Re: APTA Comments on DMEPOS Quality Standards-HOW SAD
M. Britt Spears CPO
Description
Collection
Title:
Re: APTA Comments on DMEPOS Quality Standards-HOW SAD
Creator:
M. Britt Spears CPO
Date:
12/8/2005
Text:
Hi Ms. Sheredos,
I like you do not want to see any more turf wars, and my professional-realworld PT friends will understand the following. An unofficial response is a meer way to seperate yourself from your organization. It's still official. While filling in for a absent practitioner as a favor, I have actually seen some patients in the NIH and on one occasion have witnessed where the PT was putting on a bi-valved TLSO upside down and backwards. That's hard to do if you understand the intricacies of fitting orthosis. To prevent embarrassment to my co-hort on the rehabilitation team, I took the orthosis from her and replaced it the correct way.
I've also trained many PT's in Prosthetic gait training for amputees many years into their practices. I really think this is much more common-across the board- than you may wish to admit or even assert. I do feel that we as O&P providers should be able to charge for gait training. Pt's also have a long history of providing wound care. Isn't that where the concept of Physical Therapy started? Why has the state of Maryland made it illegal for PT's to provide wound care unless they're certified wound care specialists? Competency is the answer.
The dental model which you refer would only work if you as a PT do not care if the patient ever eats-they won't be able to because of a severe toothache and gum breakdown. There are several PT's that I have great confidence in their abilities, yet they would never try to perform the dental model with an amputee. It's this vision that scares the feces out of ethical practitioners and patient advocates.
I suggest that the APTA needs to revisit the word team in their approach to O&P. It's obvious that the reasoning for the APTA's stance is sheer greed. PT's are not trained well enough to provide competent O&P service which has positive outcomes. I have also been the guest lecturer for the PT's O&P education so I know what amount of O&P training is dedicated-no disrespect to my friends that are teaching (you only have so much time to teach the basics). I'm sorry but your PT competency assertions don't hold water. With no disrespect to the late Sidney Fishman, Ph.D., that's a outdated view by more than 25 years.
There are PT's on this list-serv that have gone thru one of the O&P NCOPE programs and gone thru the education/residency/certification process. My hats go off to them and their abilities. They really should be in on this discussion. They have both perspectives. I can tell by your lengthy commentary that you will find this as a brazen, hard pill to swallow-sorry, I didn't start the fire-you & the APTA did.
It's the few elitist greedy PT's that stimulate this paranoia. No more disrespect meant than you offered. Just food for thought. I'm sure I'll get flammed for this, but it's kept me awake at night.
M. Britt Spears CPO, LPO
Sheredos, Carol (NIH/NICHD) < <Email Address Redacted> > wrote:
In my unofficial response to Paul Oswald's comments concerning the APTA statement to CMS regarding PT qualifications to fabricate prostheses and orthoses (see below), I would say -- Stop being so paranoid!
PTs do have a very long history of being involved in the prescription, fitting, and checkout of customized prosthetics and orthotics. PTs are licensed and knowledgeable about prosthetic and orthotic components, appropriate prescription, proper fit, fabrication, and training in control of the device (including gait) are - and have been - an integral part of the PT knowledge base. PT state board exams include these aspects of O & P. A physical therapist may choose to concentrate on amputee management, including O&P.
In the practical world, PTs do not get involved in the day-to-day fitting and fabrication of O&P. The APTA statement is very clear in pointing out the limitations of this part of PT practice -- On page 6 of the referenced letter <URL Redacted>, the author - G. Dave Mason, VP of Government Affairs - states that Although physical therapists fabricate immediate post-op castings and fittings and temporary prosthetics, physical therapists do not fabricate final or definitive prostheses. PTs for the most part simply do not get into the business of fabricating definitive prostheses - We do not have the equipment, materials, or time do do so. Every PT I know (I have been in practice for 40 years) would (and does) prefer to work with the prosthetist/orthotist. PTs do not want to be prosthetists or orthotists - Or they would have attended O&P school.
The late Sidney Fishman, Ph.D., had a very workable solution to all of this -- The dental model. The PT would measure and take a cast of the residual or affected limb, as a dentist would take an impression of the mouth/teeth to be fitted. The casting and measurements would be sent to the prosthetist/orthotist for fabrication of the initial device and the definitive prosthesis or orthosis, as the dentist would send the impression and measurements to the lab. The O&P professional could be very involved in the final stages, depending on logistics and agreements between the CPO and the PT. The PT would work with the patient, the O&P professional, and the physician in all - but especially the final - phases of fitting and delivery of the definitive device. The PT is always responsible to the patient, the physician, and to the practice standards in each state. PTs are held accountable for all aspects of practice in which they choose to engage. That includes the degree of involveme!
nt in
O&P, based on education and experience. To discount this fact is to denigrate the value of licensure.
The continual paranoia of the O&P profession regarding the role of the physical therapist in the O&P field is unwarranted and damaging. We have coexisted and worked together for years, despite the fact that O&Ps have historically been unlicensed. Clean up the O&P house - Obtain state licensure. Forge relationships with PTs. Stop the turf wars and let's move on.
-- Carol A. Sheredos, PT, MA
_____
Date: Mon, 5 Dec 2005 08:55:39 -0600
From: Oswald, Paul Trent
Subject: PT statement
This is from the APTA website. Brazen comes to mind. Am I the only one who is taken back by the statement that the PTs should not be held to the same standard as O&P and DME providers? Food for thought! Are we choking yet?
APTA Comments on DMEPOS Quality Standards
APTA stressed physical therapists' qualifications and long history of successfully furnishing patients with customized orthothics and prosthetics, as appropriate, in comments <URL Redacted> submitted this week on proposed Medicare quality standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Pointing out that the Centers for Medicare & Medicaid Services (CMS) did not consult therapists and other relevant parties in the development of the standards, APTA contended that the same standards should not apply to physical therapists enrolled in Medicare as apply to orthotists/prosthetists and DMEPOS companies.
The Association argued that licensed physical therapists already follow strict guidelines and are qualified to furnish customized orthotics and prosthetics to their patients as appropriate.
<URL Redacted>
Paul Oswald CPO
Director O&P Program
OSU-Okmulgee
918-293-5327
<Email Address Redacted>
I like you do not want to see any more turf wars, and my professional-realworld PT friends will understand the following. An unofficial response is a meer way to seperate yourself from your organization. It's still official. While filling in for a absent practitioner as a favor, I have actually seen some patients in the NIH and on one occasion have witnessed where the PT was putting on a bi-valved TLSO upside down and backwards. That's hard to do if you understand the intricacies of fitting orthosis. To prevent embarrassment to my co-hort on the rehabilitation team, I took the orthosis from her and replaced it the correct way.
I've also trained many PT's in Prosthetic gait training for amputees many years into their practices. I really think this is much more common-across the board- than you may wish to admit or even assert. I do feel that we as O&P providers should be able to charge for gait training. Pt's also have a long history of providing wound care. Isn't that where the concept of Physical Therapy started? Why has the state of Maryland made it illegal for PT's to provide wound care unless they're certified wound care specialists? Competency is the answer.
The dental model which you refer would only work if you as a PT do not care if the patient ever eats-they won't be able to because of a severe toothache and gum breakdown. There are several PT's that I have great confidence in their abilities, yet they would never try to perform the dental model with an amputee. It's this vision that scares the feces out of ethical practitioners and patient advocates.
I suggest that the APTA needs to revisit the word team in their approach to O&P. It's obvious that the reasoning for the APTA's stance is sheer greed. PT's are not trained well enough to provide competent O&P service which has positive outcomes. I have also been the guest lecturer for the PT's O&P education so I know what amount of O&P training is dedicated-no disrespect to my friends that are teaching (you only have so much time to teach the basics). I'm sorry but your PT competency assertions don't hold water. With no disrespect to the late Sidney Fishman, Ph.D., that's a outdated view by more than 25 years.
There are PT's on this list-serv that have gone thru one of the O&P NCOPE programs and gone thru the education/residency/certification process. My hats go off to them and their abilities. They really should be in on this discussion. They have both perspectives. I can tell by your lengthy commentary that you will find this as a brazen, hard pill to swallow-sorry, I didn't start the fire-you & the APTA did.
It's the few elitist greedy PT's that stimulate this paranoia. No more disrespect meant than you offered. Just food for thought. I'm sure I'll get flammed for this, but it's kept me awake at night.
M. Britt Spears CPO, LPO
Sheredos, Carol (NIH/NICHD) < <Email Address Redacted> > wrote:
In my unofficial response to Paul Oswald's comments concerning the APTA statement to CMS regarding PT qualifications to fabricate prostheses and orthoses (see below), I would say -- Stop being so paranoid!
PTs do have a very long history of being involved in the prescription, fitting, and checkout of customized prosthetics and orthotics. PTs are licensed and knowledgeable about prosthetic and orthotic components, appropriate prescription, proper fit, fabrication, and training in control of the device (including gait) are - and have been - an integral part of the PT knowledge base. PT state board exams include these aspects of O & P. A physical therapist may choose to concentrate on amputee management, including O&P.
In the practical world, PTs do not get involved in the day-to-day fitting and fabrication of O&P. The APTA statement is very clear in pointing out the limitations of this part of PT practice -- On page 6 of the referenced letter <URL Redacted>, the author - G. Dave Mason, VP of Government Affairs - states that Although physical therapists fabricate immediate post-op castings and fittings and temporary prosthetics, physical therapists do not fabricate final or definitive prostheses. PTs for the most part simply do not get into the business of fabricating definitive prostheses - We do not have the equipment, materials, or time do do so. Every PT I know (I have been in practice for 40 years) would (and does) prefer to work with the prosthetist/orthotist. PTs do not want to be prosthetists or orthotists - Or they would have attended O&P school.
The late Sidney Fishman, Ph.D., had a very workable solution to all of this -- The dental model. The PT would measure and take a cast of the residual or affected limb, as a dentist would take an impression of the mouth/teeth to be fitted. The casting and measurements would be sent to the prosthetist/orthotist for fabrication of the initial device and the definitive prosthesis or orthosis, as the dentist would send the impression and measurements to the lab. The O&P professional could be very involved in the final stages, depending on logistics and agreements between the CPO and the PT. The PT would work with the patient, the O&P professional, and the physician in all - but especially the final - phases of fitting and delivery of the definitive device. The PT is always responsible to the patient, the physician, and to the practice standards in each state. PTs are held accountable for all aspects of practice in which they choose to engage. That includes the degree of involveme!
nt in
O&P, based on education and experience. To discount this fact is to denigrate the value of licensure.
The continual paranoia of the O&P profession regarding the role of the physical therapist in the O&P field is unwarranted and damaging. We have coexisted and worked together for years, despite the fact that O&Ps have historically been unlicensed. Clean up the O&P house - Obtain state licensure. Forge relationships with PTs. Stop the turf wars and let's move on.
-- Carol A. Sheredos, PT, MA
_____
Date: Mon, 5 Dec 2005 08:55:39 -0600
From: Oswald, Paul Trent
Subject: PT statement
This is from the APTA website. Brazen comes to mind. Am I the only one who is taken back by the statement that the PTs should not be held to the same standard as O&P and DME providers? Food for thought! Are we choking yet?
APTA Comments on DMEPOS Quality Standards
APTA stressed physical therapists' qualifications and long history of successfully furnishing patients with customized orthothics and prosthetics, as appropriate, in comments <URL Redacted> submitted this week on proposed Medicare quality standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Pointing out that the Centers for Medicare & Medicaid Services (CMS) did not consult therapists and other relevant parties in the development of the standards, APTA contended that the same standards should not apply to physical therapists enrolled in Medicare as apply to orthotists/prosthetists and DMEPOS companies.
The Association argued that licensed physical therapists already follow strict guidelines and are qualified to furnish customized orthotics and prosthetics to their patients as appropriate.
<URL Redacted>
Paul Oswald CPO
Director O&P Program
OSU-Okmulgee
918-293-5327
<Email Address Redacted>
Citation
M. Britt Spears CPO, “Re: APTA Comments on DMEPOS Quality Standards-HOW SAD,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/225793.
