Facility Accreditation, Credentials and the Technician

Thanks to the efforts of many people working on behalf of registered
technicians, this past February an amazing thing happened and many O&P
professionals might not have grasped its importance. The American Board for
Certification in Orthotics, Prosthetics and Pedorthics, Inc (ABC) changed the
credentialed status of “Registered Technician” to “Certified
Technician,” removing the “Registered” designation from the
rosters entirely.

This is important for several reasons, some more important than others.
It might not have come with a raise, but I’m certain that technicians will
reap the reward from it soon enough. We technicians may never make the same
money that practitioners make, on average, but there are a couple of factors in
play that I think will result in technicians with an acknowledged certification
becoming more valuable on many levels.

Practitioner education

There has been a shift in practitioner education in the past few years.
In an obvious effort to raise the level of patient care, practitioner education
has focused more on the clinical level and less on the technical level. This is
due in part to a lack of the evidence-based studies relating to the
construction of O&P devices. A lot is known about the clinical aspects of
O&P patient care but not as much about the technical aspect.

  © 2010 iStockphoto.com/Tom

Because of this shift, most of the time spent by O&P students will
be in the classroom or in a clinical setting and less of it spent on the bench
learning hands-on technical skills. Unless a new student came into the modern
O&P program with some bench skills already learned, as some still do, they
probably will not develop them in school.

This leaves a gaping chasm that can only be filled by the technician.
When a conversation with the practitioner gradually goes from him saying
“fix this problem this way” to “I don’t know, just make it
work,” you will know your stock has risen. You will have a knowledge and
skill that the practitioner may not possess. And unless great advances are made
in off-the-shelf/custom O&P devices, you will have the leverage to
negotiate your worth to the team.

Facility accreditation

Ordinarily, I try to avoid prophesying or speculating on industry trends
as I am often proven wrong, but I will make an exception this time. I believe
that before we know it, CMS will begin requiring that fabrication labs be
accredited. There is already language that can be interpreted that way although
there is, as of yet, no requirement for central fabrication facilities to be
accredited. I believe that it has been assumed that O&P devices are being
manufactured with the direct supervision of a certified practitioner. We all
know that is not true and that many central fabrication facilities are run by
certified – or uncertified – technicians only.

Most patient care facilities have their own fabrication labs. These labs
are, for the most part, under the supervision of the certified practitioners,
making them compliant with CMS guidelines. If they are not under the direct
supervision of certified practitioners then they are likely (technically)

While most experienced technicians are more than capable of
manufacturing perfectly adequate O&P devices, they may not be to-the-letter
compliant to supervise the lab. But since there was no provision to include
such labs in the language of accreditation, it is something of a loophole. If
CMS ever closes that loophole it will certainly further raise the value of
certified technicians. While I’m not sure what kind of language will
comprise the certification requirements of such an accreditation, I am willing
to bet that a certified technician will be the minimum certification accepted.

Some of the other requirements that accredited labs can expect to have
to comply with are, in no particular order: safety regulations, in-the-door to
out-the-door inventory management, setting and following fabrication protocols,
implementing quality assurance plans, and repair and maintenance logs for
devices and equipment, just to name a few. Essentially, each lab will have to
be run to the same standards that patient care facilities are held, except that
these facilities will likely have fabrication-specific standards added and
clinical-specific standards dropped.

Evidence-based studies

I am not sure how they plan on tracking it, but ABC has included in the
scope of practice for certified technicians: “Promotion of competency and
enhancement of professional practice to contribute to the profession’s
body of knowledge includes, but is not limited to participation in: continuing
education, training of residents and students, evidence based studies,
promotion of public awareness of the profession, consumer organizations,
governmental and non-governmental organizations”.

The highlighted “evidence-based studies” is important because
there is a large gap in accurate and widely accepted fabrication protocols that
desperately needs to be closed. Our best chance at finding the most standard
way of fabrication is to determine it ourselves. The Orthotic and Prosthetic
Technical Association (OPTA) has begun collecting “evidence-based
studies” and “empirical data” in an effort to determine commonly
accepted standards for fabrication of O&P devices. There are ways that you
can help.

In the near future OPTA will be announcing the creation of a handful of
committees that will be charged with proving and collecting data derived from
science and experienced based experiments. In the beginning we will start out
slow and ramp up efforts as we go. This information will be used for training
technicians, testing technicians and it will be maintained in a database
available to all technicians.

If you have some empirical or evidence-based studies, please send it to
us and help to raise the bar of technician education. OPTA is looking for
scientific data regarding proper fabrication of O&P devices. Things like;
how to correctly set a rivit, how long to leave plastic on the mold after
vacuum forming, how many rivits does it take to properly attached a caliper box
to a shoe … things of that nature. If you have something you can share or
want to get involved with the committees, please either contact me through my
website (www.delphiortho.com) or at my OPTA email address,

More than just paper

If you are a certified technician and received one of those nice new ABC
certifications and wondered what just happened, I have good news for you. It is
more than just a pretty new wall hanging, as one pessimistic technician I spoke
to called it. You may not have gotten an overnight raise with it but give it
some time and your new title will automatically pay dividends. And if you make
the certification work for you, you will gain even more. You only get out of
life what you put into it. Find ways to put your credential to work for your
industry and for yourself. Participate in the local and national conventions,
get continuing education, write articles, conduct material or process studies
… whatever you can fit into your life. You might gain some knowledge and
maybe even the respect of your peers.

Steve Hill, CO

Steve Hill, CO is the secretary of the Orthotic and
Prosthetic Technological Association and owner/chief executive officer of
Delphi Ortho.

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