Prosthetic Justification Reform
The Ortho Remedy
Description
Collection
Title:
Prosthetic Justification Reform
Creator:
The Ortho Remedy
Date:
7/8/2013
Text:
Prosthetic Justification Reform
1.Do we diagnose?
2. Do we design /manufacture/engineer/ biomechanically alignand fit a product that satisfies the need of each individual?
3. Do we gait train?
4. Do we take and hold responsibility for the outcomes ofthose we treat?
This is how a responsible practitioner functions; yet we arepaid only for the product itself.
Looking back to the beginning ofthe technology implosion, I feel wiser and ashamed that I didn’t see it coming. Today’s consumers are aware of the dizzyingarray of products available. They are also often misled by media andmanufacturers. They often come to us insistingthat a particular knee or foot isappropriate and necessary. We then must walk a fine line and delicatelyrecommend activity specific components, though the profits exist in thehigh-end.
Justification for prostheticservices should be something earned by the consumer. The word potential issubjective, and cannot be incorporated into any initial prosthetic plan. Theproblem with many of us limb-makers is that we tend to become emotionallyinvolved, as artists often do. We help our patients with hope and knowledge,but like any industry, profitability is important. Prosthetics, like all otherindustries has become driven by financial before spiritual rewards.
There mustbe a balance. RAC audits have proven to be a successful way to recoup somefunds. Gangster tactics always collect. We must also consider the hugeinterruption of normal business conducted by honorable and responsibleentrepreneurs. I personally have been struggling along with my wife andchildren who share our family business, because one stupid claim, which waslegitimate, is now under scrutiny, after five years, to the tune of over$40,000. What is going on, and who paysus for the additional cost and aggravation? We now have technology that couldeasily streamline the process of prosthetic treatment, using objectivemeasurements and video analysis. The interesting thing about what we do, isthat prosthetic outcomes are often a result of patient motivation, sometimesdifficult to forecast.
Here’s aproposition: What if payers were tojustify specific activity level components/services, based on post-prosthetictreatment objective video gait analysis. In the event of an audit, theprosthetist merely produces the gait analysis from the patients’ file, whichshows objective evidence of the patients’ ability to negotiate environmentalbarriers, or ambulate at multiple cadences. Case Closed! Isn’t this method moreefficient than chasing physicians for notes causing more business interruption,and bad blood between partners in the rehab team.
Who hasaccess to a gait lab? The tools are available now and very inexpensive topurchase. We have incorporated such a device in our practice, and have foundthis portable pocket-sized gait lab to be of great value to our patients aswell as our practice. By spending an additional 2-3 minutes with the patient,we can produce a real time analysis of gait symmetry/cadence which can then beprinted or downloaded into the patients’ file. We found this treatment usefulin documenting amputee progress, or the effects of orthotic intervention.Though this analysis is not reimbursable in prosthetics, it should be, evenmandated. Physicians and physical therapists do have billable codes for thisservice:
( #97762: Prosthetic/Orthotic Checkout, #96000: MotionAnalysis)
Either way, when considering the value of measured objectiveindividual gait studies, the price tag of under $5,000 is a smart investment.
Finally thedays of “Look at me I’m walking!” are coming to an end. We can only improve, ifwe can measure what we do.
This methodof prosthetic delivery would also solve many problems:
1. It would automatically make us more careful whenselecting components.
2. It would help patients understand that what isbest for them, is not necessarily the most expensive, and can be changed asconditions change.
3. It would eliminate the tail chasing associatedwith R.A.C., who are hired to just get money.
4. It would improve our skills as practitioners
5. It would obviously streamline prostheticdelivery and justification.
Ideally, we should also bereimbursed for prosthetic and orthotic evaluations in lieu of equipmentdelivery. How often do we spend time trying to convince an unrealistic patient,that sophisticated equipment is not a solution to their problems? These aresituations that ethical clinicians constantly face. Shouldn’t we be compensatedfor responsible business practice, rather than be driven to abuse the system?
Tom Valenti, CPO, Director, TheOrtho Remedy Inc.
The Ortho Remedy
522 Anderson Ave, Cliffside Park,NJ
07010
1.Do we diagnose?
2. Do we design /manufacture/engineer/ biomechanically alignand fit a product that satisfies the need of each individual?
3. Do we gait train?
4. Do we take and hold responsibility for the outcomes ofthose we treat?
This is how a responsible practitioner functions; yet we arepaid only for the product itself.
Looking back to the beginning ofthe technology implosion, I feel wiser and ashamed that I didn’t see it coming. Today’s consumers are aware of the dizzyingarray of products available. They are also often misled by media andmanufacturers. They often come to us insistingthat a particular knee or foot isappropriate and necessary. We then must walk a fine line and delicatelyrecommend activity specific components, though the profits exist in thehigh-end.
Justification for prostheticservices should be something earned by the consumer. The word potential issubjective, and cannot be incorporated into any initial prosthetic plan. Theproblem with many of us limb-makers is that we tend to become emotionallyinvolved, as artists often do. We help our patients with hope and knowledge,but like any industry, profitability is important. Prosthetics, like all otherindustries has become driven by financial before spiritual rewards.
There mustbe a balance. RAC audits have proven to be a successful way to recoup somefunds. Gangster tactics always collect. We must also consider the hugeinterruption of normal business conducted by honorable and responsibleentrepreneurs. I personally have been struggling along with my wife andchildren who share our family business, because one stupid claim, which waslegitimate, is now under scrutiny, after five years, to the tune of over$40,000. What is going on, and who paysus for the additional cost and aggravation? We now have technology that couldeasily streamline the process of prosthetic treatment, using objectivemeasurements and video analysis. The interesting thing about what we do, isthat prosthetic outcomes are often a result of patient motivation, sometimesdifficult to forecast.
Here’s aproposition: What if payers were tojustify specific activity level components/services, based on post-prosthetictreatment objective video gait analysis. In the event of an audit, theprosthetist merely produces the gait analysis from the patients’ file, whichshows objective evidence of the patients’ ability to negotiate environmentalbarriers, or ambulate at multiple cadences. Case Closed! Isn’t this method moreefficient than chasing physicians for notes causing more business interruption,and bad blood between partners in the rehab team.
Who hasaccess to a gait lab? The tools are available now and very inexpensive topurchase. We have incorporated such a device in our practice, and have foundthis portable pocket-sized gait lab to be of great value to our patients aswell as our practice. By spending an additional 2-3 minutes with the patient,we can produce a real time analysis of gait symmetry/cadence which can then beprinted or downloaded into the patients’ file. We found this treatment usefulin documenting amputee progress, or the effects of orthotic intervention.Though this analysis is not reimbursable in prosthetics, it should be, evenmandated. Physicians and physical therapists do have billable codes for thisservice:
( #97762: Prosthetic/Orthotic Checkout, #96000: MotionAnalysis)
Either way, when considering the value of measured objectiveindividual gait studies, the price tag of under $5,000 is a smart investment.
Finally thedays of “Look at me I’m walking!” are coming to an end. We can only improve, ifwe can measure what we do.
This methodof prosthetic delivery would also solve many problems:
1. It would automatically make us more careful whenselecting components.
2. It would help patients understand that what isbest for them, is not necessarily the most expensive, and can be changed asconditions change.
3. It would eliminate the tail chasing associatedwith R.A.C., who are hired to just get money.
4. It would improve our skills as practitioners
5. It would obviously streamline prostheticdelivery and justification.
Ideally, we should also bereimbursed for prosthetic and orthotic evaluations in lieu of equipmentdelivery. How often do we spend time trying to convince an unrealistic patient,that sophisticated equipment is not a solution to their problems? These aresituations that ethical clinicians constantly face. Shouldn’t we be compensatedfor responsible business practice, rather than be driven to abuse the system?
Tom Valenti, CPO, Director, TheOrtho Remedy Inc.
The Ortho Remedy
522 Anderson Ave, Cliffside Park,NJ
07010
Citation
The Ortho Remedy, “Prosthetic Justification Reform,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235401.
