As you begin your term as AOPA president, how would you describe the state of the O&P industry? How does it compare to when you started your O&P career?
In business, it is sometimes observed that chaos creates opportunity, and the O&P industry could be the flagship example of this. Health care in general appears to be in constant flux and is somewhat chaotic. Likewise, the O&P industry has been chaotic in recent years. Has this created opportunity? I believe so. Our industry has enjoyed a positive evolution with the advancement of technology that can be adapted for the benefit of our patients and the increased education and residency requirements for practitioners. Additionally, our administrative capabilities have improved across the industry in recent years in response to the levels of audit scrutiny we have endured.
Compared to 27 years ago when I was fortunate to join this industry, the advancements that have taken place have resulted in better outcomes for our patients. Obviously, if an industry does not respond to change with constant improvement, others will move in and take over. This has not occurred in O&P and, currently, it appears the basic structure of our industry will continue as it has for a number of years — with patient care facilities providing care to patients, relying on manufacturers and suppliers to continue to improve technologically and operate more efficiently to keep our industry on a positive developmental path.
Is it getting easier to get fair reimbursement from Medicare for O&P services? Harder? How do you think AOPA has had an impact on CMS decisions?
Medicare certainly sets the policy by which the majority of our patients are provided with the services we offer. It is definitely more difficult to get fair reimbursement for our services, as the reimbursement model does not keep up with the technological advancements our industry is producing. The effort to influence CMS in decisions regarding our industry is constant and multi-faceted.
The orchestrated effort to protest the context of the CMS DMAC’s release of the 2015 proposed new LCD is probably the clearest singular example of AOPA’s impact on CMS decisions. The LCD was withdrawn from consideration after the largest contingent of industry members and patients ever assembled attended a meeting with the DMAC medical directors and the protest that followed at CMS headquarters.
Whether it affects CMS policy or all payers, the Rand Corporation study based on a 10- year simulation of the overall benefits of O&P services to payers and patients is the most relevant example of AOPA’s continuous investment in research initiatives focused on evidence and patient outcomes that improve the future of our industry.
AOPA’s constant government outreach efforts highlighted by the Annual Policy Forum is the best example of AOPA and its members working together to affect policy decisions in Congress that have an impact on patient care. The Medicare O&P Improvement Act was introduced again this year in an attempt to pass legislation that will recognize our practitioners as providers in their submission of clinical notes and to separate O&P from DME in the administrative activities at the DMAC level of the CMS.
AOPA members share the responsibility to affect the CMS and our policymakers in Washington by continuing the process of lobbying members of Congress to advance our issues. Expanding the number of participants in our 2018 Policy Forum and encouraging members to attend and invite a patient, as I do every year, is one of my personal goals in the coming year.
What do you think will happen with the Affordable Care Act and its provisions in the coming year? How will this affect O&P practices?
One of the most immediate impacts on our profession is the possibility of passing the “essential health benefits” definition to the state level. AOPA was successful in lobbying efforts to include O&P services in the ACA essential health benefits in the federal law. Pushing this issue to the state level could force us to re-fight the battle to keep O&P services as an essential benefit in all insurance plans.
I can’t predict what is going to happen — anybody going to Washington, D.C. regularly knows that is not possible. However, the current policy is creating a constantly evolving market of insurers offering varying plans to meet the changing environment, so the administrative burden has increased on our members as they continue to try and stay up with various plans of which our patients may become members.
The broader impact of potential changes in tax policy always threatens the essential funding of Medicare and Medicaid, which we are dependent on to fund our continuing operations at every level of our industry.
What do you think was the most important technological breakthrough in O&P in the last 20 years? Why?
The introduction of the microprocessor knee 20 years ago is the obvious answer because it was the most important breakthrough leading to improved mobility for our patients and, probably most importantly, safer components for amputees across our country. However, one only needs to walk the floor of the AOPA National Assembly to witness the amazingly broad market of innovation present in what is a relatively small medical service market. Large companies to Individual entrepreneurs are constantly advancing the products available to prosthetists and orthotists to help them provide mobility to the patients we serve every day.
AOPA’s introduction of Prosthetics 2020 almost three years ago and the recent initiative forming Orthotics 2020 are supportive of the research necessary to provide evidence of these new technological breakthroughs to payers so our patients can continue to benefit from the creative innovations our industry is producing.
Do you find more young people gravitating to O&P as a career? How easy or hard has it been for your facility to find qualified employees?
At least once a month we have a young person requesting a visit to shadow one of our practitioners to learn more about what we do. These may be students from high school through even graduate-level education. Young people are more interested in prosthetics and orthotics than ever before. Stories across all mediums and events such as the Invictus Games show the positive impact we have on patients’ lives and create this high level of interest in our profession.
I have heard of some patient care facilities experiencing difficulty finding qualified employees in some regions of the country. We have been fortunate to find well-qualified and very good employees when we have had the need.
The establishment of master’s-level education across our industry is one of the key contributing factors to the quality of the employees entering our workforce. We are a profession that individuals have always taken pride in, but now O&P education and training requirements put us on par with other allied health care careers.
What advice would you give young people considering a career in O&P?
Some would say that the chaos in health care today with the challenges we face in our industry relative to reimbursement and a changing health care landscape should scare some young people and keep them from choosing our profession. But I would say our industry presents an opportunity to affect the lives of the individuals we serve immediately. We can provide hope and mobility to those who truly need our services. The demographics indicate a continued growth in demand for the prosthetic and orthotic services we provide. Every industry has challenges and certain change. Trust your abilities and have the confidence to meet those challenges head-on for the benefit of your patients, and you will have a very fulfilling and satisfying career.