Significant Changes Expected in the Wake of Health Care Reform

Bezold presenting at the AOPA National Assembly on the future of health care reform
Bezold presenting at the AOPA National Assembly on the future of health care reform.
Image: A. Calabro, O&P Business News.

Should health care reform be approved, the O&P field will see significant changes in technology, reimbursement and competition, according to Clement Bezold, PhD, founder, Institute of Alternative Futures (IAF).

Bezold spoke at the American Orthotic and Prosthetic Association (AOPA) National Assembly in Seattle. In his presentation, Bezold made his case for health care reform and listed the key elements in the House and Senate bills. He also examined the points of contentiousness for health care reform by both political parties, including a government sponsored public option and taxes on middle income families.

Along with O&P statistics and predictions, Bezold covered overall health care, including projected health care costs, overall health system performance and deaths caused by medical errors.

“The U.S. health care system is unsustainable, inefficient, inequitable and sometimes toxic,” Bezold said.

Bezold predicts one of the agents of health care transformation will be the use of disruptive innovations. Disruptive innovations are simplified solutions to complex problems in affordable and convenient ways. Bezold noted that disruptive business model innovations such as the triple aim and bundled payments began off the radar screen but are now becoming more popular.

The triple aim is described as the improvement of population health care, quality of health care and the decrease of the overall cost, according to Bezold.

Bundled payment, a one-time fee for an entire episode of care could change the way the O&P industry is reimbursed, according to Bezold. Questions as to who manages the payment and how the payments will be allocated remain. The success of the bundled payment will be determined by good collaborations between practitioners and processes, Bezold predicted.

“You as a field have a variety of challenges, some of which are clear, some are less clear,” Bezold said.

Bezold noted that society is demanding more from their prosthesis. One question he posed is when will prosthetics meet and surpass natural function? Bezold believes there will be a blending of nano and biotechnology. This technology has the potential to regrow limbs and skin.

On the other end of the price spectrum, Bezold pointed to low-cost technology that engineers are currently motivated to create. Bezold highlighted the Stanford University student project that created the JaipurKnee. The JaipurKnee is a $20 lower extremity prosthesis designed by Stanford University students and the makers of the Jaipur Foot.

Bezold also released the forecasts for the number of amputations that will be performed in the year 2020, which IAF developed for the American Board for Certification in Orthotics, Prosthetics and Pedorthics. According to Bezold, amputations in 2010 are estimated to be 145,000. But if the country’s overall health decreases, Bezold and IAF predict amputations could rise to 200,000 a year by 2020. If the overall health of the country increases, Bezold and IAF project amputations could fall to 125,000 a year. — Anthony Calabro


Defined and repeatable processes will be key for O&P. Through good processes medical errors can be reduced or prevented. O&P traditionally has been devoid of these processes electing to treat each case as unique or statistically as an outlier; in reality outliers are rare. In addition, the empirical processes which do exist in O&P are individualistic between practitioners thus O&P lacks consistency of care between practitioners in the same facility.

I think [amputation forecasts] are controversial. There are statistics from the Centers for Disease Control showing the number of discharges per 1000 for non-traumatic lower extremity amputees with a diagnosis of diabetes has been declining since 1997. Also, one should be cautious about connecting amputations with the provision of a prosthesis. Simply because there is a correlation between amputations and a prosthesis one should not conclude one leads the other. Medicine has improved in its limb salvage procedures forestalling amputation to older ages. At this point, the patient may have so many other co-morbidities that a prosthesis is simply impractical. Thus an increasing amputation rate is not necessarily a leading indicator of increasing prosthesis provision.

— Brian Gustin, CP
Chief Clinical Officer, Bridge Point Medical

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