58not they're doing the right thing. You know

18:00It's all about the dollars.

18:05claims and then they didn't have to pay on it.

18:07That's rewarded with audits.

18:09It's rewarded the companies that audit claims.

18:11And they don't do this on any sort of fraud level.

18:14Not that we didn't give you the braces.

18:16It's the doctor didn't write a certain note a certain way

18:19and all of a sudden they take back all the money.

18:21We obviously don't take the braces back.

18:23They take it all back.

18:24And what happens is the companies they use for these

18:27audits, they keep a percentage of what they take back.

18:30So it's a system that is just broken.

18:32And I think they all really need to

18:34be educated and they need to be monitored.

18:36Yeah, I definitely agree.

18:38It's definitely a broken system and they really need to

18:42look into overhauling it and changing it a bit because

18:46it's not working for a vast majority of us.

18:49It's not working in our favor so that we can be out

18:53in the community, like you said, and I love what you said.

18:56I believe you said walking and standing

18:57is a right, not a privilege. Right?

19:00(Cartoon Tumbling Sound Effect)

19:01So what would you say to people out there

19:03and congressmen and women who think you are just

19:06making this plea because you want more money?

19:09I'm just trying to stay in business.

19:10That's all I want. You know

19:12It's become obviously stressful and like you know I always joke, I'm like,

19:16oh, this is gonna be my last day.

19:18You know what I mean?

19:19You know it was my brother who kinda kept

19:21me kinda fighting, like you said.

19:23I think our congressmen think I just want

19:25to go out and buy a boat.

19:26They think I'm gonna go buy

19:27a brand new Ferrari and that's that.

19:30I mean, this is about me making payroll.

19:32I mean, I have two accounts that I'm backed up on

19:35as far as ordering materials, so things are taking longer.

19:37I have to get the money in so the money can go out.

19:40Right.

19:40That's what I tell everybody. Latavia: Right

19:41I think it's obvious you know medicaid hasn't up my fee since 1987.

19:45Of course all my materials are going up.

19:46I think if you push it up against inflation,

19:48I think what everything costs close to another 30,

19:5140% of what they did in 87.

19:53So my friends think, well, you pass

19:55the cost on to the patient, right.

19:56I'm like, no, we don't do that.

19:58We're contracted for a certain price and that's that.

20:01And it's a situation where it's survival.

20:04So, yeah, it's not so much just

20:06so I can make more money.

20:07It's so I can make enough money, Latavia: Right

20:08if that makes sense to you. Yeah

20:09Yeah, that definitely makes sense.

20:11You're just trying to survive at this point. Exactly.

20:14(Cartoon Boing Sound Effect)

20:16I really hope that you stay in the

20:18fight because we need someone fighting for us.

20:22And I'm pretty sure your dad

20:23would want you to keep fighting.

20:25Yeah, of course he does.

20:27We can't let this happen, right?

20:28We can't close a business that's

20:30over 40 something years old.

20:31It's just not an option, that's all.

20:33So since it is not an option for JK to

20:36close down, can you please tell everyone what you are

20:39doing to continue to fight to keep it open?

20:43So we're actually planning a rally in front

20:45of the office october 21 at 10:00am

20:49It's not set in stone, but that's we're about

20:5280% sure that's what we're gonna do.

20:54We're gonna try to make it fun.

20:55We're gonna have some face

20:56painting and pumpkins for the kids.

20:58Gonna try to get some food there, too.

21:00Everybody's gotta be fed, you know try to get the news there.

21:03I'm sure the news will come, but I just

21:04want everybody to tell their story and tell you know why

21:07it's so important to them and you know it'll be awesome.

21:09And we could show you the place if you haven't been

21:12here and yeah, so I'm really looking forward to it.

21:15Well, I will be the first one there. You heard it everybody.

21:18All right.

21:19And what is the address?

21:21It's 699 North MacQuesten.

21:24M-A-C-Q-U-E-S-T-E-N.

21:29Parkway, mount vernon, new york, 10552. Awesome.

21:35(Instrumental Music)

22:12So now we're at the point of the show where

22:14I usually do the quote of the episode, but in

22:18today's episode, I think it would be more fitting for

22:21me to do a call to action.

22:24So everyone please call your legislators and tell

22:27them to pass the Medicaid parity bill.

22:30(Delayed Beat)

22:33So that's all we have for you today, folks.

22:36Thank you so much for listening.

22:38Thank you Mike Caputo for coming on.

22:41It was amazing.

22:42Thanks for having me again.

22:44Thank you everyone for listening.

22:47Please share this episode to as many people as you can.

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23:19And we are rolling out! Bye guys!

23:22See you next week!

23:24(Instrumental Music)

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