Re: National P&O Contracting
Jim Price
Description
Collection
Title:
Re: National P&O Contracting
Creator:
Jim Price
Date:
9/9/2006
Text:
1. Signing one contract with one provider is a socialistic tactic that benefits the upper hierarchy (the management)of the provider and the insurance company that is willing to mortgage the current quality of patient care and the future of technological and practical advancement of an industry. Yes, it is easier to sign one contract. Yes, in most cases there would be adequate coverage. Service to patients would be compromised because of the elimination of competition. You are correct about costs...they would be contained (at least until the only game in town was fully established). At that point the insurance company would have no defense against rising costs. Either it would pay for its past sins, or the wall would come down and it would run after whatever band of previously excommunicated providers remained.
One marketing tactic of the public prosthetic-orthotic provider that has been associated with Linkia is to promote the benefits of competition within a market. It is undeniable that once allowed into the market the provider uses its size and leverage to attempt elimination of that competition, which it so sincerely promoted.
2. The difference between Linkia and OPGA is that Linkia effectively has ONE member. OPGA has many members.
Points that I believe are erroneous:
1. The orthotics-prosthetics industry is not unregulated. It is young and evolving. While only approximately 20% of states have adopted licensure, this move has taken place over a relatively short period of time. Licensure of practitioners in every state is necessary and inevitable. Ethical and quality standards by the industry's primary certifying body have been in place since its birth. That same certifying body has embraced the scrutiny of several other entities that review allied health issues, educational pathways, and psychometric evaluation of testing. The laws and remedies that are in place to protect the citizens of the country apply to the orthotic-prosthetic industry as well. They are certainly not ignored in the absence of licensure.
2. There definitely are internal audit and compliance standards of consequence. Orthotic-prosthetic companies and practitioners pay a premium to ensure the integrity of the compliance system. It appears that the federal government will soon adopt these standards to protect beneficiaries covered by Medicare. If a provider entity should choose to turn its back on an audit and compliance process that has evolved since the genesis of its industry in favor of its own compliance process, and this is accepted and encouraged by the insurance industry, the fox is in the hen-house.
Jim Price, PhD
ABC Certified Prosthetist-Orthotist
Health Psychologist
-----Original Message-----
>From: sue smithson < <Email Address Redacted> >
>Sent: Sep 8, 2006 5:52 PM
>To: <Email Address Redacted>
>Subject: [OANDP-L] National P&O Contracting
>
>I am a contracting consultant in the insurance industry and have had a
>series of e-mails regarding the O&P National contracting issue forwarded
>to me. I am presently consulting with various national insurance
>companies that are presently investigating national O&P contracts.
>
>I have two questions but would like to preface them with some details to
>establish how I came to this inquiry.
>
>Linkia is setting up a national contracting process, for the insurance
>companies this appears to be a good thing, sign one contract as opposed
>to negotiating and signing hundreds of contracts. Saves administrative
>costs and thus keeps premiums down. And yes, Linkia is affiliated with
>one national provider, we know that, but why would this be an issue?
>Coverage, service and costs are the issues to be considered, as long as
>that can be delivered, everything else is secondary.
>
>The O&P industry is unregulated, few if any states have licensure, and
>the industry as a whole does not appear to have any compliance or
>internal audit standards of any consequence. By contracting with one
>network/company, a uniform and consistent patient care standard can be
>applied because it is being controlled by one group that can actually
>monitor and enforce minimum standards, something the O&P industry and
>association has apparently not been able to implement with the
>independent practices.
>
>My question is stimulated by the posting by Mr. Kidd, founder of POINT
>supporting his business partner Mr. Andreessen, President of OPGA. Mr.
>Kidd states “I see it (Linkia) as the greatest threat to traditional O&P
>in my career!”
>
>What is the difference between what OPGA and POINT are attempting to
>create and what Linkia has created? If VGM (owners of OPGA and POINT)
>were able to grow and acquire the national contracts, than the
>independents that did not join would be locked out of the contracts as
>well. If OPGA or POINT were to have secured the national Cinga contract
>instead of Linka, then OPGA would establish a network until it was
>saturated and then not allow additional providers; that is how a network
>works, once the network meets the needs of saturation, then no new
>providers are admitted.
>
>I truly do welcome any responses and feed back to my two questions.
>
>1. As an insurance contractor, why would I want to sign hundreds of
>contracts with hundreds of individual providers when I can sign one with
>a network manager?
>
>2. As an insurance contractor, what is the difference between Linkia and
>OPGA?
>
>Thank you in advance for your response.
>
>Sue Smithson
>
>Indepedent Insurance Contracting and Consulting
>
>--
>___________________________________________________
>Now you can search for products and services
> <URL Redacted>
>
>
>
One marketing tactic of the public prosthetic-orthotic provider that has been associated with Linkia is to promote the benefits of competition within a market. It is undeniable that once allowed into the market the provider uses its size and leverage to attempt elimination of that competition, which it so sincerely promoted.
2. The difference between Linkia and OPGA is that Linkia effectively has ONE member. OPGA has many members.
Points that I believe are erroneous:
1. The orthotics-prosthetics industry is not unregulated. It is young and evolving. While only approximately 20% of states have adopted licensure, this move has taken place over a relatively short period of time. Licensure of practitioners in every state is necessary and inevitable. Ethical and quality standards by the industry's primary certifying body have been in place since its birth. That same certifying body has embraced the scrutiny of several other entities that review allied health issues, educational pathways, and psychometric evaluation of testing. The laws and remedies that are in place to protect the citizens of the country apply to the orthotic-prosthetic industry as well. They are certainly not ignored in the absence of licensure.
2. There definitely are internal audit and compliance standards of consequence. Orthotic-prosthetic companies and practitioners pay a premium to ensure the integrity of the compliance system. It appears that the federal government will soon adopt these standards to protect beneficiaries covered by Medicare. If a provider entity should choose to turn its back on an audit and compliance process that has evolved since the genesis of its industry in favor of its own compliance process, and this is accepted and encouraged by the insurance industry, the fox is in the hen-house.
Jim Price, PhD
ABC Certified Prosthetist-Orthotist
Health Psychologist
-----Original Message-----
>From: sue smithson < <Email Address Redacted> >
>Sent: Sep 8, 2006 5:52 PM
>To: <Email Address Redacted>
>Subject: [OANDP-L] National P&O Contracting
>
>I am a contracting consultant in the insurance industry and have had a
>series of e-mails regarding the O&P National contracting issue forwarded
>to me. I am presently consulting with various national insurance
>companies that are presently investigating national O&P contracts.
>
>I have two questions but would like to preface them with some details to
>establish how I came to this inquiry.
>
>Linkia is setting up a national contracting process, for the insurance
>companies this appears to be a good thing, sign one contract as opposed
>to negotiating and signing hundreds of contracts. Saves administrative
>costs and thus keeps premiums down. And yes, Linkia is affiliated with
>one national provider, we know that, but why would this be an issue?
>Coverage, service and costs are the issues to be considered, as long as
>that can be delivered, everything else is secondary.
>
>The O&P industry is unregulated, few if any states have licensure, and
>the industry as a whole does not appear to have any compliance or
>internal audit standards of any consequence. By contracting with one
>network/company, a uniform and consistent patient care standard can be
>applied because it is being controlled by one group that can actually
>monitor and enforce minimum standards, something the O&P industry and
>association has apparently not been able to implement with the
>independent practices.
>
>My question is stimulated by the posting by Mr. Kidd, founder of POINT
>supporting his business partner Mr. Andreessen, President of OPGA. Mr.
>Kidd states “I see it (Linkia) as the greatest threat to traditional O&P
>in my career!”
>
>What is the difference between what OPGA and POINT are attempting to
>create and what Linkia has created? If VGM (owners of OPGA and POINT)
>were able to grow and acquire the national contracts, than the
>independents that did not join would be locked out of the contracts as
>well. If OPGA or POINT were to have secured the national Cinga contract
>instead of Linka, then OPGA would establish a network until it was
>saturated and then not allow additional providers; that is how a network
>works, once the network meets the needs of saturation, then no new
>providers are admitted.
>
>I truly do welcome any responses and feed back to my two questions.
>
>1. As an insurance contractor, why would I want to sign hundreds of
>contracts with hundreds of individual providers when I can sign one with
>a network manager?
>
>2. As an insurance contractor, what is the difference between Linkia and
>OPGA?
>
>Thank you in advance for your response.
>
>Sue Smithson
>
>Indepedent Insurance Contracting and Consulting
>
>--
>___________________________________________________
>Now you can search for products and services
> <URL Redacted>
>
>
>
Citation
Jim Price, “Re: National P&O Contracting,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/227288.
