Re: Medicare rip off ,

Re: Medicare rip off ,

Tony Barr

10/12/2006

Her maybe some answers to your questions below :

So, we need to ask ourselves. What will licensure accomplish? Will it
protect the citizens of the state from substandard care and practice? Will
it elevate our profession? Or will it simply fund salaries of lethargic
state workers at great costs to individual licensed practitioners?

Regards,
BethAnne Algie, RN, C-Ped, L-Ped
 
Jim Kaiser, CP, LP,POINT Health Centers , recommended to the POINT Board of
Directors that POINT must encourage pursuit of state licensure for O&P in
all states. This industry must unite in the common purpose of creating a
universal standard of competence for O&P, or the
patients/end-users/consumers of O&P services and we who proudly provide the
services will be the ultimate losers if we do not.

Tony Barr, Barr Foundation , agrees, The fact remains that, in most states
anyone--without regard to any qualification-- can still continue to provide
O&P services and bill Medicare. Those unqualified, non-certified,
non-licensed providers in 39 states can continue to bill Medicaid (in
California you must be ABC to bill Medical) and private insurers. We failed
to take an opportunity to stop this at the Negotiated Rules Committee
meeting in 2003 ! The O&P industry has been slow to embrace the need to
define and regulate its own profession and, as a result, is now facing
multiple issues of attempting to compete with unequally qualified O&P
service providers for equal (or potentially greater) reimbursements.As long
as your O&P field remains unlicensed its not a legitimate health care
'profession'.Yeah, we continue to beat the licensure drum but and we average
adding one state a year to the states that have been regulated since
1995.The truth is that many don't want the accountability and oversight of
state regulation and both credentialing association do neither. Can you
blame Medicare and third party payers from pulling back coverage's when
providers in approx 40 states are not even required to have a meaningless
and optional credential let alone any accountability or oversight of the
faulty workmanship you have pointed out. Every provider in every state is
aware of the crap that is being made out there by some providers.They have
seen it and laughed but not not gotten angry enough to expose it or do
anything about it ? We need folks to expose the fact that your field is
infiltrated by many incompetent, untrained providers, who are insulated from
any accountability and oversight by requirements of a optional educational
requirement,qualifications and accreditations.
The requirement of license not only better protects the patient,provides
much needed credibility to the provider,but most importantly provides better
oversight and accountability to the profession who is currently viewed as a
DME provider.
Barr hopes the O&P state associations will press O&P providers in all states
to enact state regulation and eventually a federal statute that addresses
who is clinically qualified to provide O&P services: From the prosthetic
patient perspective, wouldn't more protection have been accomplished from
adoption of legislation that established a federal standard for who is
qualified to provide care, replacing the present zero regulation existing in
40 states?
We tried that with the introduction of the William G.Barr Amputee
Protection Bill in 1998, where all providers would be mandated to be ABC
certified. AOPA would not support it. In hindsight it may of been a blessing
since it would of delayed further the need and benefits of regulation via a
state license in every state.

There is no mandatory requirement, nor accountability,nor oversight
provided by the two credentialing associations..Legtimate O&P providers
should view licensure as a means to survive and provide longeivity to their
profession and oh yea ..protect the patient.

Jeff Fredrick, CPO, LPO,Hanger Prosthetics & Orthotics Inc., Tallahassee,
Florida, is now frustrated by those who promote a double standard by
opposing licensure: First of all, it's irrational because licensure is here
to stay, and once Medicare or some of these higher payers really start
dialing into it, you're going to have to be licensed in a state to provide
services, and that means further regulation. That's coming.

The consensus seems increasingly to focus on acceptance of the oft-repeated
homily: Think about it: the person who cuts your hair is licensed, but the
person who makes a prosthesis or straightens your daughter's spine does not
have to be licensed.

It doesn't matter anymore what we think of licensure; [what we think is]
irrelevant, said Jeff Fredrick, CPO, Hanger Prosthetics & Orthotics,
Tallahassee, Florida, a longtime proponent of licensure. It is here to
stay. The question from a professional O&P practitioner's standpoint should
be, How can we make it work for us?' The answer is by upgrading our
profession and making it somewhat more limited, so that not everybody can do
it.

Licensure forces practitioners to pursue higher levels of education, and
this is good not only for the patient, but also for the profession, said
Fredrick. We should strive to be known by our education, and education is
driving the licensure issue it's not drawing tools and computers it's how
highly we are educated. What we know as clinicians is what makes us
infinitely more equipped to ensure that once a prosthesis or Orthosis is fit
on the patient, we get a rehab result that is phenomenal, not marginal.
Licensure is driving us to higher levels of performance because the
requisite bar has been raised.

Fredrick continues, But what offends me most about the guys on the other
side of the fence is that these are people who claim we don't need the high
qualifications that licensure demands, but let their three-year-old child
get sick, and offer them the choice between two doctors--one licensed, with
a lot more education; and the other one isn't licensed. Close to 100 percent
of them would opt for their family to be treated by the higher-educated and
licensed physician. Yet when they are being held to higher requisites, they
suddenly change their philosophy. That's hypocrisy.


A.J. Filippis, CPO, Wright & Filippis,Because of the direction that a
handful of states have taken at this point, prompting changes in some of the
suppliers' standards, said Filippis, the situation is changing: The
Department of Veterans Affairs (VA) is reportedly considering accepting
state licensure as its required credentials for O&P. That may force our
hand here in Michigan. If Medicare and the suppliers' standards come through
that way, and the VA accepts the criterion, I think it's going to be just a
matter of time before we need to follow suit. Otherwise we're going to be
fighting that battle through ABC as well.

The Academy Licensure legally defines a profession based upon educational
standards, protects the public through high levels of accountability, and
defines the scope of practice for the orthotics and prosthetics
professional, the Academy points out, adding, There is O&P licensure in
only ten states while most other allied health professionals are licensed in
the majority of the 50 states.

Joe Elliott, LPO, BOC ,CPO, Hanger Prosthetics & Orthotics, Birmingham,
Alabama: I think the best thing to do, if I were in a state that didn't
have licensure and I was interested in it, would be to contact people who
had been through it.I spoke to the Louisiana association in June 2005, and
the message was, You're going to get tired of hearing this, but the first
thing you're going to need is money. Then you'll need something else, and
then you need money. Then you'll need another something else, and then you
need money. It's a very expensive process--you can plan on spending $100,000
over one, two, or three years to get it accomplished. That money has to come
from somewhere, and that means the people in that state have to pony up
contributions in order to get bills through the legislature.

The only thing we have to fear is fear itself-or apathy, which is far worse.

Rogers agreed strongly. Apathy, without a doubt, is the greatest obstacle
we face failure on the part of individual professionals to recognize the
importance of licensure.

Elliott, too, concurred: I would say that the most dangerous thing that
licensure advocates face is apathy amongst our peers. When a group begins
the journey to licensure, it is absolutely necessary that your peers in your
state understand it and support it, not just accept it. If you don't have
really strong support from the grassroots of your own peers, all these other
outside groups which can be accommodated or dealt with on a legislative
basis have added material at their hands.

The rest of licensure's challenges to overcome the opposition of NOMA and
PTs takes hard work, Elliott added.

Marc David Kaufman, CPO,LPO Atlanta Prosthetics & Orthotics, Atlanta,
Georgia: Be ready to have a battle--but it's fun, and gets you introduced
to the political process. You really need three to five committed
individuals with a lobbyist to get it done; that's probably the biggest
thing. One person is not going to be able to do it.

If we want our profession to be regarded as a profession and not be
identified individually as the brace man' but rather as more scientifically
and medically oriented professionals, then this is really a good step for
our profession.
 
Jim Rogers, CPO,LPO FAAOP, Orthotic & Prosthetic Associates Inc.,
Chattanooga, Tennessee, and chair of the American Academy of Orthotists and
Prosthetists (the Academy) Licensure Task Force, noted that the Academy long
has been an advocate for licensure. We don't see it as a panacea, but as
one piece of a quilt that needs to be in place to protect the profession
over a whole range of areas. But that quilt is important. And licensure by
state is one of the very integral parts of the quilt.

Rogers pointed out that there are no more than 8,000 credentialed O&P
providers in the US. Yet according to the Centers for Medicare & Medicaid
Services (CMS), there are more than 140,000 providers with the right to bill
for L-Codes. The list includes literally thousands of medical professionals
and providers, department stores, etc. It's a virtual potpourri of
entities, very few of which have any direct connections to O&P, said
Rogers. So in the Academy's opinion, if you are licensed in your state, and
your state thus defines who can do what, then you have some measure of
protection against unscrupulous providers.

Although it may be true that licensure will protect practitioners, help to
delineate our scope of practice, and preserve our economic base, what we're
doing is protecting the patient, because ultimately, it is the patient
that's harmed the most when there is no licensure protection.

Lack of licensure protection also impacts the pocketbook of every taxpayer,
Rogers explained. When unqualified individuals provide care that does not
adequately serve Medicare or Medicaid patients, causing them to need further
services later that might not have been necessary had they been cared for
correctly the first time, the taxpayer pays more. In medically complex
patients, the potential for real harm exists as well. Insurance premiums
also can rise for the same reason, and individuals who are paying
out-of-pocket likewise are forced to pay more.

Licensure creates the privileging process to provide Orthosis and
prostheses, said Terry Supan, CPO, FAAOP, FISPO, Orthotic & Prosthetic
Associates of Central Illinois, Springfield. For example, you have been
given the privilege to drive a car with your driver's license. The right to
drive that car is not automatic, and it can be taken away from you if you do
the wrong thing. What licensing brings to a state is recourse for the
consumer and the state to have improper care stopped. It is now a privilege
for you to provide care, not an unalienable right.

 
Marc David Kaufman, CPO,LPO Atlanta Prosthetics & Orthotics, Atlanta,
Georgia, noted that Georgia's lobbyist had previous experience lobbying for
physicians and medical organizations, and is himself a spinal cord injury
patient. Not only did he commit to working with the Georgia Society of
Orthotists and Prosthetists (GSOP) in 2000, but he also remains on their
payroll.

The need is ongoing, Kaufman pointed out. You need someone to keep an eye
on the legislature to see if somebody is trying to slip their own licensure
bill in, amend their bill, or change their practice act to include orthotic
and prosthetic services. This could happen at any time, without warning. It
is essential that we be made aware of this so that we can start our lobbying
efforts to work against it, or work with it, as the case may require.

Miki Fairley Editor - Licensure: Setting O&P Apart

Every job is a self-portrait of the person who does it. Autograph your work
with excellence.Author Unknown

Licensure helps authenticate a profession and in many industries is a
hallmark of recognized expertise. For instance, what the engineering
profession says about licensure also can be applied to orthotics and
prosthetics:

The profession regulates itself by setting high standards for professional
engineers, and by law, many jurisdictions require engineers to be licensed
in order to practice. These requirements and high standards help protect the
public's safety and welfare--National Council of Examiners for Engineering
and Surveying (NCEES).

Licensure not only protects the welfare of the public, it helps protect the
livelihood of the bearer.

Licensure in O&P got off to a late start relative to other healthcare
professions and it's been traveling a rocky road. Although there are only
about 8,000 credentialed O&P providers, there are more than 140,000
providers with the right to bill L-Codes, according to the Centers for
Medicare & Medicaid Services (CMS). That's a lot of potential competition.