By Denise Napoli

What are your top concerns for the future of the O&P industry? 

This question was posed to hundreds of members of the field in preparation for last November’s O&P leadership conference, “Developing a Shared Vision,” sponsored by AOPA. O&P leaders from a broad range of professional backgrounds and affiliations met to discuss top issues and to shape the survey’s top three issues and shape the industry’s future. The meeting is the first of its kind in nearly 20 years. Conference attendees broke into three groups to address major issues facing the industry. One group dealt with developing one voice amongst industry organizations, another with research issues, and the third with regulatory challenges. It’s likely you’ll recognize some of your own concerns here. If you don’t, though, it’s not too late to speak up. See the end of this article for how to make your opinions heard. 

One voice
The need for all O&P agencies and associations to speak in a unified voice has been an issue “since the beginning of time,” said John Kenney, CPO, FAAOP, of Kenney Orthopedics and a member of the ABC board of directors. 

Why is this issue so important? According to the University of Michigan Orthotics & Prosthetics Center’s Anita Liberman-Lampear, MA, an AOPA board member, “Sending different messages from different organizations has caused many problems amongst ourselves and with those that we wish to hear our message.” If more O&P leaders say the same thing, their concerns are more likely to be heard. 

The group of leaders tackling this issue worked to develop ways that every message lawmakers and the public receive about O&P is supported by all O&P organizations. Group participants decided to use the already-formed O&P Alliance as a vehicle for all O&P associations and boards to speak as one about government relations issues, especially as they apply to reimbursement and qualified provider legislation.

“It doesn’t matter whether we have one executive director or half a dozen. If our units—NAAOP, AOPA, ABC, NCOPE, the Academy—can come together, and the rest of the world is hearing our unified message, then I think we can reach our goals,” says Frank Snell, CPO, FAAOP, of Snell Prosthetic & Orthotic Laboratory. 

Increased research
Why is research—specifically, research that can be used to justify specific forms of treatment for patients—so important? Members of this work group believe that an increase in evidence-based practice (i.e., treatment based on documented research) will not only improve patient care, but provide practitioners with justification for reimbursement. The more you base your practice on documented research findings, the more likely you are to get paid. (For more on this topic, see this month’s cover story, “O&P’s Weakest Link: Research for Reimbursement”) 

Making evidence-based practice an industry standard, however, is a multi-tiered process. “We ultimately recommended that an interorganizational committee be formed that would work to increase clinically-relevant research in the field of O&P,” said Steve Gard, Ph.D., of the Northwestern University P&O Center, a member of the group. 

The committee would catalogue already completed research projects, identify projects yet to be tackled and prioritize their importance. Then the panel would work to find funding for the efforts and encourage a multidisciplinary group of people to actually do the studies and get them published. 

“At the same time,” adds Gard, “we need to educate and encourage practitioners to become better consumers of research.” The committee would continue educating both potential donors and practitioners about the need for more clinically-relevant research studies. 

At least one participant called it a job for Superman. But Walter Racette, CPO, of the Orthotic and Prosthetic Center at the University of California, San Francisco, immediate past president of AOPA, said that he was impressed with the results of the pre-conference survey on this issue, which showed how many practitioners think that the need for reliable evidence-based studies is important. “There is great energy around this initiative,” he says. 

Enforced accreditation
A third priority was the need to ensure that only qualified O&P providers can bill Medicare. For Tom Kirk of Hanger Orthopedic Group Inc., a member of the AOPA board of directors, this issue is especially important. “When non-qualified providers [attempt to treat patients], patients can get hurt. They have gotten hurt. They do not get the maximum [benefit] out of any device, and it gives our industry a black eye.” When non-qualified providers receive payment from Medicare, they make money—and put the real practitioners, who could actually help patients, out of business. 

Legislation prohibiting payment to unqualified providers already exists in the Benefits Improvement and Protection Act. CMS simply does not have a mechanism in place to enforce the terms. 

The group plans to consult and collaborate with those states that currently grant licensure and to treat qualified providers ensure they are truly in compliance with CMS regulations. Then, says Kirk, a group must work with CMS to develop action plans that guarantee those regulations are upheld. 

It sounds simple, but as Kathy Dodson, senior director of government affairs at AOPA, attests, working for any kind of federal or legal change is never easy. “Legally, we are right. However, to succeed, it means overcoming some significant roadblocks at CMS, involving staffing and funding, that have put this issue on the back burner.” 

One positive development is CMS’ recent recognition of 11 accrediting agencies, which can now officially decide whether a facility is operating under Medicare’s requirements. (For more information, see the January 2007 O&P Almanac “In the News” story) Though some agencies have expressed concerns over how CMS decided to recognize agencies, it is certainly a step in the right direction. 

Dodson says that enforcing accreditation is possible. “We need to be persistent and not look for a quick fix.”

Be heard
So which issues are you most concerned about? What would you like lawmakers and the public to hear from the “one voice” O&P leaders say is crucial for the industry’s survival? Speak up. Here’s what you can do:

• Send a letter to the editor at the O&P Almanac by e-mailing Malissa Bennett at mbennett@AOPAnet.org.
• Get in touch with one of the points of contact for these three issues:

O&P leaders hope to have another meeting in the near future. Get your concerns on the agenda, and share your vision for the future of the O&P profession.

Denise Napoli is the staff writer for the O&P Almanac.