Do we need more prosthetists in the US?
Melinda Janowitz
Description
Collection
Title:
Do we need more prosthetists in the US?
Creator:
Melinda Janowitz
Date:
2/26/2014
Text:
Hi all. Been reading about your concerns regarding the numbers of Prothetists & Orthotists currently needed. Please look at the “other” very good Report done by Dobson and DaVanzo for AOPA,” Study: Medicare Scandal Continues with Significant percentage of payments for O & P Devices going illegally to unlicensed Providers.” The report analyzes a 5% sampling on which providers were receiving payments from CMS. Claims period was 2007 thru 2011.
<URL Redacted>
The five categories for providers listed were Certified O & P, DME without certified personnel, Pharmacies, Other and Physicians. The report further breaks out services provided across all states vs. 3 licensure states for O & P. Please pay particular attention to “Custom Fabricated & Fitted Orthotic Base Code Allowed Services”. Nation wide the CMS payments of custom orthosis has dropped for certified orthotists from 2007 to 2011 from 43% to 37% a reduction of 6%, with most of that shift going to physicians at 37% up from 31%. Simply stated, O & P receives 1/3 of CMS payments, physicians have 1/3 and 1/3 going to the other 3 categories. That is bothersome. However, now look at Texas, a licensure state. Certified/Licensed orthotists were again providing 43% Custom orthotics in 2007, but by 2011 the percentage drops to 31%. A decline of CMS payments by 12%. By extrapolation, by 2020 in Texas, licensed orthotists will only be receiving 9.4% of CMS payments for custom orthotics. Assuming this is because more physicians will be supplying more complex orthoses and/or CMS will be requiring the use of less costly devices.
To address the question “do we need more or less prosthetists”? I think it depends on what part of the country you live in…or more accurately (as someone pointed out) what part of the world. There is a need for well-qualified prosthetists and orthotists, however will they fit into the changing insurance climate of the US. Not if CMS has their way. The need for custom prosthetics, as with custom orthotics, will be challenged as cost containment mandates take precedence. In the same report, CMS payments for prosthetics are not nearly as bad they are for orthoses. However, once physicians have control over the majority of orthotics, custom and otherwise, what is stopping them to make the leap to “EZ FIT” modular prosthetic componentry? Vendors are already re-evaluating their market and offering cheaper componentry that meets a lower K-level. Will the vendors next move to go directly to the physicians and load them up on 100s of 1000s of dollars in prosthetics components? Sound far-fetched….?
If you have time, carefully listen to the accompanying Press Conference sponsored by AOPA back in September 2013.
<URL Redacted>
You will hear from Thomas Kirk, Rep. Glenn Thompson, Allen Dobson and Tom Scully. Mr. Kirk states that according to the Dobson DaVanzo Report, out of this sampling of claims, 2/3 were paid illegally by CMS. Later in the press conference Mr. Dobson states only 1/3 were illegally paid. Why the difference in opinion? First of all, which payments are they referring to? Neither the report nor AOPA say. As a side note, this report was not available recently on the AOPA website until I contacted Dobson and DaVanzo the week of February 10th. It had been “accidentally dropped” from the website. Once the report was back up, there was an addendum added that implies that the 1/3 payments to physicians were not part of the CMS illegal payments. So…. you all can make your own inferences, I’ve made mine. Comments welcome.
Melinda Janowitz CMF, COF
Antelope Valley Orthotics & Prosthetics
Palmdale, CA
Sent from Windows Mail
<URL Redacted>
The five categories for providers listed were Certified O & P, DME without certified personnel, Pharmacies, Other and Physicians. The report further breaks out services provided across all states vs. 3 licensure states for O & P. Please pay particular attention to “Custom Fabricated & Fitted Orthotic Base Code Allowed Services”. Nation wide the CMS payments of custom orthosis has dropped for certified orthotists from 2007 to 2011 from 43% to 37% a reduction of 6%, with most of that shift going to physicians at 37% up from 31%. Simply stated, O & P receives 1/3 of CMS payments, physicians have 1/3 and 1/3 going to the other 3 categories. That is bothersome. However, now look at Texas, a licensure state. Certified/Licensed orthotists were again providing 43% Custom orthotics in 2007, but by 2011 the percentage drops to 31%. A decline of CMS payments by 12%. By extrapolation, by 2020 in Texas, licensed orthotists will only be receiving 9.4% of CMS payments for custom orthotics. Assuming this is because more physicians will be supplying more complex orthoses and/or CMS will be requiring the use of less costly devices.
To address the question “do we need more or less prosthetists”? I think it depends on what part of the country you live in…or more accurately (as someone pointed out) what part of the world. There is a need for well-qualified prosthetists and orthotists, however will they fit into the changing insurance climate of the US. Not if CMS has their way. The need for custom prosthetics, as with custom orthotics, will be challenged as cost containment mandates take precedence. In the same report, CMS payments for prosthetics are not nearly as bad they are for orthoses. However, once physicians have control over the majority of orthotics, custom and otherwise, what is stopping them to make the leap to “EZ FIT” modular prosthetic componentry? Vendors are already re-evaluating their market and offering cheaper componentry that meets a lower K-level. Will the vendors next move to go directly to the physicians and load them up on 100s of 1000s of dollars in prosthetics components? Sound far-fetched….?
If you have time, carefully listen to the accompanying Press Conference sponsored by AOPA back in September 2013.
<URL Redacted>
You will hear from Thomas Kirk, Rep. Glenn Thompson, Allen Dobson and Tom Scully. Mr. Kirk states that according to the Dobson DaVanzo Report, out of this sampling of claims, 2/3 were paid illegally by CMS. Later in the press conference Mr. Dobson states only 1/3 were illegally paid. Why the difference in opinion? First of all, which payments are they referring to? Neither the report nor AOPA say. As a side note, this report was not available recently on the AOPA website until I contacted Dobson and DaVanzo the week of February 10th. It had been “accidentally dropped” from the website. Once the report was back up, there was an addendum added that implies that the 1/3 payments to physicians were not part of the CMS illegal payments. So…. you all can make your own inferences, I’ve made mine. Comments welcome.
Melinda Janowitz CMF, COF
Antelope Valley Orthotics & Prosthetics
Palmdale, CA
Sent from Windows Mail
Citation
Melinda Janowitz, “Do we need more prosthetists in the US?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236047.
