By Tyler Wilson

The leaders of AOPA, the Academy, ABC and the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) in early February announced the formation of a government affairs coalition to address federal and state issues confronting the O&P community.

The "O&P community"—it's a term often used to describe the extended network of professionals working in the O&P field. However, many would say a distinct sense of "community" has long been absent among the various O&P groups handling government relations in Washington, D.C.

Legislative initiatives, lobbying campaigns and important efforts to work with the Centers for Medicare and Medicaid Services (CMS) have at times gone off track, failed or otherwise been stymied by the inability of AOPA, the Academy, the NAAOP and ABC to see eye to eye and cooperate on a number of key issues.

In fact, these organizations—all claiming an interest in government affairs—have on occasion been more noted for their level of disagreement than for what they have collectively accomplished. In recent years, one might have been reminded of the old expression: "We have met the enemy, and he is us!"

This result is particularly ironic since many in our field view the groups as having high cross-over in membership. Many ABC-certified practitioners are members of the Academy, and those same practitioners or their facilities are members of AOPA, NAAOP or both associations.

Given these close connections and the overlapping memberships, the recent announcement that the four organizations have formed a new government relations coalition is understandable—surprising maybe, but understandable.

Moreover, it is good news. This unprecedented effort at cooperation to tackle government affairs jointly means more resources, more coordination, better communication and, undoubtedly, better outcomes in moving O&P initiatives through Congress and CMS.

The agreement

The new coalition will be known as the Orthotic & Prosthetic Alliance, and the key to its future success lies in the commitment of the four organizations to work together on developing a strategic plan for guiding the group's efforts.

The Alliance is framed around the idea that, while every organization's point of view will be discussed and all ideas heard, the entire group will reach accord on each of the coalition's public policy positions before moving forward on Capitol Hill or approaching CMS.

This consensus-based method of operation is the strength of the coalition. It also works to the advantage of the entire O&P field.

In the past, AOPA, the Academy, NAAOP and perhaps even ABC may have taken public stances on some issues without full regard to possible inconsistencies between their positions and the other organizations' points of view.

Now, the new Alliance has moved those policy debates out of the public—or at least the O&P community—spotlight. Differences on legislative and regulatory issues can be harmonized through discussion and negotiation, without a lot of public posturing.

Even so, none of the groups have sacrificed their independence or the right to advance each of their own agendas. Each organization has its own mission, and the Alliance has no intention of addressing any issue inconsistent with those goals.

Supporting one lobbyist

Instead of spending their own dollars on separate outside lobbyists to address threats such as a new reimbursement rate freeze or competitive bidding, this new coalition is throwing all its combined resources behind one lobbyist who can carry a unified message to Capitol Hill.

The Orthotics & Prosthetic Alliance has aligned itself behind attorney Peter W. Thomas, of the Washington law firm Powers Pyles Sutter & Verville. Thomas, the long-time general counsel for NAAOP and a well-recognized advocate for the O&P field, is now the point person and legislative counsel for the coalition.

Thomas recognizes the potential synergy of four key players in O&P government relations coming together. "With serious policy threats looming, it is more important than ever to work collaboratively on a consensus agenda in Washington, D.C.," Thomas states. "This collaboration is long overdue and creates an historic opportunity to meet the needs of O&P patients and the providers who serve them."

AOPA representatives

The Alliance will be managed by a steering committee made up of two to four representatives from each of the four groups. Each organization represented will have one vote on issues addressed by the coalition.

While Thomas has a deep understanding and appreciation for the challenges faced by the O&P community and the amputee population, he will also be supported by the volunteer leadership, staff and other resources offered by each of the organizations in the Alliance.

For its part, AOPA brings the expertise of Kathy Dodson, senior director of government affairs, and Walter Gorski, director of legislative and regulatory affairs. Both have extensive knowledge of O&P issues and a keen understanding of the workings on Capitol Hill and at CMS.

Their involvement in the Alliance's efforts are complemented by the volunteer leadership of Michael Hamontree, AOPA's 2005 president and current chair of AOPA's government relations committee. Hamontree, along with 2006 AOPA President Walter Racette, CPO, represents AOPA on the coalition's steering committee.

AOPA is also lending the deep pockets of its political action committee (PAC), the O&P field's only registered entity for making political contributions to Senate and House lawmakers. As legislative races continue to become more expensive, campaign contributions to senators and representatives from PACs such as AOPA's are a critical ingredient in the Washington lobbying process.

In addition to its PAC, AOPA is also providing the Alliance with the analytical studies and other Medicare research it purchases from contracted consultants such as Don Muse and Associates, based in Washington, D.C. Among the information that comes from the Muse firm is an annual detailed analysis of Medicare payment data for O&P.

Muse's findings are well-respected on Capitol Hill and will enhance and support the policy positions the Alliance intends to put before lawmakers.

From there to here

While a formal coalition is probably long overdue, no reasonably astute observer of the O&P field would have predicted 12 months ago that AOPA, NAAOP, the Academy and ABC would be working in concert on government relations in March 2006. Despite a history of disagreement and some perceived differences even today, once the organizations began to explore the possibility of working more closely together, discussions moved quickly.

"Although some might have thought the idea of a coalition improbable, once in a room together, everyone realized that what could be done for the good of the profession far surpassed any individual organization's effort," AOPA's Racette states.

"I believe the formation of the Orthotic & Prosthetic Alliance is the beginning of a new era of cooperation that will help focus the resources, vision and effort needed in the coming years to improve patient care, encourage development of new technology and advance our profession," he continues.

Racette's counterpart at the Academy, Paul Prusakowski, CPO, FAAOP, says his organization is excited about joining this new government relations venture.

"[The Academy] believe[s] that by working together we can do more for the field than by working on our own," Prusakowski said. "Though our organizations have a number of different missions, the one we have in common is making sure that the O&P field and the professionals that work in it are respected and appreciated for their unique ability to serve the public and make people's lives better."

Why now?

None of the Alliance's principal partners will comment extensively on how the idea gained traction. Nor will they explain the steps that brought four sometimes girded-for-battle organizations into the same room for discussions.

Perhaps it was the dustup last spring over the American Physical Therapy Association's direct access initiative and the public outcry over the failure of the various O&P organizations to work together cooperatively.

Or, perhaps it is the growing sense that the greatest threats the O&P field and end-users face are not from other groups within the profession but, instead, from would-be providers far outside the traditional circle.

Maybe the impetus is the realization that there has been a needless duplication of resources spent on lobbyists and other government relations activities.

"As businesses in the O&P field increasingly feel the financial pinch, all of the organizations in the Alliance have grown more concerned about redundancies in the services or functions that each performs," AOPA's Hamontree remarks. "At times we have duplicated our efforts and still not been very effective. The new coalition should address both concerns."

The overlap in the organizations' memberships also argues for a more coordinated approach to government affairs. In other words, how can each organization justify maintaining a separate lobbyist when the dues or other revenue used to pay for those various lobbyists often come from the same companies and individuals?

Maybe, also, it is a case of hardened positions and inflexible points of view mellowing over time. Some have openly acknowledged that the O&P field has suffered and would have continued to do so if a better effort was not made by all the groups to cooperate on future initiatives.

Long-time NAAOP Executive Director George Breece shared his enthusiasm for the new forward-looking Alliance.

"I have long felt this type of unified government relations effort would benefit the O&P profession and the patients it serves," he states. "I am proud that NAAOP is a part of this new Orthotic & Prosthetic Alliance. NAAOP's highest priorities are patient outcomes and safety. By working together, we have an enhanced opportunity to meet the challenges facing the O&P community."

AOPA's Dodson adds, "This coalition is long overdue and will definitely make our work on Capitol Hill and with CMS more effective and coherent. While working as a group is frequently more difficult than working as a single organization, the benefits to the profession and ultimately to our patients should prove worth it."

Trial efforts set the stage

Late last spring, AOPA, the Academy, ABC and NAAOP took their first tentative steps in fostering greater cooperation by working jointly on several ongoing matters under consideration by CMS. The informal group, known loosely as the "G-4," began to meet regularly by conference call.

The G-4 initially formed because of a desire to meet with CMS about the fraud in prosthetic billings in Florida in early summer 2005. The group solidified even further around the need to deal with proposed supplier quality standards under fast-track development by CMS.

While it wasn't intended to serve as a prototype for today's formal coalition, the G-4 demonstrated—and confirmed for many—that the four organizations had a great deal in common. The difference in views that surfaced during G-4 discussions proved small and always resolvable.

"The experience of the G-4 discussions proved that when all the organizations sat down in a room or were on a conference call together, we were able to work through our differences and reach an understanding that all participants could fully support," Hamontree explains.

The early success of the G-4 spurred NAAOP, the Academy and ABC to promote and support AOPA's June 2005 Policy Forum in Washington, D.C.

The enthusiasm the Policy Forum generated throughout the O&P field bolstered the belief that the organizations had to do more to establish a formal effort of cooperation. While the G-4 was effective, it was too loosely structured to be a permanent vehicle for guiding the four groups.

Late last summer several of the organizations now in the Alliance began discussions, and by this past December the four partners were well on their way to a formal understanding of the coalition's structure, the necessary resources and the selection of Thomas as the principal lobbyist.

Identifying the work

In looking ahead, the Alliance's steering committee intends to sit down at the Academy meeting in Chicago to formulate a strategic plan for tackling the myriad issues confronting our field.

Despite all the work in front of the coalition, the enthusiasm is great.

ABC President Jeff Yakovich, CO, says, "Formally bringing O&P's four leading groups together for the purpose of cooperation in government relations efforts is in the best interests of the profession and our patients.

"With facility accreditation being the central requirement for Medicare's new qualified supplier guidelines, ABC is pleased to actively participate with our sister organizations in crafting a unified message to our lawmakers and Medicare decision makers," he continues. "We are proud of the unity being shown in our profession today."

The challenges, as well as the opportunities on Capitol Hill, are many, and the need to step up involvement with CMS officials is apparent to anyone who understands Medicare policies.

"The plate will be filled with issues that need the coalition's undivided attention," Racette acknowledges.

He also cites some of the issues AOPA has recommended the Alliance consider. "AOPA sees maintaining Medicare payments, addressing the need for outcomes measures showing the efficacy of O&P and focusing on private-payer reimbursement levels as just a few of the near- and long-term concerns the four organizations must confront."

What about BOC?

Another challenge facing the Alliance is the absence of the Board for Orthotist/Prosthetist Certification (BOC) from its ranks. Professions and industries that unite and speak with one voice generally tend to see better results on Capitol Hill, and BOC's role as an outsider may be a detriment to the long-term success of the coalition.

It remains to be seen whether policy positions adopted by the Alliance will incorporate BOC's views or whether BOC will choose to move from its perennial role as Mr. Outside to Mr. Inside.

In either case, the Alliance must address BOC's points of view as the current group of four sizes up the issues and decides the best strategies for moving forward.

The right direction

As one looks at the interaction of AOPA, NAAOP, ABC and the Academy over the past decade, the failure to strike a cooperative accord on a joint government relations plan must reasonably be viewed as a missed opportunity.

But, the unprecedented step by these four organizations to form a new coalition is a clear signal that a page of unfortunate history is set to become just that—history.

Now, a new era is unfolding.

With the Orthotic & Prosthetic Alliance, the four partners are demonstrating a commitment to a heightened level of cooperation, with a renewed emphasis on communication and a focus on results.

All of us in the O&P field should be encouraging, and help the Alliance realize success.

Tyler Wilson is the executive director of the American Orthotic & Prosthetic Association, in Alexandria, VA.