Re: Review/Study of the Effects of O&P Licensure

Re: Review/Study of the Effects of O&P Licensure

Hello List
       Sam Hamontree writes an interesting letter that makes some key points
and asks important questions. To my understanding, the fundamental purpose or
benefit of licensure is to insure that clients / patients either receive O and
P care only from sufficiently qualified practitioners or have legal recourse
if they do not.

What happens after that in terms of benefits or disadvantages to
practitioners, facilities, etc. is certainly important to know but not the core issue.
Personally, the effect on the licensed practitioners in our facility has been
some additional responsibilities. My understanding of licensure in Ohio is that
there is at the present time no fitter or assistant level of licensure. An ABC
registered fitter or other eminently qualified individual has to have a
licensed practitioner in the room during an initial evaluation or final fitting.
Patient care may not suffer but practitioner workload could increase. The cost of
obtaining and maintaining a license would I think be considered a con whether
borne by the individual or facility. Certainly, the additional paperwork and
time spent in insuring adherence to the law is another con when added to the
ever-increasing administrative burden placed on legitimate facilities. I don't
at present have a response to the other questions raised about practitioners
and facilities.

On the issue of the effect of licensure on patients: One of the main problems
in addressing Sam's question is simply that there is not yet a true consensus
on who is a qualified provider and which services they are qualified to
provide. The other significant problem relates to patient care services and whether
they have improved with licensure. To evaluate that you would have to have
some sort of baseline with which to begin. In this respect the entire field is
like Sam's mention of motherhood - who can argue with the fact that O and P
services are beneficial? We know, physicians know, patients know that they are
receiving a benefit from our services but we have almost nothing that identifies
or quantifies the benefit. So how do we know if something makes it better?

I know that some important work has been done in identifying and evaluating
clinical outcomes, best practices, etc. as related to O and P. I also
understand that Hanger, through their subsidiary Linkia, is building a facility and
investing a ton of money in developing software in part to crunch numbers in
order to study and evaluate outcomes and produce utilization criteria, hopefully
for the common good. These efforts are, however, currently in their infancy.
Which brings me to my basic point - it is too early to tell. That doesn't mean
that the questions should not be asked now, just that the jury is probably
still out.

We exist in this field in a tumultuous time because of the confluence of a
great many factors. More people than ever are candidates for O and P services.
The technology of O and P has advanced considerably but produced different
effects:
More and better options are certainly available. Some require additional
training and expertise on the part of providers of service and this promotes the
general raising of academic and scientific standards. Other improvements, like
the proliferation of well designed prefabricated items and components can
either, depending on one's viewpoint, make it easy for less qualified people to
encroach on O and P, or simply allow equal opportunity for the provision of
services that do not require as much in the area of skill or expertise and
should not be held to the same standards.

The key factor in all of this is, of course, money. With the increase in
older Americans as well as others requiring O and P, the improvements in
technology, the limited number of practitioners, and the lack of regulatory oversight
of the profession / industry, the opportunity to make considerable legitimate
profit arose in the last 15 or so years. Unfortunately, so did the
opportunities for fraud and abuse. OIG studies in the 1980s, which revealed considerable
potential fraud and abuse are now coming to fruition in the increased
government scrutiny of O and P practices, whether or not the entities were O and P,
DME, or some combinations or hybrid.

Meanwhile, the overall cost of health care skyrockets and the era of managed
care begins. Health care, including cost, accessibility, and fraud and abuse,
becomes an important political issue. The O and P industry, among others,
receives lower and lower reimbursements. Competitive bidding looms. Terror
strikes, the economy tanks, untold money is spent on defense and security, insurance
premiums double and triple and coverage is cut.

So now there is less money for the provision of both more and less expensive
treatment whose effects are largely unstudied by individuals or facilities
whose qualifications are not standardized. What's the problem?

I apologize for straying from some of the issues raised in Sam's letter. I
could not argue against a study as suggested, but feel the challenges would be
enormous, including to the unbiased part. Enough philosophizing. Time to
provide care, or at least try to get it pre-authorized.

Tom Heckman CO