Evidence based practices.
Andrew Cinque
Description
Collection
Title:
Evidence based practices.
Creator:
Andrew Cinque
Date:
4/26/2020
Text:
I’d like to start some realistic discussion on this topic, specifically regarding pediatric orthotics, because from what I read, as in the recent O&P Almanac, most articles revolve around compliant prosthetic patients. Here’s a scenario:
You are presented with a boney, 10 year old boy with CP. His existing braces are outgrown and completely worn out. He is cared for by a single Mom who was lucky enough to be able to make the appointment. His level of available PT ends with once or twice a week in school, with PT’s who play games with him for 20 minutes, if they are actually PT’s at all. There isn’t any at home follow up, if he even wears the braces at home because he hates them and Mom is working two jobs and doesn’t have the time to battle him. His siblings are busy with their own thing.
Medicaid already has cut codes to the bare minimum where you are lucky to be able to provide the definition of a brace from 1970, let alone what you really know he needs, with adequate padding and straps to control his deformity comfortably. So, OK, its prescribed, “approved” (something you can’t depend on anyway), fabricated as it should be which means you are already borderline loosing money right off the bat, but that's what separates you from the company who don’t install padding in their braces at all, or instep straps, so you do it because you want to stay in the Clinic’s good graces in the hopes of acquiring more work before it goes to someone else who is touting quicker service - sure - because they are providing sub-par appliances. The braces are fabricated and ready for delivery. You see the patient, don it for trial, after 30 minutes you check the skin, all looks great, the patient isn’t complaining and his Mom is happy. You know you have done a good job. You can’t really measure what you have done against what he came in with because what he came in with was horrible and is that really a valid “measurement of outcome” or are you just filing out a form for the sake of doing so ? Again, he is a 1 year old boy. He couldn't care less about your gait analysis, he only want to get from point A to point B ASAP and sit and play with toys. He’s boney, and hasn’t gained or lost weight over the past 3 weeks. If you spend any more significant time with the patient after that you may as well have not even billed for it because then your pretty much doing charity work. There is no compensation in it for you. There is no incentive.
PLEAASE, if you are going to be respond, do so with 20-30 years of experience behind you. Be realistic. Please don’t respond after a few years of textbook idealistic thoughts and start preaching to me. But I welcome the responses !!! Go at it !!! My skin is plenty thick. And if you feel you don’t want to be part of the resources, but want to email me privately or text me, I’m in. I’d like to know that someone out there is in possession of common sense.
Tell you what, Insurance Companies: Raise rates; something that hasn’t been done in 3 decades. Reinstall coding that allows us to bill for appliances that we know will do the intended job. Stop auditioning us to death for the sake of finding any way possible to take back the money you already approved, and place a stipend on top of the new rates for our time to more carefully analyze our patient’s progress and outcomes. Then we will be talking business.
And again, as I have questioned in a past email which started a small firestorm, where is AOPA in all this? Where is ABC how are you certifying practitioners who have the nerve to provide appliances that are an embarrassment to this industry? Where is our support for our dues? I am told be patient, its coming. We are doing this and that… yeah yeah yeah, blah blah blah. I feel like Charlie Brown listening to his teacher.
I'm done. back to Corona downtime.
Andrew A. Cinque CPO
34 Ridge Road
Cortlandt Manor, NY 10567
Cell: (914) 755-5145
Fax: (914) 737-1488
AC Prosthetic & Orthotic Svs Inc.
<URL Redacted>
Mgr @ JK Prosthetics & Orthotics Corp.
699 North MacQuesten Parkway
Mount Vernon, NY 10567
Office: (914) 699-2077
Fax: (914) 699-0676
<Email Address Redacted>
You are presented with a boney, 10 year old boy with CP. His existing braces are outgrown and completely worn out. He is cared for by a single Mom who was lucky enough to be able to make the appointment. His level of available PT ends with once or twice a week in school, with PT’s who play games with him for 20 minutes, if they are actually PT’s at all. There isn’t any at home follow up, if he even wears the braces at home because he hates them and Mom is working two jobs and doesn’t have the time to battle him. His siblings are busy with their own thing.
Medicaid already has cut codes to the bare minimum where you are lucky to be able to provide the definition of a brace from 1970, let alone what you really know he needs, with adequate padding and straps to control his deformity comfortably. So, OK, its prescribed, “approved” (something you can’t depend on anyway), fabricated as it should be which means you are already borderline loosing money right off the bat, but that's what separates you from the company who don’t install padding in their braces at all, or instep straps, so you do it because you want to stay in the Clinic’s good graces in the hopes of acquiring more work before it goes to someone else who is touting quicker service - sure - because they are providing sub-par appliances. The braces are fabricated and ready for delivery. You see the patient, don it for trial, after 30 minutes you check the skin, all looks great, the patient isn’t complaining and his Mom is happy. You know you have done a good job. You can’t really measure what you have done against what he came in with because what he came in with was horrible and is that really a valid “measurement of outcome” or are you just filing out a form for the sake of doing so ? Again, he is a 1 year old boy. He couldn't care less about your gait analysis, he only want to get from point A to point B ASAP and sit and play with toys. He’s boney, and hasn’t gained or lost weight over the past 3 weeks. If you spend any more significant time with the patient after that you may as well have not even billed for it because then your pretty much doing charity work. There is no compensation in it for you. There is no incentive.
PLEAASE, if you are going to be respond, do so with 20-30 years of experience behind you. Be realistic. Please don’t respond after a few years of textbook idealistic thoughts and start preaching to me. But I welcome the responses !!! Go at it !!! My skin is plenty thick. And if you feel you don’t want to be part of the resources, but want to email me privately or text me, I’m in. I’d like to know that someone out there is in possession of common sense.
Tell you what, Insurance Companies: Raise rates; something that hasn’t been done in 3 decades. Reinstall coding that allows us to bill for appliances that we know will do the intended job. Stop auditioning us to death for the sake of finding any way possible to take back the money you already approved, and place a stipend on top of the new rates for our time to more carefully analyze our patient’s progress and outcomes. Then we will be talking business.
And again, as I have questioned in a past email which started a small firestorm, where is AOPA in all this? Where is ABC how are you certifying practitioners who have the nerve to provide appliances that are an embarrassment to this industry? Where is our support for our dues? I am told be patient, its coming. We are doing this and that… yeah yeah yeah, blah blah blah. I feel like Charlie Brown listening to his teacher.
I'm done. back to Corona downtime.
Andrew A. Cinque CPO
34 Ridge Road
Cortlandt Manor, NY 10567
Cell: (914) 755-5145
Fax: (914) 737-1488
AC Prosthetic & Orthotic Svs Inc.
<URL Redacted>
Mgr @ JK Prosthetics & Orthotics Corp.
699 North MacQuesten Parkway
Mount Vernon, NY 10567
Office: (914) 699-2077
Fax: (914) 699-0676
<Email Address Redacted>
Citation
Andrew Cinque, “Evidence based practices.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/254869.
