Maintaining Professional Discipline

The reputation of an O&P professional or facility is not necessarily determined by the success of their patients. Restoring a person’s quality of life is the desired result at the end of the day.

However, numerous decisions are made to lead to that end. These decisions and the process leading up to them is a large part of individual, facility and industry-wide reputation. Lurking behind these day-to-day decisions is the gray matter of ethical responsibility.

Considering your responsibility to not only your patient but also to your profession should be at the forefront of the decision-making process. This will ensure not only patient success but also a continued positive reputation for the O&P industry.

ABC expectations

The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) is currently the leading credentialing body for O&P practitioners. Many other professional organizations use the ABC Code of Professional Responsibility (formerly the Canons of Ethical Conduct) as a backbone for their own ethical considerations.

This one document covers every aspect of O&P as broken down into several areas of responsibility; to the physician or appropriately licensed health care provider, to the patient, and to the profession. Additionally, the guidelines set forth by this code are met through self-policing. It is not only the O&P practitioner’s job to uphold the code, but also to report individual instances when those conditions are not being met.

Tom Derrick, the public relations, marketing manager and professional discipline manager for ABC, said that one of every three complaints received by the Professional Discipline Committee is not investigated due to the fact that the filed complaint cannot prove any violation of code.

“ABC’s Professional Discipline Committee reviews all complaints and opens investigative procedures for those complaints that demonstrate the possibility of a violation of the Code of Professional Responsibility,” Derrick told O&P Business News.

The remaining complaints amount to approximately 25 per calendar year which are then investigated for validation. Investigated cases typically take 4 to 6 months to adjudicate.

Personal ethics in a professional setting

Man looking through magnifying glassThe idea of ethics essentially means simply doing the right thing. But often the process of making ethical decisions is not as simple. The intertwining of personal, professional and business ethics can be confusing especially if for some reason, these three categories come to a crossroads for you.

So where do they all fit into the bigger picture?

Personal ethics, which everyone has developed over time as a result of individual experiences, will sometimes coincide with those ethics that you are bound to adhere to professionally. The beliefs that do not are the specifics that should be left at the door when entering the workplace. Putting professional ethics ahead of your own personal beliefs is vital for a consistent and healthy working environment.

In the O&P atmosphere, it is almost a secondary expectation to become friendly with patients due to the nature of your work so it is especially important to be sure that communications are clear and no interactions are left up to interpretation.

“We are having a tremendous impact on a patient’s lifestyle and livelihood so you tend to invest more emotionally for the individual,” Terry Supan, CPO, FAAOP, FISPO, clinical associate with Orthotic and Prosthetic Associates of Central Illinois and a clinical professor at Southern Illinois University School of Medicine and vice chair of the Illinois Orthotic, Prosthetic, and Pedorthic Licensure Board said. “You can become friends with patients and you can have other associations with them, but you have to always remember not to cross the line.”

Establish your business ethics

Business owners are responsible for not only their ethical behavior but also for those people who work in their facilities. Therefore, it is essential for owners to set the standard for the ethics of their businesses.

“Have integrity as part of the basis for your practice,” Supan suggested. “Be vigilant and make sure that your employees are handling themselves in an ethical manner. You have to be aware about what is going on in your practice.”

In order to negate the likelihood of ethical debate within your facility, it might be a good idea to hold meetings as a refresher on ethical issues every so often as recommended by many of the practitioners interviewed.

Bryan Malas, CO, chairman of the National Commission on Orthotic and Prosthetic Education (NCOPE), suggested including the practitioners in the planning stages of those meetings.

“One thing that we have found effective is if you have someone … review a particular section of the [ABC Code] and then ask that employee to present it at the meeting,” Malas said.

This helps in retention of the information and will also aid in an open dialogue about the selected topic.

ABC past president Frank Friddle Jr., CO, president of Friddle’s Orthopedic Appliances, said these meetings would be helpful to not only reeducate practitioners but “also to understand the intent of the ethical rules that are being administered.”

Instead of just reiterating information that everyone should know, it is also important to answer the question – why do we follow this rule?

Larger chain facilities might use a human resources affiliate to either arrange for larger meetings based on the same framework that a smaller facility would employ or arrange for the disbursement of materials that will keep everyone on the same track.

Working with the outside

“It is really critical to make sure that you have appropriate business practices in place so that you do not have to worry about compliance issues, improper billings, fraudulent cases or things like that,” Supan said.

Work is not over when a patient leaves your office. Proper documentation, such as billing records, is just as important ethically as are appropriate patient relations and care.

Billing is of particular importance as codes are always in flux and practitioners need to make an effort to stay informed and updated about correct coding for reimbursement and proper documentation. Without the correct knowledge, fraudulent billing can result.

“Whether this fraud is intentional or just an error in coding, it is up to the practitioners to find that out,” Friddle said. “With the help of the AOPA coding seminars you can correctly bill on the L codes.”

Beyond billing is also the issue of visit documentation. Identifying the exact health care needs that you see and treat each patient for as well as the means by which you treat them should always be identified following a visit. This information should remain confidential and on file.

ABC Discipline Committee Violations

Man looking through magnifying glassThe ABC Professional Discipline Committee has found the following individuals in violation of the ABC Code of Professional Responsibility since Jan. 1, 2006:

  • A certified orthotist was suspended for 2 years for violations of C1.2 (Ethics, Custom and the Law), C3.4 (Trust and Honesty), C4.1 (Dignity) and C5.1 (Adherence to Code) of the Code of Professional Responsibility.
  • Two certified prosthetists and a certified orthotic fitter were suspended for violation of Rule 3.2 (Affiliations), all in separate incidents.
  • A certified orthotist was permanently revoked for violation of Rule 3.1 (Conviction/Charge).

The changing role of education

Much is changing in the areas of O&P education and training which will in turn affect the way that ethics is approached in an educational setting.

Current O&P students and residents enrolled in schools and residency programs regulated by NCOPE are held to several sets of ethical and behavioral standards, Malas explained. Students are expected to uphold NCOPE and university standards while residents are expected to uphold NCOPE resident standards and ABC’s Code of Professional Responsibility.

In order to regulate the level of ethical responsibility at each institution, NCOPE representatives visit each school before allowing the school to be an NCOPE affiliate.

“When we do a site visit and review programs, we review the university catalog from the school to see that there are policies in place regarding ethical conduct,” Malas said. “A lot of programs currently have elements of ethics that are integrated in other program coursework.”

The bachelor’s degree program curriculum originally created by NCOPE has not required a specific course revolving around this topic, however, there is a portion of instruction related to professional responsibility.

“You follow the progression of a student to a resident to an exam candidate to an ABC certifee. Once [the certifee] leaves school and begins their residency, the NCOPE resident is under the obligation to follow the ABC Code of Professional Responsibility. A violation of the code under the resident status will jeopardize your residency,” Derrick explained.

However, as NCOPE continues to develop a master’s level curriculum, Malas said that more emphasis will be placed on ethics education both directly and indirectly.

“You are going to see ethics being taught in the curriculum and by that I mean that parts of the curriculum will deal with HIPAA regulations, discussion on state licensure, and certainly a review of the expectations by the ABC credentialing body and specifically their code of professional responsibility,” Malas said.— by Jennifer Hoydicz

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