ABC/BOC Negotiations

[tony barr]

Wayne, I would say you did a fine job summarizing  the issue below..

For those of you whom have an interest(and you should!) here is mine and
many other's read of this dilemma.

The O&P Industry generates over $1 billion dollars annually. The great
majority of that is reimbursed by Medicare and Medicaid.

More on the issue of the need for the O&P profession to be regulated can be
viewed at:

http://www.oandp.com/edge/issues/articles/2004-01_07.asp

A 1999 IOG (Office of Inspector )General Report of O&P Fraud and Abuse
concluded the following.

1)  Any supplier with a HCFA provider number, regardless of qualification
can provide and bill Medicare for Orthotic and Prosthetics.

2)  At Least 19% of orthotics provided are medically unnecessary. This
represented $6.4 million in Medicare payments.
Another 5% of orthotic devices are medically questionable, which represent
another $1.5 million

3)  54% of Medicare beneficiaries have questionable billings.

4)  Due to lack of policies ,carrier prepayment checks are limited to
utilization and supplier screens.

Unlike any other professional allied health care or medical service, the
provision of professional O&P is highly clinical and technical service yet,
it is regulated in only 10 of 50 states and has no federal regulation or
price control of health care  devices as they are in most all other health
care arenas.

Identifying "qualified practitioners" and "qualified suppliers" of O&P
health care  with the appropriate professional knowledge and skills can only
be achieved through identifying appropriate recognized education and
mandating licensure models for theses unique allied health care services.

The federal govt.needs to step in a investigate the hold the O&P industry
has on the O&P profession which has resulted in unqualified services being
delivered and reductions and elimination of benefits for  patients requiring
these services.
..
On July 14 , 2003 CMS (Centers of Medicare and Medicaid Services) thru a
Negotiated Rules Committee process was unable to determine O&P provider
qualifications after  9 months of meetings of which the Barr Foundation
participated. These Neg Reg meetings began in October 2002 to provide advice
and make recommendations to the Secretary of Health and Human Services and
reach consensus on rules and regulations for Section 427 of the Benefits
Improvement Act (BIPA).
BIPA was a federal statue passed in 2001 as the result of the fraud and
abuse finding of the OIG report in 1999.

Since no consensus was reached by the Neg Reg Committee ,CMS will have "the
responsibility to promulgate the rules consistent with their legislative
mandate", i.e.. BIPA..CMS has yet to announce the proposed rule or define
"third pathway" of qualification of providers since the end of our meeting
in July,2003. 

In addition to comprehensive O&P services being provided by
unqualified/unlicensed practitioner, much of the amputation surgery that
occurs in this country today(approximately 3,000 per week) are being done
without enough detail to avoiding post-op complications i.e. unstabilized
tibia and fibia ,muscle tissue and growth of nueromas,etc. as well as
without regard to the compatibility to today's prosthetic rehabilitation
technology.

I hope you will generate from your US Congressman to investigate the
national O&P association, AOPA (the American Orthotic and Prosthetic
Association) whom has been in control of the O&P industry since 1948 and has
priced O&P devices outside the realm of most patients and third party
payers. Further more they  encourage the continued utilization of
credentialing and no formal education for providers ,and oppose all efforts
that would regulate the industry.

The present credentialing system of BOC/ABC is seriously flawed since
standards have been lessened since their origin and no oversight is provided
to better protect the public.

Both credential associations were initially established by industry
interests to provide the perception that its providers are qualified.

Prosthetics is now less of a skilled trade by the advances made in
technology many driven by the manufacture to bring profitably up and
liability down.  Manufactures are still doing this and they are having
success with many more off-the-shelf products the practitioners do not have
to fabricate or modify to fit. When have gone from custom fabricated devices
to "custom fitted" devices. AOPA keeps pushing the "custom fitted" to keep
profits up and market share to their members.
 
Today's expensive (high profit) but cheap to produce prostheses and orthoses
do not require a skilled practitioner to deliver. Proof of this is in the
education of our practitioners which still uses the same text book from when
I went to school 40 years ago. However, the caliper of individuals coming
into the trade are less skilled and why you have seen the deep penetration
of BOC into O&P, and why it has been embraced by AOPA and companies like
Hanger.
 
With the advancements made in technology the profession of O&P has not
expanded its scope of practice into PT, OT and PM&R as was proposed by the
Academy in the 1980s. The industry (AOPA) through politics, brut force, and
lots of money from the manufacturers did not want this to happen because as
we all know there is no money in academia. This was/is true for those in the
practice of PT, OT and PM&R. AOPA wanted to go were the money was and that
was in selling product and why AOPA invented the "L-codes."
 
What is needed is a good shake up in O&P showing the public what all is
involved in the delivery the product and exposure of its business practices.

 
With licensure we are going to still have the poor and dishonest patient
care that was reported on the OANDP list recently from the same people
because they will qualify for licensure. As was reported this poor care and
dishonesty occurred in a state with licensure. Licensure will only work when
these problems are shown in the light of day to the American public and
people go to jail.
 
Given what I am seeing being graduated out of the O&P programs, I would
rather see a licensed PT trained in prosthetics, and I understand there are
now a number of them in the program. At least they have a college degree and
a license to lose if they screw up.
 
The education ball got dropped in the 1980s, not sure that we can recover it
now. Today's practitioner to get ahead is not educated in O&P but in
salesmanship, detailing doctors ,and business building.
Tony 

Tony Barr
Barr Foundation
www.oandp.com/barr  
www.ertlreconstruction.com 

-----Original Message-----
From: AMP-L-owner at u.washington.edu [mailto:AMP-L-owner at u.washington.edu] On
Behalf Of Wayne Renardson
Sent: Friday, March 26, 2004 8:41 AM
To: Amputee Information Network
Subject: ABC/BOC Negotiations

One fine day Anita Kliber asked:

AK> I'm not well versed int he politics of all this, i just know what
my cp was saying to me,  and he wondered had this topic crossed the board?  

Not really Anita. Not until you inquired. I  see you received answers from
Al and Tony to your ABC/BOC query. A different perspective if you will. 

The ABC/BOC mess is a very serious situation that combines ego, pride,
politics, and a mishmash of history that is quite complex. I have difficulty
understanding much of it but I did read the traffic on OANDP-L about it. I
have no doubt there is much, much more to the 
situation that I am aware.         

A very basic overview:

Basically, two credentialing bodies ABC and BOC award 'certification' 
as a prosthetist. One body---ABC---requires much more... a 4 year degree,
hours of  training, testing, other items, while BOC requires less.  

Of course, if the states required (most do not--some 10 or 12 do) high
standards to license a person to fit us, well, the issue would become moot
or irrelevent since the person wishing to work would then have to meet
higher state requirements. Where I live, Tennessee has zero requirements so
I could rent a shop, hang a shingle, and call myself a prosthetist.  

In addition, due to the rapid encroachment into P&O from OTs and PTs,
prosthetists see a pressing need to unite to protect their turf, which some
suggest would also help their patients by disallowing unqualified PTs to fit
amputees and/or work with the people who use P&O gear.  I say this since I
have been the token gimp for a class of graduate PT students at Belmont
Univiersity (and it is often their first exposure to a walkin' talkin'
amputee) for several years. And in two hours they certainly do not learn
much of anything from me. I think James Stewart has been involved in
something similar in Canada. 
YO~ James....     

After negotiations between ABC and BOC broke down, each blaming the other
for 'walking out' and the failure of negotiations,  (I do wish someone would
remind them that blame is suitable for god and little children), ABC offered
to allow BOC members into their fold for less money ($75) and less
educational and other requirements. The hue and cry from ABC was to be
expected, but this wailing might be short-term gut reaction rather than
taking the long view and thinking down the 
road a piece.   

Anyway, a not very good overview but please know it is far more complicated
that my simple rendition allows. 

Back to lurk.....



Wayne Renardson