Update: manufacturers who compete

Update: manufacturers who compete

Hello List members:

Here are more responses to my post as well as the list of manufacturers I
received E-mail about in regards who sell to non-O&P facilities. I am not
recommending any group action, but wanted you to be aware of the info. I've
compiled so you can make your own decisions as to who you purchase from.
   Remember that each manufacturer has it's own reasons for it's policy and
so do we as O&P providers. We need to remember that we aren't always the
only outlet for the manufacturers, but I definately support the ones who
market their product to docs and recommend that they send their patients to
my facility. For instance, I've heard that Townsend doesn't bill patients,
doctors or insurance companies itself. The reps. are all independent
contractors and have their own policies. Check with your rep. to determine if
he/she is supporting you.

 I've also heard that Don Joy has an exclusive contract with Kaiser for
their knee orthoses but Breg may have won it recently. I don't know if this
is a regional thing or nation wide. Has anyone heard?

If there is any information in this post that you feel is inaccurate, please
let me know so I can post it.


More replies:

Think thats bad check out: HTTP//factotem.com/cgi-bin/kneebbs.pl Enough to
make you sick, they have trained fitters


Found Randy McFarland's list very interesting and informative. I was
surprised,
however, at the response from practitioners in Florida who have been led to
believe
the new State Licensure will stop fittings in a doctor's office. Like to hear
from Wade, Ron, Steve, Morris, etc. concerning this small item. Also, how
about pharmacists,
P.T.'s, O.T.'s, etc. doing orthotic and possibly prosthetic fittings.
   The pattern here is, of course, prosthetic goods only sell to O & P firms
because
the other outlets can't use them, are not into prosthetics. The same is true
for the
hard core orthotics. The real culprits here is usually the Soft Goods and
Knee Brace people. And they claim emphatically they could not stay in
business if they
did not sell to everyone.
   The overall answer is to find a Soft Goods manufacturer who will sell only
to O & P
facilities and the facilities will support them. It may never happen.

This is an old, old problem. When I had my own facility in Muncie, Indiana
in the late '70's, I told the CAMP rep he should sell only to O & P shops, he
laughed. He
claimed O & P shops accounted for less than half his sales. At that time,
D.M.E.
dealers and Drug Stores were setting up a fitting room and the Soft Goods
salesman were telling them about the profits to be made fitting orthotics.
That's about the time NARD was formed. Shoe cobblers were getting card
printed with
C.P.O. after their name. (Certified Ped Orthotist).
   Also, I strongly believe State Licensure will NOT stop this, as so many
here in
Florida have been led to believe. I faxed you the exceptions to our license
laws. The
Doctors, Therapists, Pharmacists, etc. lobbies are too strong to stop them
from fitting orthotics. The only way is do what you are doing. Simply
boycott the
companies that sell to the malls, etc. and detail the doctors hard to refer
their patients to qualified orthotists & prosthetists for fittings.

   I agree in principle with your list EXCEPT with HALO's since we cannot
apply a HALO without a physician. Well ok some guys do actually put the pins
in, but that is like just like a sales rep in the OR actually putting in the
total joint.
   I have come to the conclusion that I do NOT want MY organization to have
manufacturers in it! keep the ACADEMY separate!
   If the people think the big two/mfgs can't take it over they are mistaken!
It looks like you have to be willing to serve 10 years to work your way up
to the top of the National organizations.
   I do not know if it has been added in the other licensure bills, I think
if you are licensed you should have to show the ability to custom fab and
adjust ie. have a lab and equipment! Teh AMA has already to ld the M.D.s not
to prescribe AND fill, next is to get the PT's to stop and without equipment
for adjustments etc. it would stop them as well.

EBI is a company that stocks doctors offices with all softgoods and casting
supplies for free, pays them rent for their closet space, and does the
billing for them. The Doc likes it because they do not have to worry about
putting anything on a deadbeat pt. and not getting paid. This company I
heard was being investigated by Medicare, but in the meantime, we get beat
up. Add them to your list.


The list is by no means complete but I wish to comment on the concept not the
list. There is a fine line between being protective of your turf (by keeping
your patients and your professional credentials as well as your pocketbook in
mind), and being counter-productive. We can very easily appear to be a dying
group of unlicensed professional succombing to the inevitable march of
technology, pulling out all the stops to save our buts.
   For example: There are many practicioners who still feel slighted because
therapists fit corsets and pre-fab AFO's, and pharmacies provide soft goods
through certified fitters. These individuals often comment on how the
organizations that represent us should be doing something about these
injustices. They can eloquently argue for professional credentials, patient
rights and economic reasons, but I think the tact is misguided. I don't care
if these folks provide the items to individuals, even if it's the same item I
might provide. I do care if they are reimbursed at my level and are allowed
to use my codes to do so. Our future is not in off the shelf soft goods or in
any product for that matter. Our future is in our professional service.
The knowledge that determines which item is appropriate for an individual.
The skill to modify an item to better serve an individuals functional needs
and the ability to service that patient and educate them to overcome their
defecits.
    You can identify many manufacturers who sell to our industry because we
are another (albeit small) outlet for their products. Let's look at one:
OrthoAmerica. This organization markets their products to our industry while
they aggresively market to DME providers, provide comprehensive education to
fitters so they can fit custom items, accept casts from anyone with a pulse
for custom AFOs, and then provide these persons with the recommended
L-codes for billing. They even provide a better discount arrangement for DME
accounts than they do for O & P providers. These are economic decisions
however terrible it sounds. But should we boycott them or beat them at their
own game?
    I'm sure that manufacturers such as OrthoAmerica are responsible at least
indirectly for HCFA's decision to eliminate the L-codes for such items as the
Multi-podus splint and the Ultra-flex joint. The aggressive marketing of
these devices and coding recommendations that promoted maximum return for
minimum effort resuted in predictable abuses of such magnitude that HCFA
threw the baby out with the bath water. I have been courted by a reputable
manufacturer to use their dynamic multi-podus and bill it out using L1970
and several add on codes that bump the reimbursement up over $1800.00 on
Medicare allowables. When I questioned the billing recommendations I was told
that the company had correspodence from HCFA approving their recommended
coding. Despite repeated requests I have yet to see that correspondence. Now
the sales rep calls on a local Rehab hospital and sells their items directly
to the P.T. Dept. instead of my custom products.
   The profession needs a discussion on this matter. But I feel that real
progress will be made by such efforts as Sen. Harkins' Bill and closely
working with HCFA to show them the reality of these practices. Should they be
members of our organization? Sure, we need their money and eventually will
need their attention as well. Perhaps this profession is on the brink of
really having to do something it has failed to do for some fifty years now:
identify itself and establish its' priorities in such a way as to insure our
survival.

In the essence of fairness, I want to post Ray Fujikawa's response to BREG
being listed as not supporting (or competing with) O&P facilities.
It is as follows:
Mr. Kidd,
    Thank you for the opportunity to respond to your letter dated August
3, 1999.
    Let me first start by saying that Breg has always enjoyed our
association with the O&P marketplace and have felt that they are a
key partner in our growth as a company. We support whole heartedly
the business that Orthotist around the world have built and will continue to
do
whatever we can to be a resource to them.
    As for the question about Florida. Breg, or our local representative down
there, does not have a contract with a large HMO at all. Where this
information came from, I don't know but it is totally false and
unfounded. In fact, we Breg has no contract with any HMO in Florida.
Our biggest contracts nation wide are with O&P organizations. Should
you have any questions about this issue, please don't hesitate to
call me direct.
    Now, about our Florida representative fitting braces. When he does
fit a brace for whatever reason, he does so at the request of the
physician. He is a BOC certified orthotic fitter and that is in
compliance with the law. He did tell me that he always encourages
accounts to use the local O&P shop. It makes it much easier for him
and frees up more time to do what he's paid to do. And that's to sell!
   I hope that this puts to bed any concerns that you might have
concerning Breg and our commitment to the O&P marketplace. We wish it
to be a long and worthwhile relationship.

We are writing in response to the letter from Ray Fujikawa, Sales Manager for
Breg, Inc.
   If his statement that Breg does, indeed, support the orthotic community is
true, perhaps Breg should investigate more thoroughly the actions and ethics
of their outlying representatives.
   The Breg distributor in Florida is marketing the HMO reimbursement sources
personally with the offer of a pricing structure which equals our cost for
the product from Breg, i.e. we pay $300.00 to Breg for a knee orthosis and
the local Breg representative charges the HMO $300.00. Further, the
physician's prescriptions are being changed from another manufacturer's
product to the Breg product. This exact situation happened to a patient we
had originally evaluated. The order was for a Don Joy knee orthosis, the
Florida representative contacted the HMO and offered a price equal to our
cost and fit the patient with a Breg.






Here is the updated list coompiled from responses:


company providing sells to P&O exclusively
Ace Medical halos no
Air cast pneumatic splints no
AOA soft goods no
Bauerfeind soft goods no
Bledsoe leg no
Bremmer halos no
Breg knee orthoses no
Camp SWASH child's hip orthosis yes
Cascade Ortho. o&p supplies yes
Cascade DAFO child's afo no
Centec soft goods no
Century XXII knees yes
College Park prosthetic feet yes
Don Joy knee orthoses no
Dynasplint dynamic splints no
Empi dynamic splints no
Flex Foot prosthetic feet yes
Generation II knee orthoses no
Hope spinal ext.orthoses yes
Innovation Sports knee orthoses no
Jim Smith Sales o&p supplieis yes
Kingsley o&p supplies yes
Knitrite o&p supplies yes
Lennox Hill custom KOs no
Medical Designs L'Nard afos no
OrthoAmerica prefab. orthoses no
Otto Bock prosthetic components. yes
OTS orthotic joints yes
Townsend knee orthoses no
Ultraflex dynamic splints yes