Re: US Politics - Consolidation

Re: US Politics - Consolidation

John Billock

January 17, 1999

Opinions & Questions on the Consolidation of AAOP, AOPA, ABC, & NCOPE

As a matter of clarification, to those who are unaware of specific
US O&P organizations involved in the Consolidation Issue being
discussed, they are as follows:

The American Academy of Orthotists & Prosthetists, Inc. (The Academy or AAOP)
        A national professional society or organization representing
individual O&P practitioners, assistants, associates, and technicians
credentialed by the American Board for Certification in Orthotics and
Prosthetics, Inc.

The American Orthotic and Prosthetic Association, Inc. (AOPA)
        A national trade association or organization representing the
O&P patient care facilities, as well as the manufactures and suppliers
of O&P components and materials.

The American Board for Certification in Orthotics and Prosthetics, Inc. (ABC)
        A national credentialing organization which establishes
standards and credentials for O&P practitioners, assistants, associates,
and technicians, as well as, O&P patient care facilities.

The National Commission on Orthotic-Prosthetic Education, Inc. (NCOPE)
        A national credentialing organization which establishes
standards and credentials for O&P education and training programs.

        All four of the above organizations reside within a single
national office in Alexandria, Virginia. They all share a variety of
common services provided by the common staff within that office
and each have certain designated staff members. Although they
have specific areas of interest, and as one might expect, there are
common areas of overlapping interest which at times have created
controversy and have recurrently stimulated the idea of
consolidation. Collectively, in the fall of last year, the Executive
Committee of the O&P National Office Service Organization
identified the following as the purposes or issues to be resolved by
consolidating into one single organization:

* Become more focused and better organized to meet membership
needs as the O&P environment continues to change;

* Build a better governance and planning structure, sensitive to
appropriate representation for all, that leads the organization, sets
priorities, and focuses staff efforts

* Communicate more effectively and efficiently, both internally and
externally; and

* Promote one, unified voice to the marketplace.


        This concept or discussion then led to the organization of a
Consensus Conference on the issue of Consolidation which was hosted
and coordinated collectively by the organizations, and was to provide
an opportunity for input from the profession. The Consolidation
Consensus Conference was in Phoenix, Arizona in early December.
All members, certifiees and/or affiliates of the respective organizations
were notified and invited to attend at their expense to provide their
input. It is my understanding 50 + individuals attended and that
non-board member representation was less the than 10 individuals.
Although no “official” outcome to this Conference has yet been
conveyed, it is understood there was a general consensus among the
majority of attendees that consolidation would, in deed, be beneficial
and should be pursued.

        To the best of my knowledge based on what has been indirectly
conveyed to me, the following are four (4) primary reasons which were
identified as being the purpose and/or benefit of consolidating the
organizations:

1.) Provide a stronger O&P voice

2.) Eliminate redundancy in the organizations

3.) Better representation the O&P profession and/or industry

4.) Better value to membership


Regardless of the above, the expressed reasons for Consolidation have
not been clearly communicated or defined by those in leadership and,
as one might expect, many questions remain unanswered!

Personally, I am adamantly opposed to the idea of Consolidation and
have made that known to those in the leadership of the Academy. My
point in coming forward is to publicly clarify my position of opposition
at the request of several well-respected colleagues and consumers of
O&P health care. Also, it is hoped that my comments will serve as the
foundation for further “open discussion” on this dramatic initiative.

Given the above points, and based on my nearly 30 years with the
Academy and the politics of O&P at the national and state level, I
would offer the following opinions and observations on the subject of
Consolidation. Although they represent my personal opinions, I am
aware they also represent the opinions of others whom I hope will
come forward with their thoughts as well.

I am disappointed that more of those in leadership have not come
forward to clarify their position or share their opinions. On the other
hand, knowing the politics of our profession at the national level as I
do, I suspect their opinions are being suppressed in an effort to show
unity amongst the organizations and their boards.

My first opinion is that the Consolidation Consensus Conference was a
costly and premature exercise that gave little opportunity for the
constituents of the organizations to openly discuss and/or debate the
very important issues. I suspect the Phoenix Conference cost the
profession over $100,000 in overall expenses to our organizations and
not to mention the personal costs incurred by those who paid their own
expenses. Collectively, this was money that would have been better
spent on lobbying for legislative or regulatory changes affecting and
assuring the delivery of quality O&P health care.

Given the stormy experiences of the last consolidation effort just a few
years ago, the Consensus Conference should have been preceeded by a
reasonable period of open discussion and input from the constituents of
the organizations. It should be understood that only a small minority
would have been able to attend the Consensus Conference. Are we
returning to the opinions of past that the constituents of the
organizations really don’t know what’s best for them?

As most of those in the profession are aware, a costly ($350,000 +)
effort towards consolidation (ACPORS) was soundly defeated
approximately 6 years ago and created much division within the US
O&P community. Why current leadership is again considering this is
almost beyond comprehension. Ironically, however, it is my
understanding many of those now in leadership who were opposed to it
then are in support of it now. Again, I trust they will come forward to
clarify their reasons for now supporting consolidation and some have.

From my perspective, this is not a “consolidation” as it really boils
down to a “merger” between the Academy and AOPA since everyone is
aware that it is imperative ABC and NCOPE must remain autonomous.
By their very nature as credentialing organizations, they must remain
autonomous, if they are to maintain their creditability. Regardless of
the legal opinions that will support their autonomy under a consolidated
structure, it will suggest an even greater level of influence than we now
have by the mere fact that they would come under the umbrella of a
“single” O&P organization. This issue alone has been targeted in the
past by adversarial or conflicting credentialing organization who have
suggested a level of indirect influence already exists under our existinig
structure. If ABC and NCOPE must legally continue to retain their
own independent Boards of Directors to maintain creditability and
autonomy, what is to be gained here?

O&P is much different than any other allied health or medical
profession in existence. It simply cannot be represented fairly by one
national organization, and history has already proven this.
Fundamentally, it will be impossible for a single organization to
“clearly” represent and address the specific needs, wants and desires of
both a professional society (The Academy) and a trade association
(AOPA), and without conflict! If so, how will that be changed by
consolidation and what are the real benefits?

Although I was personally invited to attend the Conference, it became
apparent to me, that it was to be a Consolidate-Or-Else Conference and
I simply did not want to be a part of the process or the dismantling of
the Academy and stature it has developed over the years.

From my perspective, as one who has devoted nearly 30 years of
volunteer service to the advancement of the Academy, this will do
nothing more than weaken the voice of individual practitioners on
matters of professional interest within the profession. Even more
importantly, on behalf of the entire profession externally, it will reduce
the relatively “untapped” collective voice of all four organizations as a
unified coalition on matters of concern. How will the individual
practitioners maintain their autonomy in a consolidated structure and
how will the “One Voice” as a profession really benefit us all in
legislative matters?

Additionally, with respect to the issue of having “One Voice for O&P”,
it will be impossible for a consolidated organization to adequately
represent the needs of all four organization’s members; credentialed
individuals and facilities; manufacturers and suppliers; and educational
facilities. Again, their issues of concern are not all the same. For this
reason, it has always been my personal opinion that instead of merging
into one organization, there needs to be one additional organization that
just represents the needs of O&P Manufacturers & Suppliers,
independently of the O&P facility members of AOPA. Having
manufactures and suppliers blended into the individual practitioner
memberships would be akin to a pharmaceutical company having
membership in the AMA. Is this not a conflict of interest?

Personally, I feel there is a false sense that having only “One Voice for
O&P” will strengthen our lobbying efforts at the State and Federal
levels. AOPA has always been the self-appointed Government
Relations Representative for O&P in this arena and should continue to
do so. However, AOPA has rarely and willingly used the untapped
power of coalition support to bolster its legislative initiatives by asking
the Academy, ABC, or NCOPE to sign on to legislative or regulatory
issues they are attempting to move forward. Wouldn’t the “collective
support” of an issue be more dramatically strengthened by having (3)
three organizations or more sign on to support an issue -- instead of just
one?

The Academy has made great strides in the area of providing excellent
continuing education, and in recent years, addressing professional
issues of concern beyond our educational needs that assure quality
O&P care. This has happened only through the voice of the individual
practitioner members of the Academy who are concerned about
defining who is truly qualified to provide comprehensive O&P care and
strongly supporting the ABC O&P credentials. How will this support
continue under a consolidated structure that will recognize more than
the ABC credentialed practitioners and/or facilities?

Consolidation will dilute the opinions of the majority -- the individual
practitioners -- who’s greatest concern is and always will be
“professional recognition” amongst their peers within the health care
community. This will occur by reducing the number of volunteer
leaders representing the voice of individual practitioners, as only a
“chosen few” will have the time and/or resources to become involved
in a larger more complex and diverse organization. One would have to
ask themselves: Why is this happening again?

The consolidation effort, as I understand it, was initiated by AOPA and
I suspect came about largely due to the awareness that its membership
and income was on the decline due to the growth of larger and stronger
O&P service provider organizations, such as NOVA/CARE, Hanger,
and RDA, to name a few. They have become large enough that their
need of AOPA membership is diminishing and they do not, for obvious
reasons, wish to pay the same membership fee for all their facilities as
do an independent facility owner. AOPA has been struggling with this
trend both financially and from a leadership perspective.

The Academy, on the other hand, has been steadily growing. Its
membership retention and new membership growth is at an all time
high. It is doing an increasingly better job educating practitioners and
representing their professional interests and concerns. The Academy
needs to continue with its well-established initiatives, stay focused and
stay organized. Is consolidation necessary for the Academy to maintain
its existence and stay solvent? I think not!

The complexity of drafting effective governing bylaws and membership
categories for such a “blended” membership base seems almost
incomprehensible, as well as determining a fair and equitable
membership fee for each of the various membership categories a
consolidated organization will have to have. This, in itself, will create
internal strife and, I suspect that membership fees for the individual
practitioners will escalate immediately or over time, as the large O&P
corporate groups grow in size and numbers.

The expressed concerns about reducing the “duplication of efforts and
services” will actually eliminate the much needed “checks and
balances” that now exists especially between the Academy and AOPA.
It must somehow be understood that the current checks and balances
created by the separate organizations is a positive feature and not a
negative. Our organizations simply need to become “collectively
focused” on a “unified direction” rather than consolidate! In my
opinion, given the events of recent years, our current leadership is
closer to a more unified direction or voice than it ever has been in its
history. Why not utilize that unified spirit to strengthen our collective
goals and objectives within the current structure and put focus efforts
on working together, while maintaining our individualness?

I am also concerned that Consolidation will directly result in a decrease
in number of active volunteers in our leadership roles. Volunteers are
necessary to give direction and perspective, They are the necessary
chemistry that keeps an organization alive with fresh ideas from within
the membership. More importantly, they provide the checks and
balances that assures our goals and objectives are truly member driven.
Volunteering and giving of one’s time is a necessary commitment to
one’s profession. It is necessary to develop well-rounded committee
members and board level leaders within the profession. A decrease in
volunteerism will only place greater emphasis and responsibility on
staff to manage and direct the affairs of our profession. It also
increases the need for a larger staff and many already contend that our
national office staff has grown too large!

Consolidation will lessen the number of volunteer members involved in
decision making process, as only those with time and resources to
become politically involved will be able to do so. I fear a larger more
complex organization will only discourage individual practitioners
from becoming involved and committed at the state and national level.
Further, it will only give credence to the notion of our leadership being
a “Good-Ole-Boys Society, and give credence to the phrase: “The
Golden Rule”. The Board will not be a good representation of the
membership -- fewer numbers to represent more members.

Another issue of concern with the dismantling of these organizations
and, particularly the Academy, are the deep emotional issues that have
bound past officers, award recipients, committee members and chairs
to the professional ideals of the Academy. After consolidation, these
will have lost their original meaning. Many dedicated people, both in
the profession and those recognized outside the profession, will loose
the initial identity of their efforts and recognition’s. What will come of
the Academy’s Titus-Ferguson Award, Distinguished Practitioner
Award, Honorary Membership, The Mohamed Amin Humanitarian
Award, Clinical Commitment Award, Educator Award, Creativity
Award, Research Award, when it ceases to exist?

There is talk of eventually attempting to bring other “splinter” O&P
groups and/or certifiees into the membership roles of the new
consolidated organization. This would certainly increase our
membership numbers and certainly increase income, and for those who
advocate and believe in the “One Voice” concept, it certainly sounds
like the inevitable thing to do. If this is where we are headed, what
would it do to the overall primary focus of the consolidated
organization and it’s mixed membership base?

To my knowledge there has been no indication that consolidation will
lead to a reduction in membership fees or a reduction in the size of our
staff at the National Office; therefor, primary expenses will remain the
same. The only major savings will be in the reduced expenses
associated with the reduced number of volunteer leaders. This leads to
the subject of establishing fair and equitable membership fees, which
becomes another very complex issue to address in a consolidated
organization. Although no specific membership fee structure has yet
been identified, I suspect individual practitioner membership fees will
increase -- not decrease. If not now, they will have to in very short
order.

The Academy was formed because individual practitioners felt they did
not have a voice in the profession over the facility owners, suppliers
and manufactures. Simply because they held the purse strings and were
the ones who had the time and resources to attend the meetings and get
involved. The Academy was formed to represent the individual
practitioner. Consolidation will be a giant step backward for the
individual practitioner. This step, in my opinion, will take the
profession back 30 plus years -- before the Academy! I cannot, in good
conscience, support such a decision.

My thoughts and opinions lead me to ask the following final questions:

* Why change now when the Academy is a strong and viable
organization which has painstakingly developed its image into the
only true professional society representing the profession and one
that is ingrained in the minds and hearts of its member
practitioners?

* Why do away with all of the rich tradition the Academy has
developed and achieved in its efforts to represent the needs, wants,
and desires of the individual ABC Certified O&P practitioner?

* Why not spend our time and resources working towards
establishing a meaningful process by which the Academy, AOPA,
ABC, and NCOPE can “collectively” address issues related to
marketing and assuring the delivery of quality-driven O&P health
care services?

* Why not spend our time and resources working towards
establishing a meaningful process by which the Academy, AOPA,
ABC, and NCOPE can “collectively” address legislative and
regulatory issues which impact the delivery of quality-driven O&P
health care services?

Our profession needs stability at the National level now more than
ever! Consolidation will only divide members of the profession further
and waste a great deal of time and financial resources over the next
year...... which could be put to better use.

Lastly, I have made it clear to all who have asked me to come forward
with my thoughts, opinions and experiences, that I do not plan to go
down the road again of leading an opposition effort to the proposed
consolidation initiative. Regretfully, I have grown weary of what I
have seen and experienced as a cycle of our profession’s
self-destruction, missed opportunities, and wavering direction -- which
I feel has been influenced by internal confusion or indecisiveness at the
national level over our role in health care as either a profession or an
industry. I contend that this very simple but basic perception of
Orthotics and Prosthetics is the foundation for a great deal of our
internal and external problems with the identity of our field. Simply
stated, therein lies the oil and water that to this day separates the
Academy and AOPA! They are two very different organizations and
they need to stay that way for the good of our profession, and from my
perspective, it truly is a health care profession!

For the benefit of clarifying the difference between a profession and
industry, below a descriptions taken from The American Heritage
Dictionary:

pro·fes·sion ( pro-fesh-on ) n. 1. An occupation requiring
considerable training and specialized study: the professions of law,
medicine, and engineering. 2. The body of qualified persons in an
occupation or field: members of the teaching profession. 3. An act
or instance of professing; a declaration. 4. An avowal of faith or
belief. 5. A faith or belief: believers of various professions.

pro·fes·sion·al ( pro-fesh'n-nal ) adj. Abbr. prof. 1. a. Of, relatingto,
engaged in, or suitable for a profession: a professional field such
as law; professional training. b. Conforming to the standards of a
profession: professional ethics. 2. Engaging in a given activity as a
source of livelihood or as a career: amateur and professional actors.
3. Performed by persons receiving pay: professional football. 4.
Having or showing great skill; expert: a thoroughly professional
repair job. n. Abbr. prof. 1. A person following a profession,
especially a learned profession. 2. One who earns a living in a given
or implied occupation: hired a professional to decorate the house.
3. A skilled practitioner; an expert. pro·fes “sion·al·ly adv.

pro·fes·sion·al·ism ( pro-fesh'n-nal-ism ) n. 1. Professional
status, methods, character, or standards. 2. The use of professional
performers, as in athletics or in the arts.

in·dus·try ( in/ das tre ) n. pl. in·dus·tries Abbr. indus. ind. 1.
Commercial production and sale of goods. 2. A specific branch of
manufacture and trade: the textile industry. See note at business . 3.
The sector of an economy made up of manufacturing enterprises:
government regulation of industry. 4. Industrial management. 5.
Energetic devotion to a task or an endeavor; diligence: demonstrated
great intelligence and industry as a prosecutor. 6. Ongoing work or
study associated with a specified subject or figure: the Civil War
industry; the Hemingway industry. [Middle English industrie skill
from Old French from Latin industria diligence, from feminine of
industrius diligent; See ster- 2 in Indo-European Roots.]

Notes: A clear indication of the way in which human effort has been
harnessed as a force for the commercial production of goods and
services is the change in meaning of the word industry. Coming
from the Latin word industria, meaning “ diligent activity directed
to some purpose, ” and its descendant, Old French industrie, with
the senses “ activity,” “ ability,” and “ a trade or occupation, ” our
word (first recorded in 1475) originally meant “ skill,” “ a device, ”
and “ diligence” as well as “ a trade. ” As more and more human
effort over the course of the Industrial Revolution became involved
in producing goods and services for sale, the last sense of industry
as well as the slightly newer sense “ systematic work or habitual
employment ” grew in importance, to a large extent taking over the
word. We can even speak now of the Shakespeare industry, rather
like the garment industry. The sense “ diligence, assiduity, ” lives
on, however, perhaps even to survive industry itself.

in·dus·tri·al ( in/ das tre al ) adj. Abbr. indus. ind. 1. Of, relating to,
or resulting from industry: industrial development; industrial
pollution. 2. Having highly developed industries: an industrial
nation. 3. Employed, required, or used in industry: industrial
workers; industrial diamonds. n. 1. A firm engaged in industry. 2. A
stock or bond issued by an industrial enterprise. 3. A person
employed in industry. in·dus “tri·al·ly adv.


In closing, my opinions are sincerely offered out of concern for our
profession and to stimulate further constructive discussion on this very
important subject.

I urge everyone to gain as much information from both sides of this
issue prior to making your decision when it comes to a vote.

Respectfully,
John N. Billock, CPO