Summary of responses to doctors doing o and p
Eric Eisenberg
Description
Collection
Title:
Summary of responses to doctors doing o and p
Creator:
Eric Eisenberg
Date:
9/2/2011
Text:
Work in collaboration and sharing <URL Redacted> I can tell you for a fact that what you are describing is going on in birmingham. One of the companies you describe is from Huntsville, and that is their business model. It is my feeling that this is the future. You are also correct about the Stark violation aspect. The prosthetist/orthotist is employed by the physican group. I also believe that the other way around the violation is that the prosthetist/orthotist has to be in same location with the physician. In other words the physician can't send the patient off site to see the prosthetist/orthotist.Might be a national trend, but this practice trend should be addressed to our Alabama association and determine
to what extent it is occuring in Alabama.
You have, in a very professional and admiral way, expressed a concern that
most fundamentally effects our professional stature and position. There are
many factors that have brought use to this present set of circumstances, a
few of which we have some measure of control, but most of which we do not.
I would like very much to discuss with you those areas of control, and how
we might exercise these consolable factors to the benefit of not only are
profession but also to the benefit of our clients and medical specialist's
patients if you have the time and are interested.
Here are a few points on some of the new models out there.
1. It is legal for a physician to own an O&P practice. An O&P practice can not Employee a doctor, though
2. O&P does not come under stark. DME does (e-codes, for instance)
3 No one can pay for referrals - that is against the OIG and illegal. I have some concerns about manufacturers who are doing the billing for the device and financially incentivizing O&P companies based on referrals sent to them.
4. You can have a clinic in a practice and then pay for use of the space, staff, etc - but you better be able to prove that you have documented the costs as fair-market-value (FMV). This means have a copy of their lease or documentation from a realtor as to FMW. If you are paying for staff, again, you have to have documentation you can back with the amount of time and cost.
Reality is that Medicare is planning cuts to physician revenue. The physicians are going to look wherever they can to gain it back. Locally, some of the other insurance companies may NOT allow an Orthopedic practice to bill for custom, for example. Now that doesn't stop some from billing it anyway and it slips through. I recommend you talk to your local carriers about their regulations. Probably after a few years of seeing increased utilization - which always happens with these things - the government may step back in and change the laws. In the meantime, it is important for o&p companies to sit down and do some strategic planning. This is only going to get bigger and shrink your revenue streams- first for off-the-shelf, then for custom. I think prosthetics is more secure, at this point in time.
Before I reply to you, can I get a few more specifics.
I wonder if the manufacturing members of AOPA will restrict sales to these type of practices. It seems that sales to a large volume smaller group of professional practitioners is managed easier than a small volume with thousands of wanna be orthotic and prosthetic Dr's. We will see where AOPA's alliance lies
Since AL is an O&P licensed state you need to check the state's statutes to see if there are any violations. IL has specific rules against paying for referrals both in the Medical and O,P,& Ped regulations.
Our local Hanger has been doing this type of practice for years. Noone has stopped them. They rent space in the physicians building, then a practitioner sits in the physicians office and assists by bringing patients from the waiting room to fitting room or x-ray and back, etc... Free labor to get the referals. I don't have an answer for you, but I do see this in upstate NY
Hello Eric,
In my candid option, i guess the country of origin is important in matters of this.
secondly if the person in question is an orthopedics surgeon why not and he is well equipped to use others as leverage and has the same end product i will go for it.
to what extent it is occuring in Alabama.
You have, in a very professional and admiral way, expressed a concern that
most fundamentally effects our professional stature and position. There are
many factors that have brought use to this present set of circumstances, a
few of which we have some measure of control, but most of which we do not.
I would like very much to discuss with you those areas of control, and how
we might exercise these consolable factors to the benefit of not only are
profession but also to the benefit of our clients and medical specialist's
patients if you have the time and are interested.
Here are a few points on some of the new models out there.
1. It is legal for a physician to own an O&P practice. An O&P practice can not Employee a doctor, though
2. O&P does not come under stark. DME does (e-codes, for instance)
3 No one can pay for referrals - that is against the OIG and illegal. I have some concerns about manufacturers who are doing the billing for the device and financially incentivizing O&P companies based on referrals sent to them.
4. You can have a clinic in a practice and then pay for use of the space, staff, etc - but you better be able to prove that you have documented the costs as fair-market-value (FMV). This means have a copy of their lease or documentation from a realtor as to FMW. If you are paying for staff, again, you have to have documentation you can back with the amount of time and cost.
Reality is that Medicare is planning cuts to physician revenue. The physicians are going to look wherever they can to gain it back. Locally, some of the other insurance companies may NOT allow an Orthopedic practice to bill for custom, for example. Now that doesn't stop some from billing it anyway and it slips through. I recommend you talk to your local carriers about their regulations. Probably after a few years of seeing increased utilization - which always happens with these things - the government may step back in and change the laws. In the meantime, it is important for o&p companies to sit down and do some strategic planning. This is only going to get bigger and shrink your revenue streams- first for off-the-shelf, then for custom. I think prosthetics is more secure, at this point in time.
Before I reply to you, can I get a few more specifics.
I wonder if the manufacturing members of AOPA will restrict sales to these type of practices. It seems that sales to a large volume smaller group of professional practitioners is managed easier than a small volume with thousands of wanna be orthotic and prosthetic Dr's. We will see where AOPA's alliance lies
Since AL is an O&P licensed state you need to check the state's statutes to see if there are any violations. IL has specific rules against paying for referrals both in the Medical and O,P,& Ped regulations.
Our local Hanger has been doing this type of practice for years. Noone has stopped them. They rent space in the physicians building, then a practitioner sits in the physicians office and assists by bringing patients from the waiting room to fitting room or x-ray and back, etc... Free labor to get the referals. I don't have an answer for you, but I do see this in upstate NY
Hello Eric,
In my candid option, i guess the country of origin is important in matters of this.
secondly if the person in question is an orthopedics surgeon why not and he is well equipped to use others as leverage and has the same end product i will go for it.
Citation
Eric Eisenberg, “Summary of responses to doctors doing o and p,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/232986.
