July 2018 O&P Visionary

Charles Dankmeyer Jr., CPO

It’s time for O&P practitioners to unite to improve and advance the profession and the O&P community

When most people are asked what changes they would make to a profession, they naturally reflect on what is not working. Before I go into that arena, I will take a few lines to remind us that we are part of an incredibly rewarding profession. I often commented to my physician and therapist colleagues that I may have been working for 40 years, but I can count on my fingers how many days were really work—and still have a few left over.

We all experience the satisfaction of providing ability to our patients. And to boot, they express amazing gratitude! That does not happen to doctors and therapists on such a routine basis. Yes, we get the invitations to the graduations, birthdays, and, sadly, the funerals. It is pretty much universally experienced by prosthetists and orthotists that our relationships with patients and their families are very personal and appreciated, so much so that we are considered part of their extended family. And we actually get paid to do this! So with all that going for us, what could we possibly want to change?

While we were cruising along in our own personal utopias, our attention was on our day-to-day work. Slowly at first, but with an increasing tempo, our little Shangri-La was invaded by the business of bureaucrats. All of the major payors—Medicare, Medicaid, the U.S. Department of Veterans Affairs, and private insurers—gradually increased their paperwork demand on us in an unwarranted, poorly focused effort at reducing fraud. Once we “mostly” pulled out of that stigma, the focus of the Feds changed to cost control. Other demands came one after another—compliance with the Health Insurance Portability and Accountability Act, K-level documentation, need for custom orthosis documentation, regional contracting, and on, and on, and on. Eventually, the time we spent in our most useful and satisfying role was wrestled away into a smaller and smaller part of our everyday practice. And on top of it, we lost control of our fee schedule. That paycheck is getting slimmer. Our ability to provide much of today’s technology is hampered by margins that prevent us from applying current, appropriate technology. How could we possibly have let this happen? And we did let it happen—no excuses, please.

What happened to our professional recognition? CPOs now must complete a master’s degree and a residency, and then pass a national exam to become certified. The educational institutions that provide our degrees are nationally recognized, well-respected universities. Our facilities go through a rigorous accreditation process in order to be accredited. Yet there remains little recognition of O&P as a profession in the eyes of the bureaucrats, and even less desire to limit payment to those qualified by our accrediting bodies. Why? Here’s a little inside baseball: A few years ago I was part of a group representing O&P to those in CMS responsible for creating regulations implementing Section 427 of the Benefits Improvement and Protection Act limiting O&P L codes and payments to only qualified providers. It takes a very long time and a great deal of effort to arrange these encounters. At the table for O&P were representatives from AOPA; the American Academy of Orthotists and Prosthetists (AAOP); the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC); the Board of Certification (BOC); the National Association for the Advancement of Orthotics and Prosthetics (NAAOP); and the National Commission on Orthotic and Prosthetic Education (NCOPE). When we finished our presentation, the leader of the CMS group said, “That’s the same thing we heard from the therapeutic shoe people two weeks ago!” Exit stage left with the usual comments like, “Thanks for the opportunity to meet with you, look forward to working with you to have qualified provider regulations in place.” Sure, not happening. In their world, ABC and BOC certificants are all the same—orthotists, prosthetists, pedorthists, therapeutic shoe fitters, orthotic fitters, and others—all the same. Remember, each of those certifications is aligned with associations that are lobbying CMS, too. It is to their advantage to grab our coattails. Some progress has been made since then, but the basic O&P dilemmas remain.

What are the dilemmas? First, too many organizations. I listed six organizations at that one meeting. Those organizations all have varying views, opinions, member bases, and, of course, finances. In order to keep some semblance of order and a cohesive message, they have formed yet another organization called the O&P Alliance. This group discusses common issues, attempts to come up with direction, develops responses to regulations and proposals for new legislation, and so forth. By now you might imagine that melding all those points of view seldom results in a solid direction that is consistently pursued year over year. Rivalries between the groups continue to develop and hamper real progress. Most everyone is familiar with ABC versus BOC. How about AAOP versus AOPA versus NAAOP? The more we have continued petty bickering among the various groups, the less coherent our message to the regulators. We need one representative organization and one national meeting. We need every opportunity for all of us to be together!

The second dilemma? Credentialing. As orthotists and prosthetists, we no longer have a credentialing organization that is solely focused on our profession. The professions have been sliced and diced into multiple certificants at the expense of our profession. ABC and BOC now credential a host of certificants, most of them from simply unbundling the professional orthotist and prosthetist. Whether it’s the pedorthists, orthotic fitters, durable medical equipment (DME) specialists, mastectomy fitters, or the aforementioned therapeutic shoe fitters, they all have been blessed with some sort of credential by the same accrediting bodies that govern O&P practitioners and facilities. Additionally, each of those certificants have their own organizations pushing their own agendas on the same bureaucrats O&P is trying to impress. Want to get away from DME? We need one accrediting body solely focused on the professional practice of O&P. 

What about manufacturers and central fabrication facilities? They also have organizations walking the hallways of Congress and hitting the bureaucrats for their own benefit. Why? Because some of them, whose products are geared to O&P patients, have goals not aligned with the professional orthotist and prosthetist. Those who demonstrate respect for our profession need our support. Those who don’t, kiss off. We don’t need the stain or stink from those who unscrupulously sell products and custom devices to other than professional orthotists and prosthetists. Point them out, expose them at every opportunity. They are scum who harm patients and your professional reputation.

As practicing professional members of the community, we have an obligation to be united in our efforts to improve our profession and thereby improve the quality of life to the community we serve. We have the ability to obtain full professional recognition, have current appropriate technology available, maintain reasonable reimbursement rates, and reduce the regulations unfairly burdening our practices. As a profession we owe that to our patients. We also owe it to those entering our profession so they have the opportunity to practice to their fullest ability. It really is not a choice any longer. It is survival.

If I were O&P king for a day, my decrees would be very basic:

  • Demand your leaders to unite the organizations.
  • Demand your credentialing
    organizations limit their focus to professional practice of O&P.
  • Get involved, and participate at every opportunity. Attend meetings. Speak up and write letters to elected representatives and editors.

This is your profession; take ownership. United, we will make a better world for O&P and the people who need us.

Charles Dankmeyer Jr., CPO, is a consultant at Dankmeyer Prosthetics & Orthotics in Linthicum Heights, Maryland, and a past president of AOPA.