ABC/BOC crossovers

ABC/BOC crossovers

Jim DeWees

3/10/2004

I have been contemplating what to say for the past couple days and how to
say it.

A few things that I observed in a few postings really bother me (well, a lot
of things actually), the first issue is with a couple emails from a couple
practitioners stating why they just could not go to school and get the
education. One was due to his small children and other family issues.
Although I feel for this person, there are many people in this world that
are working in other professions or trades due to circumstances that left
them unable to do what they would rather be doing. I am sure there are many
would-be surgeons that will never perform an operation because they could
not go to college or to medical school. They might be flipping burgers at
McDonalds today, but should we excuse his/her lack of opportunity and just
give him/her a knife and say go for it? I don't think so. Another
practitioner, who started his career as a pedorthist and then started making
AFOs and KAFOs, spinal orthoses, etc. because a doctor asked him to start
doing that. So, after a few years of practice, he is now BOC and considered
a qualified provider. He might be a good practitioner, but is there any
other medical profession where this can happen? Can a surgeon just ask a
nurse, janitor, or whoever might be working in a hospital to grab a knife
and join in during an operation? And then that nurse or whoever end up
going into practice as a brain surgeon? Well, many of you will argue that
O&P is not brain surgery, but if it is a trade that can just be learned by
anyone without formal education and training, then why not let everyone into
it, including PTs in California?

Other members of this list have mentioned the alphabet soup game, and that
it does not matter what is behind a persons name. Both ABC and BOC are
recognized and that we just need to get over our issues and our egos and
just provide quality care for the patients. Well, this is also disturbing.

If it does not matter what is behind our names, then why are we all so upset
when there is a PT behind a name, or if there is anything at all. As the
one person noted, he got into doing orthotics just because a doctor asked
him to do it. Well, don't we realize that there are doctors out there that
are not at all pleased with the orthotic and prosthetic care they have seen
from ABC or BOC practitioners? I am sure that doctors and therapists have
both thought that they could provide better, or at least equal, quality
products for the patients. So, why does a person with no formal education,
no anatomy classes, no biomechanics, nothing, feel like if a doctor asks him
to make braces, he can do it. But heaven forbid if a PT that has been
educated in anatomy, physiology, biomechanics, etc. try to enter the field
and make a brace. I am definitely in favor of keeping the PTs out of this
field, but I am also in favor of not allowing this profession to be degraded
to a trade with no formal education required.

Just an interesting side note, I was looking over some recent O&P magazines
and looking at some of the research articles in them. It is clear that more
O&P research and publications are done by PTs than by ABC or BOC
practitioners. In fact, every article that I saw and read was either
written by a PT or an MD, or had a co-author that is a PT or MD.
Interesting, we call it OUR field, OUR profession, but more research is
being done by other people.

Another disturbing comment from a past president of ABC which stated that
when he was president, that the feelings were that We were too good for
that referring to having a BOC, non-education pathway into this field. And
then he applauds and supports the current ABC leaders for having the
backbone to make such a bold and unpopular decision and allow this to
happen. So a few years ago, ABC was too good for that pathway, and today it
is fine. So what has happened? We have degraded to a level where education
is of no value anymore? That is a very sad commentary for this field.

So if we, the practitioners, and ABC leaders, do not value an education,
then I hope that some other organization and profession will take this field
over and bring some dignity and respect. The amputees need that protection
and some guarantee that the practitioner treating them has met some
educational standards that are meaningful. Even though a person that has a
CP, or BOCP behind their name, or has a college education, does NOT mean
they can make a leg worth a crap. But, at least the patients know that they
SHOULD be qualified to make one if they have credentials. The CP behind a
name now does NOT represent the standards that ABC has posted in their
literature, the website, or anywhere. ABC is in violation of deceiving the
public at this very moment. If ABC had been planning this move, and had
made thoughtful, well based decisions, they should have changed the
paperwork first, and then made the announcement of allowing BOC
practitioners to join the ranks.

If ABC had made the offer to all BOC to join, provided they take the exam,
pay for the exam, pass the exam, etc. that would make their credentials more
valid. But I don't feel, and I am sure there are many that agree, that $75
is any way acceptable.

I talked to BOC today, filled out my application and faxed it back to them.
I asked about the response they have gotten, and she said it is very good.
There are hundreds of ABC cross over applications at the office already.
That should wake up the ABC leadership. I figured that it will not hurt to
carry dual credentials at least for 2004, until my ABC dues expire. At the
end of this year, I will have to decide which organization will best
represent this profession. Actually, we will all have until Jan 2007 to
decide if we want to stay involved with ABC. According to the Book of
Rules, an ABC practitioner can go overdue on the payment of dues for up to 2
years. So, starting in 2005 if I do not choose to pay ABC, I will just have
to put BOCP behind my name and not CP. I can do that for 2006 as well. I
can be reinstated without taking any exam, re-certification process, as long
as I don't let more than 2 years pass. I will have to pay 2007, and also
pay back-dues for 2005 and 2006. We can all do that until we see where ABC
is heading. Maybe they will tell us something before 2007 rolls around.
Well, one thing to say about BOC, they have not changed their standards in
any way to accomodate this issue. ABC has totally changed their values and
standards to a lower level just to win this contest, or so it seems.

I also talked to a friend of mine that works for Hanger who told me that
they were informed that all BOC practitioners working for Hanger will have
to go to ABC and drop ties with BOC. Can anyone else verify this comment?
If so, why is Hanger forcing their employees to sever ties with BOC? That
also smells bad.

One of the most recent posts, about the reinbursments dropping and bigger
discounts, etc. That person seems to be blaming the government for cutting
costs for O&P services, that the war on terror is causing this. Well, I
think it is safe to say that Medicare is one of the best payors (if not THE
best payor) for O&P. I just signed my BCBS, Anthem contract a few months
ago, and I also got a copy of the fee schedule. I could not believe how
discounted their rates are. Who can we blame for this? Pres. Bush? I
don't think so. We can blame the big O&P company that offered this huge
discount in the first place. One of us in this field tried to cut a deal
with them to get their business by offering such a huge discount. Well, now
anyone can do the work, but have to accept that discount. What was that
company or person thinking? So now Medicare sees what we can do the work
for, as much as 40% discount on certain L-codes, and they figure that they
(Medicare) must be overpaying us as it is, and we expect an increase? Why
an increase from Medicare when we offer a huge discount to a private
insurance? If all of us would refuse to be BCBS providers until they pay at
least the Medicare allowables, what could they do? Send the patients to
Canada to get cheaper services, oops, that just works for prescription
drugs. Or send them to Mexico where we send all our other manufacturing
jobs? No, they need us. They need the services right here in the US. They
need us to make limbs and braces for their patients, we have the upper hand
here, but some of us still prostitute ourselves to gain the upper hand for
more business, at the same time devalueing our services to CMS and other
agencies. I just hope that Medicare does not follow the payment/fee
schedule that BCBS GM, Ford, or Chrylser uses. They are administered by
ABP and Northwood, which are owned and managed by a major O&P company in
Michigan, and they have scraped the bottom of the barrel for reinbursement
fee schedules. If CMS follows their pricing, we will all be out of work,
and the patients will be whittling their own peg legs out of willow wood
again.

And still, ABC keeps silence. That either says that they don't know what to
say, or that they don't really care, or they don't respect any of us enough
to tell us anything. I just don't understand what is going on with them.
If this was a well thought out plan, which I seriously doubt, they should
have, or would have, had statements, letters, or something prepared to calm
this storm down.

What are the plans for ABC? Keep it a free-for-all for ever? Set a time
limit of the cross over process? If this open policy is going to be good
for a while, then maybe I should get out my camcorder and make a video and
become a CPO, oh yeah, don't forget the $75.

To make it clear, I am in favor of a unified voice, one organization, but
not one that does not value a formal education. ABC has been very critical
for too many years of BOC and their low standards. But all of the sudden,
ABC could not come to an agreement with BOC over these issues, and so ABC
just caves in and accepts the BOC practitioners with open arms. Again, why
not offer these practitioners the credentials based on passing the exam? If
they want to join, then that is what they will do. I am sure there are many
BOC practitioners that can pass that exam, there are many of them that are
very good and brilliant. Give them the opportunity to pass the exam, and
have the dignity and respect of knowing that they did demonstrate their
knowledge and ablilties as a competent practitioner. Then they would truly
feel that they were our equals, and many of us would also accept them as our
equals. But, there also needs to be a time liimit set on this education
requirment. We need to require a formal education, at least a BS or BA.
Anyone entering this field with anything less than that could maybe be an
assistant, technician, fitter, or something. If we want the respect of
other health care professionals, we need to up our standards to be more like
a health care profession, not a trade.

We need some communication from ABC, and not the past presidents, former
this or that. We need the current leaders to inform us of what is going on.

Jim DeWees, CP (BOCP applicant)

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