U.S. Politics/Orthotic Suppliers
Bob Van Hook
Description
Collection
Title:
U.S. Politics/Orthotic Suppliers
Creator:
Bob Van Hook
Date:
2/16/2000
Text:
The following are the responses I have received to date, stripped of course
of their identity. I think we are on to something here. I would appreciate
hearing from more of you. We are working on answers to some of the
questions raised in the responses. Thank you for your participation.
Bob
Robert T. Van Hook, CAE
Executive Director
American Orthotic and Prosthetic Association
1650 King Street, Suite 500
Alexandria, VA 22314
Phone: 703/836-7116
Fax: 703/836-0838
STMP: <Email Address Redacted>
URL: <URL Redacted>
Bob VanHook's inquiry - AOPA is working on the DME closet issue, also
known as stock and bill programs among some orthotic manufacturers. Some
manufacturers place their devices in the offices of physicians and physical
therapists, then bill the device when it is fitted by the clinician. I
would like to hear from people on the listserv about their experiences with
these operations without mentioning the companies involved. Please post to
me directly at <Email Address Redacted> <mailto:<Email Address Redacted>> and I
will send the comments to the listserv.
How are stock and bill programs organized?
What items (L codes) are common in these programs?
Who takes the measurements?
Who does the fitting?
Who does the billing?
How often do you see patients for refitting?
Medical Supply Companies Running Supply Closets Out of a Doctor's Office:
* Supply company has part-time employee working in doctor's office.
* Space is rented from doctor for purposes of Medicare billing
* When doctor determines that patient needs an off-the-shelf device,
informs patient what they need and gives them the option of using the item
that they can get in that office visit, or they can choose to go down the
street.
* Patient usually selects the item available right then and there.
* Supply company employee pulls item for stock closet in doctor's
office and gives to doctor
* Doctor has patient sign a form permitting the supply company to
accept assignment and bill for the device
* Form also doubles as physician's prescription complete with device
prescribed and diagnosis ICD-9 codes
* Supply company bills for the device under their name with the
location as the doctor's office (where they are paying rent.)
This scenario is common and performed with the private insurances
regularly. The supply company bases their billing charge on the Medicare
Fee Schedule. They receive reimbursement without question and without every
providing any service for this device.
We hold a weekly clinic in a rural area Doctor's office (an Orthopedist) and
it is very convenient for him and his patients for us to leave a stock of
back supports there in his office. We maintain the stock and fit his
patients on the days that we are there for our clinic, but he fits the
patients on any other day. We have a package of paperwork which gets filled
out at the time of fitting, and on the following clinic day, we pick those
packages up and return them to our facility for billing. It has enhanced
our usefulness with the Doctor and pleased many of his patients by giving
them immediate care while limiting the number of miles they have to travel
for service. Note the type of back supports we are talking about do not
require the bending of stays or have a low range of sizing for a good fit.
Over all since we started this program our business in this area has easily
quadrupled.
Suppliers in our area rent space in the physicians office and provide the
stock in the space. The physician and or an assistant measures for and
fits the product. The supplier bills for the product and collects for
non-allowed, deductibles, etc. I have no idea who or if the patients have
any follow up.
I know of one company that employs at least two people who work either
directly in a large group orthopedic surgery office (15 orthopedists) or
rent space in the same or an adjacent office. The orthopedic group is
located in a neighboring state. Call it Widget Brace for lack of a better
term. They do not have a telephone listing in the local phone book. I am
not sure what the financial arrangement is with the surgeons. I believe
they supply most any type of orthopedic soft good, probably including AFOs.
Whether or not they supply custom fabricated devices, I don't know. I also
don't know whether they provide Medicare services, but would be amazed if
they did not.
I was under the impression that providers of Medicare services had to have a
bonafide physical location to provide services, including a physical address
and a phone number. How can you have a phone number and not be listed in
the phone book? Would a business have an unlisted number? Or, are they
using the phone system of the orthopedic surgeons? I am also under the
impression that Medicare providers must have a unique provider number for
each location. Finally, I understand that a Medicare physician cannot have
a financial interest in a company that he/she refers too. Would that
include collecting rent? I don't know what the financial arrangements here
are, but you and I both know that the physicians are not giving free space
to a company that is based 300 miles away in another state. How this
arrangement can be in compliance with Medicare regulation is beyond me.
This is a scenario that is going on around the country. Somehow, this type
of arrangement needs to be investigated. If it's legal, then I need to jump
on the bandwagon too.
Custom knee orthoses are all but a thing of the past, since a national knee
brace company started sending direct reps to our local physician offices.
Somehow, I'll bet that the physicians are getting a piece of the pie.
I believe that the standards of CAHEP (or whatever it is called today)
should be promoted to all third party payors, corporations, and professional
medical groups. If this standard cannot be recognized as the only
legitimate standard for evaluating who is and who is not qualified to
provide comprehensive orthotic and prosthetic services, we might as well
forget it and dissolve ABC, AOPA, and the like. Any medical device that can
ultimately hurt someone, if misused, could and should be regulated by the
standards of CAHEP. Misuse of L Codes can only cease after such a plan is
put in place. For your information, I can remember when a simple foam
cervical collar had a label on it reading something like Federal Law
Prohibits Dispensing This Device, except by or under the direction of a
licensed physician. I don't believe these labels are used anymore, or are
they? If not, why not?
In the meantime, I would lobby Medicare and the like to install an orthotic
and prosthetic code classification for each type of medical provider. For
example if physicians want to bill for L Codes, let them call them P Codes
and let their group be responsible for lobbying Medicare for the language,
fee structure, and validity of these codes. I say the same for all other
types of professionals. If therapists want to bill for O&P services, give
them a code all their own and let them lobby Medicare for the language, fee
structure, and validity of their codes, etc., etc., etc. Certainly, this
would clean up some of the misuse of the L Codes that is taking place today.
In other words, if your group wants to provide orthotic and prosthetic
services, you ought to be able to talk the talk and walk the walk. How
likely do you think that is for most of these other groups?
I would also poll and educate the insurance companies who provide payment
for O&P services about which health care professionals are covered by a
professional liability policy that SPECIFICALLY states coverage for orthotic
(orthopedic brace) and prosthetic (artificial limb) services. I'll bet
money that most insurance companies don't realize that many of their O&P
providers do not actually have specific O&P professional liability coverage.
As I understand it, it is one thing to have product liability coverage and
quite another to have professional liability coverage for specific devices,
like O&P. If the insurance companies got behind the CAHEP standards, most
of the problems associated with unqualified providers would disappear,
along with most of the misuse and abuse of the codes.
I have a question and comment relating to your posting on the list serve.
I have no experience with manufacturers directly stocking doctors offices. I
have seen local independent rep's doing this and therefore no not support
them. Isn't our reimbursement for L-codes inclusive of both a product and a
service together? I am of the understanding if someone ( a manufacturer )
bills for a device that is fit by another ( ie: a therapist or doctor ) that
this is factoring . I am of the understanding this is illegal. Is it?
I would also expect the therapist/doctor doing the fitting is likely being
paid for an office visit as well. The payor gets socked twice.
We have three specific rep's in our area who supply orthotic custom fit
items to O&P as well as Dr's, PT's, OT's, Surgical Supplies, etc... Other
offices have their PA, NP and/or RN staff order from supplier catalogues,
while many PT/OT offices cross over through their suppliers.
The items range from canvas/elastic WHO's (L3908, L3914), to Poly WHO's
(L3984), to KO's (L1845, L1800-L1820, L1858/L1855), to LSO's (L0500,L0515)
and TLSO's (L0300, L0315)
In the case of the three rep's, they go into the Dr's office, stock him with
a range of products (on consignment), inservice his staff, and check stock
on a regular basis. All make themselves available to the Dr's to come into
the office and measure and fit for him. I have had a few patients come to
me after a rep was unable to find a size that would fit, or screwed up the
fitting with an inappropriate application (the my brace does it all
syndrome).
I know of one OB/GYN office that has the RN fit L0515's, DC offices
fitting L3002/L3020s, L0500's, L0515's etc..,
The Dr's office bill's the insurance, the rep may charge the Dr's office a
fitting fee, and most take a commission on the sale. All the while, they
come into my office and swear up and down that it's the other guy who's
doing it (the creeps!!!) not ME!!! I support O&P...so the mantra goes.
They are made to custom measurements all braces are custom made except a few
and they are soon to offer a computerized measuring system. I don't think
the technicality of measuring or casting specific is the question with new
devices to measure with CADCAM systems. Yes brace reps are doing most of the
fitting. The manufacturer's rep fits them directly also charges only 600.
something for the brace that costs us $525., How can we compete?
Another example is heel cups sell at the local department store for $10. pr
from our distributors they also cost us $10. a pair. They have to fitted by
a high paid fitter as opposed to a self help drugstore kiosk. Off the shelf
Knee Braces are cheaper at the sporting good store at retail prices than
our wholesale prices.
> How are stock and bill programs organized?
Usually the manufacture buys existing stock and replaces with their own like
items. Most of the items are cast shoes., slings, post-op range of motion
devices. A lot depends on each individual office. However, some of the
manufactures will buy competitor products and bill for those.
Furthermore, the manufactures may even pay the practice rent for the space
the products take up. They push their products but will buy competitors and
bill at current L code prices.
>
> What items (L codes) are common in these programs?
Common L Codes are the ones for soft goods. Rarely are custom items used.
However some companies do fit and bill L1858 custom ACL braces along with
the soft goods.
>
> Who takes the measurements?
Many times a cast tech, PA or key office person is designated for off shelf
soft goods, the rep will come in for custom items. Also, some companies
will pay the tech or reimburse the practice for use of the tech.
>
> Who does the fitting?
Same as above.
> Who does the billing?
The manufacture bills Medicare and insurance themselves. They also attempt
to become Preferred provides for key insurance companies that the practice
may deal with.
>
> How often do you see patients for refitting?
On regular physician follow up.
>
I think there is another side of that issue that needs to be addressed as
well. It is bad enough that the manufacturers are doing it to us, but a lot
of us (practitioners) are doing it to ourselves. I know a number of
practitioners who stock a ton of what I consider crap orthotics in local
hospitals and physicians offices and follow the same procedures. They stock
it, some non practitioner who is not an employee of the O&P practice fits
it, and the individual practice bills for the services. I think that this
is a self destructive practice that blurs the differentiation between O&P as
a profession and O&P as an extension of DME. Are those practitioners
hurting the profession? Are they getting wealthy without doing a thing? Are
they ultimately liable for anything that goes wrong? Are they breaking any
code of ethics? Are they lowering themselves to the level of salesmen?
********************
To unsubscribe, send a message to: <Email Address Redacted> with
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questions, send e-mail to the moderator
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OANDP-L is a forum for the discussion of topics
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should not be sent to the entire oandp-l list.
of their identity. I think we are on to something here. I would appreciate
hearing from more of you. We are working on answers to some of the
questions raised in the responses. Thank you for your participation.
Bob
Robert T. Van Hook, CAE
Executive Director
American Orthotic and Prosthetic Association
1650 King Street, Suite 500
Alexandria, VA 22314
Phone: 703/836-7116
Fax: 703/836-0838
STMP: <Email Address Redacted>
URL: <URL Redacted>
Bob VanHook's inquiry - AOPA is working on the DME closet issue, also
known as stock and bill programs among some orthotic manufacturers. Some
manufacturers place their devices in the offices of physicians and physical
therapists, then bill the device when it is fitted by the clinician. I
would like to hear from people on the listserv about their experiences with
these operations without mentioning the companies involved. Please post to
me directly at <Email Address Redacted> <mailto:<Email Address Redacted>> and I
will send the comments to the listserv.
How are stock and bill programs organized?
What items (L codes) are common in these programs?
Who takes the measurements?
Who does the fitting?
Who does the billing?
How often do you see patients for refitting?
Medical Supply Companies Running Supply Closets Out of a Doctor's Office:
* Supply company has part-time employee working in doctor's office.
* Space is rented from doctor for purposes of Medicare billing
* When doctor determines that patient needs an off-the-shelf device,
informs patient what they need and gives them the option of using the item
that they can get in that office visit, or they can choose to go down the
street.
* Patient usually selects the item available right then and there.
* Supply company employee pulls item for stock closet in doctor's
office and gives to doctor
* Doctor has patient sign a form permitting the supply company to
accept assignment and bill for the device
* Form also doubles as physician's prescription complete with device
prescribed and diagnosis ICD-9 codes
* Supply company bills for the device under their name with the
location as the doctor's office (where they are paying rent.)
This scenario is common and performed with the private insurances
regularly. The supply company bases their billing charge on the Medicare
Fee Schedule. They receive reimbursement without question and without every
providing any service for this device.
We hold a weekly clinic in a rural area Doctor's office (an Orthopedist) and
it is very convenient for him and his patients for us to leave a stock of
back supports there in his office. We maintain the stock and fit his
patients on the days that we are there for our clinic, but he fits the
patients on any other day. We have a package of paperwork which gets filled
out at the time of fitting, and on the following clinic day, we pick those
packages up and return them to our facility for billing. It has enhanced
our usefulness with the Doctor and pleased many of his patients by giving
them immediate care while limiting the number of miles they have to travel
for service. Note the type of back supports we are talking about do not
require the bending of stays or have a low range of sizing for a good fit.
Over all since we started this program our business in this area has easily
quadrupled.
Suppliers in our area rent space in the physicians office and provide the
stock in the space. The physician and or an assistant measures for and
fits the product. The supplier bills for the product and collects for
non-allowed, deductibles, etc. I have no idea who or if the patients have
any follow up.
I know of one company that employs at least two people who work either
directly in a large group orthopedic surgery office (15 orthopedists) or
rent space in the same or an adjacent office. The orthopedic group is
located in a neighboring state. Call it Widget Brace for lack of a better
term. They do not have a telephone listing in the local phone book. I am
not sure what the financial arrangement is with the surgeons. I believe
they supply most any type of orthopedic soft good, probably including AFOs.
Whether or not they supply custom fabricated devices, I don't know. I also
don't know whether they provide Medicare services, but would be amazed if
they did not.
I was under the impression that providers of Medicare services had to have a
bonafide physical location to provide services, including a physical address
and a phone number. How can you have a phone number and not be listed in
the phone book? Would a business have an unlisted number? Or, are they
using the phone system of the orthopedic surgeons? I am also under the
impression that Medicare providers must have a unique provider number for
each location. Finally, I understand that a Medicare physician cannot have
a financial interest in a company that he/she refers too. Would that
include collecting rent? I don't know what the financial arrangements here
are, but you and I both know that the physicians are not giving free space
to a company that is based 300 miles away in another state. How this
arrangement can be in compliance with Medicare regulation is beyond me.
This is a scenario that is going on around the country. Somehow, this type
of arrangement needs to be investigated. If it's legal, then I need to jump
on the bandwagon too.
Custom knee orthoses are all but a thing of the past, since a national knee
brace company started sending direct reps to our local physician offices.
Somehow, I'll bet that the physicians are getting a piece of the pie.
I believe that the standards of CAHEP (or whatever it is called today)
should be promoted to all third party payors, corporations, and professional
medical groups. If this standard cannot be recognized as the only
legitimate standard for evaluating who is and who is not qualified to
provide comprehensive orthotic and prosthetic services, we might as well
forget it and dissolve ABC, AOPA, and the like. Any medical device that can
ultimately hurt someone, if misused, could and should be regulated by the
standards of CAHEP. Misuse of L Codes can only cease after such a plan is
put in place. For your information, I can remember when a simple foam
cervical collar had a label on it reading something like Federal Law
Prohibits Dispensing This Device, except by or under the direction of a
licensed physician. I don't believe these labels are used anymore, or are
they? If not, why not?
In the meantime, I would lobby Medicare and the like to install an orthotic
and prosthetic code classification for each type of medical provider. For
example if physicians want to bill for L Codes, let them call them P Codes
and let their group be responsible for lobbying Medicare for the language,
fee structure, and validity of these codes. I say the same for all other
types of professionals. If therapists want to bill for O&P services, give
them a code all their own and let them lobby Medicare for the language, fee
structure, and validity of their codes, etc., etc., etc. Certainly, this
would clean up some of the misuse of the L Codes that is taking place today.
In other words, if your group wants to provide orthotic and prosthetic
services, you ought to be able to talk the talk and walk the walk. How
likely do you think that is for most of these other groups?
I would also poll and educate the insurance companies who provide payment
for O&P services about which health care professionals are covered by a
professional liability policy that SPECIFICALLY states coverage for orthotic
(orthopedic brace) and prosthetic (artificial limb) services. I'll bet
money that most insurance companies don't realize that many of their O&P
providers do not actually have specific O&P professional liability coverage.
As I understand it, it is one thing to have product liability coverage and
quite another to have professional liability coverage for specific devices,
like O&P. If the insurance companies got behind the CAHEP standards, most
of the problems associated with unqualified providers would disappear,
along with most of the misuse and abuse of the codes.
I have a question and comment relating to your posting on the list serve.
I have no experience with manufacturers directly stocking doctors offices. I
have seen local independent rep's doing this and therefore no not support
them. Isn't our reimbursement for L-codes inclusive of both a product and a
service together? I am of the understanding if someone ( a manufacturer )
bills for a device that is fit by another ( ie: a therapist or doctor ) that
this is factoring . I am of the understanding this is illegal. Is it?
I would also expect the therapist/doctor doing the fitting is likely being
paid for an office visit as well. The payor gets socked twice.
We have three specific rep's in our area who supply orthotic custom fit
items to O&P as well as Dr's, PT's, OT's, Surgical Supplies, etc... Other
offices have their PA, NP and/or RN staff order from supplier catalogues,
while many PT/OT offices cross over through their suppliers.
The items range from canvas/elastic WHO's (L3908, L3914), to Poly WHO's
(L3984), to KO's (L1845, L1800-L1820, L1858/L1855), to LSO's (L0500,L0515)
and TLSO's (L0300, L0315)
In the case of the three rep's, they go into the Dr's office, stock him with
a range of products (on consignment), inservice his staff, and check stock
on a regular basis. All make themselves available to the Dr's to come into
the office and measure and fit for him. I have had a few patients come to
me after a rep was unable to find a size that would fit, or screwed up the
fitting with an inappropriate application (the my brace does it all
syndrome).
I know of one OB/GYN office that has the RN fit L0515's, DC offices
fitting L3002/L3020s, L0500's, L0515's etc..,
The Dr's office bill's the insurance, the rep may charge the Dr's office a
fitting fee, and most take a commission on the sale. All the while, they
come into my office and swear up and down that it's the other guy who's
doing it (the creeps!!!) not ME!!! I support O&P...so the mantra goes.
They are made to custom measurements all braces are custom made except a few
and they are soon to offer a computerized measuring system. I don't think
the technicality of measuring or casting specific is the question with new
devices to measure with CADCAM systems. Yes brace reps are doing most of the
fitting. The manufacturer's rep fits them directly also charges only 600.
something for the brace that costs us $525., How can we compete?
Another example is heel cups sell at the local department store for $10. pr
from our distributors they also cost us $10. a pair. They have to fitted by
a high paid fitter as opposed to a self help drugstore kiosk. Off the shelf
Knee Braces are cheaper at the sporting good store at retail prices than
our wholesale prices.
> How are stock and bill programs organized?
Usually the manufacture buys existing stock and replaces with their own like
items. Most of the items are cast shoes., slings, post-op range of motion
devices. A lot depends on each individual office. However, some of the
manufactures will buy competitor products and bill for those.
Furthermore, the manufactures may even pay the practice rent for the space
the products take up. They push their products but will buy competitors and
bill at current L code prices.
>
> What items (L codes) are common in these programs?
Common L Codes are the ones for soft goods. Rarely are custom items used.
However some companies do fit and bill L1858 custom ACL braces along with
the soft goods.
>
> Who takes the measurements?
Many times a cast tech, PA or key office person is designated for off shelf
soft goods, the rep will come in for custom items. Also, some companies
will pay the tech or reimburse the practice for use of the tech.
>
> Who does the fitting?
Same as above.
> Who does the billing?
The manufacture bills Medicare and insurance themselves. They also attempt
to become Preferred provides for key insurance companies that the practice
may deal with.
>
> How often do you see patients for refitting?
On regular physician follow up.
>
I think there is another side of that issue that needs to be addressed as
well. It is bad enough that the manufacturers are doing it to us, but a lot
of us (practitioners) are doing it to ourselves. I know a number of
practitioners who stock a ton of what I consider crap orthotics in local
hospitals and physicians offices and follow the same procedures. They stock
it, some non practitioner who is not an employee of the O&P practice fits
it, and the individual practice bills for the services. I think that this
is a self destructive practice that blurs the differentiation between O&P as
a profession and O&P as an extension of DME. Are those practitioners
hurting the profession? Are they getting wealthy without doing a thing? Are
they ultimately liable for anything that goes wrong? Are they breaking any
code of ethics? Are they lowering themselves to the level of salesmen?
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list.
Citation
Bob Van Hook, “U.S. Politics/Orthotic Suppliers,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/213743.
