AOPA’s Big Picture: Protecting O&P

The champions of AOPA’s Protect Initiatives highlight their goals for the future of the O&P profession.

The end of the year always causes people to reflect. They take stock of good qualities, and bad, and promise to accomplish more in the new year.

The new year, then, inevitably brings large hopes for the future, but not always great plans.

The American Orthotic & Prosthetic Association (AOPA) has great plans.

Beginning in December 2007, AOPA surveyed its members and took stock of the orthotic, prosthetic and pedorthic fields to determine their needs moving forward. From this survey emerged three themes — to protect, to provide for and to promote the O&P profession — and 11 Strategic Planning Initiatives to accomplish these goals.

Feedback from AOPA members

Several years ago AOPA put together strategic planning exercises known as the Sunriver Initiatives, which were examined at a leadership conference held in Chicago in November 2006. Throughout the next year, the AOPA board of directors worked to identify the issues.

To further explore this idea, and to solicit the members’ thoughts and fears about the current and future status of the profession, AOPA created a workgroup of representatives from its board of directors and other AOPA groups, and conducted an intensive membership survey. The survey brought together both the patient care perspective and the supplier perspective on a variety of issues.

“We had fantastic reply, in the world of surveys,” Dennis Janisse, CPed, member of AOPA’s National Assembly committee, said.

Brad Ruhl, 2009 immediate past president of AOPA, attributes the high rate of response — which he estimates at approximately 15% of membership — to conducting the survey during the end of December.

“I think because we hit them right around holiday time, people were a little more willing to be reflective and take a little time,” Ruhl said.

Even more important was the fact that survey responses reflected the honest concerns felt throughout the O&P profession.

“People weren’t all over the board,” Janisse said. “The initiatives that we came up with and the goals that we came up with were representative of the industry.”

The workgroup then began the task of evaluating the information.

Establish the issues


AOPA’s workgroup — which primarily consisted of chairs Tom Kirk, PhD, and Tony Filippis, CPO; Ted Snell, CP; Brian Gustin, cp; Mark Emery; Mike Hammontree; Tom DiBello, CO, FAAOP; Don DeBolt; Jim Kaiser, CP, LP; Tom Fise, JD; and Ruhl and Janisse — sifted through the information that the members provided and identified goals based on commonality in the responses. These members looked at the issues from several angles, including the two distinct perspectives of the respondents: patient care providers and suppliers. These groups did not always agree on the level of importance of an issue.

“As you can imagine, the priorities and the urgency are not always the same,” Ruhl said.

Overall, however, the surveys showed that members want their professional organization to offer some degree of protection, provide tools to help them succeed, and promote the profession to those inside and outside the industry, Gustin, 2009 AOPA president, told O&P Business News.

Under the heading of these three themes, the workgroup developed 11 initiatives to accomplish the goals. Each of the initiatives serves to accomplish the objective, as well as to improve the industry as a whole.

The workgroup members were assigned to an initiative based on experience and preference, and recruited other AOPA members to join these smaller groups and begin implementing plans.

This call for help touches everyone in the orthotics, prosthetics and pedorthics professions.

“There are just so many things that are threatening our survival at this stage of the game,” Janisse said.

Make a plan

Under the umbrella of protecting the industry are the need to link service with quality, provider and payment; the need to improve the payment system for providers; the need to foster research and further support evidence-based practice; and the need to ascertain clear guidelines for those states that wish to enact licensure laws. Each of these is equally important, and each is necessary to preserve O&P for the future.

“All of these [objectives] are, in some way, related to assuring that patients receive the best quality care that is available to them, and that providers are fairly reimbursed for what they do,” Fise, executive director of AOPA, said. “In a sense, they all sit under that heading.”

The first of these initiatives under this heading links each of the different facets in protecting O&P’s providers and suppliers.

Specifically, and perhaps closest to home, is the issue of obtaining appropriate reimbursement for products and services rendered. Without maintaining a certain payment level, O&P practices will be unable to continue to treat patients. Protecting payment remains pertinent to AOPA members.

“I think everybody realizes that the reimbursement is not going to go up,” Janisse said. “Obviously we want to protect what reimbursement we have at this stage of the game.”

In order to do this, Janisse recommends solidarity throughout the profession.

“We have to stake our claim that we are the most qualified people to be doing this because there are a lot of different players coming into our different fields that are taking business away from us,” he said.

To prevent encroachment on O&P territory, practitioners must prove that they are, without a doubt, the most qualified to provide necessary care to patients. Furthermore, to continue to be able to provide that care, practitioners must be reimbursed at a reasonable rate.

One way to indicate to Medicare and other payers that quality services are being provided is through evidence-based practice. More and more in the health care community, physicians and payers — and patients — demand proof that procedures and products benefit those patients. The amount of work involved in this process will pay off, however, when it also lessens the threat of encroachment to the extent that we can demonstrate that orthotists, prosthetists and pedorthists indeed are best equipped to provide O&P services to patients.

Janisse also feels strongly about the need to improve the payment system, and has taken steps to do this in his own practice. Otherwise, he has concerns that submitting for claims costs him money.

“Medicare requires so much more in documentation for the whole billing process that I’m making less money now,” he said. “Not because of the practitioner, not because of the product itself, but because of the people in the middle of the system trying to get verification of benefits to even get paid.”

The final initiative in the protect category, licensure, continues to be an issue of debate within the profession. AOPA has set a goal of enacting “good” licensure laws throughout the United States by 2012, and has proposed this to serve the overall goal of protecting its members. AOPA’s role in enacting these laws is one of education.

“Our job is to provide the resources and information to try to help those states that are going to pass a licensure law to pass a good one, and to avoid things that are detrimental to the industry or to patients,” Fise said.

Janisse agrees.

“It comes back to who is qualified to do this patient care and licensure is going to be one of the only ways to do it,” he said. “It is about protecting the patients.”

AOPA’s Protect Initiatives

The following initiatives fall under the common theme of protecting the purpose and livelihood of the orthotic, prosthetic and pedorthic professions.

Link Service/Quality/Provider/Payment

Objective: To achieve the creation of a new approach to the O&P fee schedule under Medicare, as well as under private insurance plans that would link reimbursement amount with the specific device prescribed to the complexity of the patient’s needs and the qualifications of the provider.

Improve Payment System

Objective: Seek to refine the reimbursement system, if the opportunity presents itself, by having available a supplemental payment methodology that could be submitted to the Centers for Medicare & Medicaid Services. This would entail a redefinition of the role orthotics and prosthetics play in the delivery of care in the rehabilitation continuum where reimbursement for follow-on care plays a role in lowering Medicare costs by proper maintenance of devices and dealing with any complications in the early stages before they require more expensive treatment programs.

Foster Research into Outcomes to Further Support Evidence-Based Practice Models

Objective: AOPA will commit to funding that will allow participation in a pilot study of an O&P practice/modality commonly used in the O&P practice setting. Outcome studies could/would potentially have a positive impact on reimbursement, covered modalities/services, credibility and acceptance from both the medical and patient community.

Licensure Initiative

Objective: Licensure was identified as a priority project based on responses from the December 2007 member survey, resulting in a commitment by AOPA to enact “good” licensure laws in all 50 states by 2012 “to ensure quality O&P care for our patients.”

Initiatives reprinted with permission of the American Orthotic & Prosthetic Association.


Move the plan forward

Once the strategic plan was finalized, the staff began its secondary role of moving the initiatives forward, Fise said. Personally, he has worked on each of the initiatives, but has concentrated more of his efforts on the linking service, quality, provider and payment, and the evidence-based practice initiatives.

Anita Liberman-Lampear, MA, a member of both AOPA’s board of directors and its government relations committee, also works on the initiative fostering research into outcomes supporting evidence-based practice models.

“I volunteered to take this job because of my interest in advancing evidence-based medicine efforts,” she said.

Liberman-Lampear joins Walter Racette, CPO, AOPA past president and original AOPA representative to the AOPA/American Academy of Orthotists and Prosthetists jointly sponsored O&P Outcomes Steering Committee, on one of the subgroups that is working on this initiative.

Thus far, the evidence-based practice initiative committee has identified a list of priorities; brought on a staff member, George Barnes, to help push the initiative; published an Evidence Note, relating to ankle-foot-orthoses in managing stroke patients; developed a request for proposal for pilot grant support funded by AOPA; and begun negotiating with outside experts to gain help with an industry-wide framework for a registry to collect outcomes/evidence-based practice information at an individual practice level.

The individual workgroups then are responsible for involving the AOPA membership in advancing the initiatives. For example, AOPA worked to introduce bill H.R. 6878 in the last Congress that would help link service, quality, provider and payment, and asked its membership to communicate with legislators to encourage support for the bill.

In addition, Liberman-Lampear hopes that the new request for proposal and the prospect for data-gathering at the practice level will empower more AOPA members to participate.

See the big picture

The most important thing to note, Gustin said, is that the three areas — Protect, Provide and Promote — each work together to improve the industry.

“They are not three separate silos, but they all connect to make a big picture of things,” he said. “Individually they don’t mean a great deal, but if you put the pieces together, it begins to show you a bit of the overall picture. You snap all of them together and you get the whole picture.”

That said, he thinks that evidence-based practice is the key component to the protect initiatives.

“Increasingly we are going to have to justify why we do what we do in order for any of the rest of this stuff to matter,” Gustin said.

Janisse’s main focus among all of the initiatives is that pedorthics cannot be forgotten when discussing the future of the O&P profession.

“[AOPA also is] paying attention to pedorthics,” he said. “I feel strongly about that. These initiatives apply to us as well.”

He examines each initiative through the eyes of pedorthists.

“There is some research in O&P but there’s virtually nothing from the pedorthics standpoint. We have to have that to survive,” Janisse said. “We cannot lose anything that we already have.”

For Fise, however, the issue is twofold. First, he points out that the future of the O&P profession affects everyone involved in some way. Second, everyone who is in the field has the ability to participate in activities like AOPA’s annual Policy Forum, held this April 22-23, where AOPA members can meet with their legislators about important issues.

“We hope to dispel a mentality that says, ‘Somebody needs to do this, but not me.’ If nobody does it then everybody suffers,” Fise said.

Gustin agrees that each individual AOPA member needs to get involved in facing these challenges.

“Everybody is running their own practices and they get mired down in the day-to-day and don’t necessarily see the forest for the trees,” he said.

He encourages members to get involved and to contact any of the members of the AOPA board for more information on a specific initiative, or to offer suggestions about these or other projects.

With these initiatives, AOPA hopes to rally together orthotists, prosthetists and pedorthists, improving the profession for all those involved. The power of an entire industry would speak volumes to others in health care.

“This is just one example of how an organization like AOPA can allow us to accomplish together things which no single practice, large or small, could have accomplished alone,” Liberman-Lampear said.

Keep reading O&P Business News to learn more about AOPA’s Promote and Provide Initiatives in future issues.— by Stephanie Z. Pavlou

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