States must be willing to donate their time, money and energy if they wish to pursue an O&P licensure bill.
Twelve states have passed O&P licensure bills, none since 2006. Why has the progress stalled? Behind the scenes, states are inching closer to getting bills passed, but hurdles remain, including our nation’s economic crisis, state budgetary concerns and the slow-moving legislative process. Yet, state organizations have been working tirelessly, making their way through these roadblocks. Practitioners from Pennsylvania, Iowa and Kentucky unanimously agree that they are pursuing licensure to first and foremost protect the patient and are cautiously optimistic that they can get a bill through legislation and passed for the first time in 3 years.
According to the American Academy of Orthotists and Prosthetists (the Academy) Orthotic & Prosthetic Licensure: A Comprehensive Guide, licensure requirements protect the patient and enables the individual to access the highest quality of care.
“While licensure can improve competency standards, professional validation, a defined scope of practice, reduction of fraud and abuse, a greater voice in state policy, professional accountability, increased quality and improved economics, the overriding reason for states to license the orthotic and prosthetic profession is consumer protection,” the Academy wrote in the Guide.
Despite the Academy’s call for passage, no state has obtained licensure in 3 years. The stall in progress has not gone unnoticed.
“I actually thought there would be more states with licensure by now,” John R. Reynolds, CPO, FAAOP, Reynolds Orthotics and Prosthetics Inc., said. “But it is expensive to do and there are just very few who support it financially.”
The lull in progress may not have been anticipated, but with states such as Pennsylvania turning to high priority matters like their state budget, legislation for a licensure bill is at a standstill. The current economic climate has handcuffed states’ ability to spend. According to Reynolds, legislators are advising practitioners pursuing licensure to create a bill that remains budget neutral. Lawmakers are essentially asking practitioners to produce a fiscally responsible bill that is at no cost to the state and maintain a licensing board that is self-sustaining. This is a difficult task.
“A budget neutral bill simply makes the consideration by the legislature easier and eliminates one potential element to kill a bill,” Jim Rogers, CPO, FAAOP, immediate-past president of the Academy, said.
The O&P field has continually fought to gain credibility within the health care industry and state licensure has been recognized as a major instrument for that credibility.
“The strategy that worked for us in Tennessee was that if we do not define who we are, someone else will do it for us,” Reynolds explained. “That is what lit the fire under everyone.”
Kentucky: Legislator education
Practitioners from the state of Kentucky have been pursuing licensure for 3 years. In the first year of pursuit, a bill was passed unanimously through the Kentucky House and Senate, only to have the bill amended and ultimately struck down. After two more unsuccessful tries, practitioners in Kentucky decided to switch strategies. Tony Ward, CPO, LPO, president of the Kentucky Orthotic and Prosthetic Association (KOPA) and his organization made a greater effort to tell their story to legislators as they work toward the new legislative session in January, 2010.
“I think the biggest change for us, working toward next year, is that we’re really making a conscious effort to educate a number of legislators and letting them know what we do and why it is needed,” Ward said. “We’re creating more dialogue with legislators outside of the legislative session. We are doing a lot of work in preparation for the start of the new session.”
In order to get a bill passed, state organizations pursuing licensure must lay the groundwork. Attending fundraisers outside the legislative session is a crucial step in raising money for expenses such as lobbyists. This may take time away from a practitioners practice, however attending these events and committee meetings will also provide education for legislators on the importance of licensure and keep the topic fresh in their minds.
“Unfortunately, licensure costs time, money and requires a considerable commitment in organizational resources. Not every state is ready or capable of making this commitment,” Rogers said.
Reynolds believes practitioners can do more, despite the challenges.
“More practitioners need to participate,” Reynolds said. “It is their livelihood; they should be involved in it.”
KOPA crunched the numbers and avoided a major roadblock by providing Kentucky legislators with evidence proving they could sustain themselves without increasing the state budget. KOPA also kept everyone happy by allowing their grandfathering period to coincide with the 2013 minimum education and training requirements that was agreed upon by five major national organizations representing the O&P profession. According to Ward, coinciding with the 2013 agreement will decrease resistance to their bill.
“I am optimistic, but we have been close in years past, so I am cautiously optimistic,” he explained.
Pennsylvania: The 5-year struggle
“We have been struggling with attempting to get licensure in Pennsylvania for 5 years,” Eileen Levis, president of the Pennsylvania O&P society, told O&P Business News. “One of the major roadblocks was that the state does not want to establish new licensure boards.”
State organizations should research if any existing boards are open to the possibility of having a sub-board formed. An organization may have limited representation on a sub-board, but the cost is much less than that of a free-standing board with full-time employees. In Pennsylvania, board seats must be filled by full-time employees.
“If people can do their homework and find out what is required for a licensing board in their state, it would make the process go quicker,” Reynolds said.
The Pennsylvania O&P society’s analysis showed having a board in Pennsylvania could cost as much as $600,000.
“After investigating the situation it was determined that the only way we were going to get a board in Pennsylvania was to become a sub-board of another board,” Levis said.
Today, Levis’ organization acts under the offices of the medical board. In June, after more than 2 years of legal wrangling, House bill 255 was created and eventually sent to the Pennsylvania House. Due to the state’s budgetary concerns, the bill is still waiting for a floor vote. The bill was also introduced by Pennsylvania Sen. Jeff Piccola, signaling support from the Senate side and effectively increasing the odds of passage.
Levis is hopeful that with favorable support and bills in both the state House and the Senate, that licensure can be passed by the end of this year. Despite her optimism, Levis is concerned with her committees own financial situation. She admits the process has been very expensive, having spent in excess of $125,000 over the course of the entire pursuit.
“We’ve been going at this for 5 years and we’re just determined to get this done,” Levis said. “You have to be willing to work hard and fight through those distractions and disappointments.”
Iowa: Can they do it again?
Coming off their state’s passage of a parity bill, Dennis Clark, CPO, president of Clark & Associates, is confident a licensure bill can be passed. The Iowa Orthotics, Prosthetics and Pedorthics Association (IOPPA) was created specifically to address the parity and licensure bills, according to Clark.
“Our pursuit of licensure really began after parity was signed last year, so we are less than a year into this,” Clark said. “We are focusing purely on licensure in the state of Iowa. We have a lobbyist employed and they are giving us a 24- to 36-month timeline, but I am hoping that because of the groundwork that was laid in regards to parity, that we can get a licensure bill passed ahead of that timeline.”
Clark noted that IOPPA has researched the 12 licensure bills that have passed and talked to individuals of those states about some of their pitfalls. Clark received tremendous feedback from individuals directly involved with licensure and national health care organizations.
“We reached out to a number of organizations and individuals and looked at fine tuning a bill that would be really helpful and would address the issues that we have,” Clark said. “There is a wealth of knowledge out there.”
IOPPA and Clark understand the legislative process can be difficult. But mastering the process early is essential for later success.
“The licensure bill is one of those things that not only are we going to have to do, but we’re going to have to maintain,” Clark said. “It is going to have to make sense and we’re going to have to be involved at the board level within the state. Therefore, you need to do everything correctly on the front end, so the actions made after that make sense, are usable and doable.”
For more information:
- American Academy of Orthotics and Prosthetics. Orthotic & prosthetic licensure: A comprehensive guide. Available at: http://www.oandp.org/assets/upload/Licensure-Toolkit.pdf. Accessed Sept. 28, 2009.
- Advocacy Matters. Major O&P organizations reach agreement on minimum standards for providers and suppliers of custom orthotics and prosthetics. Available at: www.amputee-coalition.org/newsletters/advocacy_matters/january_2009. Accessed Sept. 28, 2009
Anthony Calabro is a staff reporter for O&P Business News.